Dynamic Radiologic Evaluation of Horizontal Instability in Acute Acromioclavicular Joint Dislocations

Background The acromioclavicular joint (ACJ) is one of the more common sites of shoulder girdle injury, accounting for 4-12% of all such injuries, with an incidence of 3-4 cases per 100 000 persons per year in the general population. Current topics of debate include the proper standard diagnostic evaluation, the indications for surgery, and the best operative method. Methods This review is based on publications retrieved by a selective literature search. Results Mechanical trauma of the ACG can tear the ligamentous apparatus that holds the acromion, clavicle, and coracoid process together. Different interventions are indicated depending on the nature of the injury. In recent years, the horizontal component of the instability has received more attention, in addition to its vertical component. Persistent instability can lead to chronic, painful limitation of shoulder function, particularly with respect to working above the head. Surgical stabilization is therefore recommended for high-grade instability of Rockwood types IV and V. Modern reconstruction techniques enable selective vertical and horizontal treatment of the instability and have been found superior to traditional methods, particularly in young athletes. Arthroscopic techniques are advantageous because they are less invasive, do not require removal of implanted material, and afford the opportunity to diagnose any accompanying lesions definitively and to treat them if necessary. Surgery for acute injuries should be performed within three weeks of the trauma. For chronic injuries, additional tendon augmentation is now considered standard treatment. Conclusion High-grade ACJ instability is a complex and significant injury of the shoulder girdle that can cause persistent pain and functional impairment. The state of the evidence regarding its optimal treatment is weak. Large-scale, prospective, randomized comparative studies are needed in order to define a clear standard of treatment.

The Diagnosis and Treatment of Acute Dislocation of the Acromioclavicular Joint.

To develop a consensus on diagnosis and treatment of acromioclavicular joint instability. A consensus process following the modified Delphi technique was conducted. Panel members were selected among the European Shoulder Associates of ESSKA. Five rounds were performed between October 2018 and November 2019. The first round consisted of gathering questions which were then divided into blocks referring to imaging, classifications, surgical approach for acute and chronic cases, conservative treatment. Subsequent rounds consisted of condensation by means of an online questionnaire. Consensus was achieved when ≥ 66.7% of the participants agreed on one answer. Descriptive statistic was used to summarize the data. A consensus was reached on the following topics. Imaging: a true anteroposterior or a bilateral Zanca view are sufficient for diagnosis. 93% of the panel agreed on clinical override testing during body cross test to identify horizontal instability. The Rockwood classification, as modified by the ISAKOS statement, was deemed valid. The separation line between acute and chronic cases was set at 3 weeks. The panel agreed on arthroscopically assisted anatomic reconstruction using a suspensory device (86.2%), with no need of a biological augmentation (82.8%) in acute injuries, whereas biological reconstruction of coracoclavicular and acromioclavicular ligaments with tendon graft was suggested in chronic cases. Conservative approach and postoperative care were found similar A consensus was found on the main topics of controversy in the management of acromioclavicular joint dislocation. Each step of the diagnostic treatment algorithm was fully investigated and clarified. Level V.

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High degree of consensus achieved regarding diagnosis and treatment of acromioclavicular joint instability among ESA-ESSKA members

To study the incidence of acromioclavicular joint injuries in a general population. All acute shoulder injuries admitted to an orthopaedic emergency department were registered prospectively, using electronic patient records and a patient-reported questionnaire. The regional area was the city of Oslo with 632,990 inhabitants. Patients with symptoms from the acromioclavicular joint without fracture were registered as a dislocation (type II–VI) if the radiologist described widening of the joint space or coracoclavicular distance on standard anteroposterior radiographs. Patients without such findings were diagnosed as sprains (type I). Acromioclavicular joint injuries constituted 11% of all shoulder injuries (287 of 2650). The incidence was 45 per 105 person-years (95% confidence interval [CI] 40–51). 196 (68%) were diagnosed as sprains and 91 (32%) as dislocations. Median age of all acromioclavicular joint injuries was 32 years (interquartile range 24–44), and 82% were men. Thirty percent of all acromioclavicular joint injuries were registered in men in their twenties. Sports injuries accounted for 53%, compared to 27% in other shoulder injuries [OR 3.1 (95% CI 2.4–4.0; p < 0.001)]. The most common sports associated with acromioclavicular joint injuries were football (24%), cycling (16%), martial arts (11%), alpine skiing and snowboarding (both 9%), and ice hockey (6%). Our study suggests that in the general population, one in ten shoulder injuries involves the acromioclavicular joint and young men in sports are at highest risk. A prognostic level II cohort study.

https://link.springer.com/content/pdf/10.1007/s00167-020-05958-x.pdf

Young men in sports are at highest risk of acromioclavicular joint injuries: a prospective cohort study

Robotic-assisted unicompartmental knee arthroplasty (UKA) has gained popularity over the last decade claiming enhanced surgical precision and better joint kinematics, with peer-reviewed publications about this new technology also increasing over the past few years. The purpose of our study was to compare manuscripts about robotic-assisted UKA to those about standard UKA in terms of industry funding, author conflict of interest, scientific quality, and bibliometrics. A systematic search using PRISMA guidelines on PubMed and Google Scholar from 2012 to 2016 resulted in 45 papers where robotic technology was performed for UKA and 167 papers that UKA were performed without the assistance of a robot. Between the two groups, we compared (1) rate of manuscripts with reported conflict of interest or industry funding, (2) journal impact factor, (3) level of evidence, and (4) relative citation ratio. Fifty-one percent (23/45) of robotic UKA manuscripts were industry-funded or had authors with financial conflict of interest, compared to 29% ([49/167], p < 0.01) of non-robotic UKA papers. Significantly more robotic UKA papers (24% [11/45] vs 9% [16/167), p < 0.01) were published in journals that were not assigned an impact factor by the Journal Citations Report. There was no difference in regard to bibliometrics or level of evidence. Manuscripts in which UKA was performed with the assistance of a robot were more likely to be industry funded or be written by authors with financial conflicts of interest and published in less prestigious journals. There were no differences in scientific quality or influence between the two groups. Readers analyzing published data should be aware of the potential conflicts of interests in order to more accurately interpret manuscripts data and conclusions.

Robotic-assisted versus standard unicompartmental knee arthroplasty-evaluation of manuscript conflict of interests, funding, scientific quality and bibliometrics.

Interobserver and intraobserver reliability of radiographic classification of acromioclavicular joint dislocations

Funding sources and financial disclosures, and their relationship to study outcomes and level of evidence in the Journal of Shoulder and Elbow Surgery.

Zachary Foughty

Papers

Interobserver and intraobserver reliability of radiographic classification of acromioclavicular joint dislocations

Funding sources and financial disclosures, and their relationship to study outcomes and level of evidence in the Journal of Shoulder and Elbow Surgery.