Is Coraco-Clavicular Stabilisation Alone Sufficient for the Endoscopic Treatment of Severe Acromio-Clavicular Separation (Rockwood Types III, IV, and V)?

Abstract

The primary objective was to evaluate correlations linking anatomical to functional outcomes after endoscopically assisted repair of acute acromio-clavicular joint disruption (ACJD). Our hypothesis was that at 1 year combined acromio-clavicular and coraco-clavicular stabilisation improves radiological outcomes compared to coraco-clavicular stabilisation alone. A prospective multicentre study evaluated clinical outcome (pain, QuickDASH, and Constant’s score), and anatomical outcomes (standard XRays and dynamic radiographs). 116 patients (48% type III, 30% type IV, 22% type V), minimal FU was 1 year. Coraco-clavicular stabilisation was achieved using a double endobutton in 93% of patients, and concomitant acromio-clavicular stabilisation in 50%. The Constant’s score ≥85/100 and a subjective QuickDASH functional disability score ≤10 in 75% of patients. The radiographic analysis showed significant improvements and in the horizontal plane. The anatomical outcome correlated significantly with the functional outcome (absolute R value =0.19 and p=0.045). Implantation of a biological graft significantly improved both the anatomical outcome in the vertical plane (p=0.04) and acromio-clavicular stabilisation in the horizontal plane (p=0.02). The coraco-clavicular ratio on the antero-posterior radiograph was adversely affected by a longer time from injury to surgery (p=0.02). This study demonstrates that acute ACJD requires stabilisation in both planes, i.e., at the coraco-clavicular junction and at the acromio-clavicular joint. Implantation of a biological graft should be considered when the time from injury to surgery is longer than 10 days.