Prevalence of concomitant intraarticular lesions in patients treated operatively for high-grade acromioclavicular joint separations

Abstract

The purpose of this study is to investigate the prevalence of concomitant intraarticular lesions to the glenohumeral joint or to surrounding soft tissue structures with non-randomized prospective case series. High-grade acromioclavicular (AC) joint dislocations result from direct or indirect force impact to the shoulder girdle. Fourty consecutive patients (2 female, 38 male) with high-grade acromioclavicular joint dislocations (Rockwood III: n = 3; IV: n = 3; V: n = 34) who underwent diagnostic arthroscopy at the time of acromioclavicular joint repair were evaluated. Associated pathologic lesions were documented and treated by an all-arthroscopic approach. As a result, traumatic intraarticular lesions were found in 15% (n = 6/40) of cases. Two patients had an isolated partial tear of the subscapularis tendon. One patient had a combined tear of the subscapularis and supraspinatus tendon (PASTA type lesion). Two patients showed a type II SLAP-lesion and one patient had a type VI SLAP-lesion. Arthroscopic treatment included rotator cuff reconstruction in two cases and debridement of the partially torn tendon in one case. Two patients underwent an arthroscopic SLAP-repair and in one patient a debridement of a labral flap tear was performed. Acromioclavicular joint reconstruction was achieved via an open technique using suture anchors in 14 cases and via an all-arthroscopic approach using a double Tight-rope technique in 26 cases. To conclude, in number of cases, high-grade AC-separations may be associated with traumatic concomitant glenohumeral pathologies resulting from the same trauma impact to the shoulder girdle. A combined or an all-arthroscopic approach allows to accurately diagnose and treat associated intraarticular pathologies.