Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Loma Linda University Medical Center, Loma Linda, California, USA.
Am J Sports Med. 2019 Sep;47(11):2745-2758. doi: 10.1177/0363546518795147. Epub 2018 Oct 1.
Acromioclavicular (AC) instability is a frequent injury affecting young and athletic populations. Symptomatic, high-grade dislocations may be managed by a myriad of operative techniques that utilize different grafts to achieve reduction. Comparative data are lacking on the ability of these techniques to achieve excellent patient outcomes and stable AC reduction and to minimize complications.
To systematically review the outcomes and complications of different techniques of AC joint reconstruction.
Systematic review and meta-analysis.
The MEDLINE, Scopus, Embase, and Cochrane Library databases were accessed to perform a systematic review of the scientific literature from 2000 to 2018 using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following keywords: "acromioclavicular" and "reconstruction." Included articles were evaluated for loss of reduction, complication rate, revision rate, and change in coracoclavicular distance. Articles were stratified by graft and surgical material used: suture only, Endobutton with suture, TightRope, GraftRope, synthetic artificial ligament, tendon graft, and Weaver-Dunn coracoacromial ligament transfer. These outcomes were pooled using a random-effects model and stratified by surgical technique and arthroscopic versus open reconstruction.
Fifty-eight articles were included in the analysis, with 63 homogeneous populations composed of 1704 patients. The mean age was 37.1 years (range, 15-80 years) with a mean follow-up of 34.3 months (range, 1.5-186 months). The overall failure rate was 20.8% (95% CI, 16.9%-25.2%). The overall pooled complication rate was 14.2% (95% CI, 10.5%-18.8%). The most common complications were infection (6.3% [95% CI, 4.7%-8.2%]), fracture to the coracoid or distal clavicle (5.7% [95% CI, 4.3%-7.6%]), and hardware/button failure (4.2% [95% CI, 3.1%-5.8%]). There were no differences between arthroscopic and open techniques in regard to loss of reduction ( = .858), overall complication rate ( = .774), and revision rate ( = .390). Open surgery had a greater rate of clavicular/coracoid fractures than arthroscopic surgery ( = .048). Heterogeneity, best assessed from the pooled loss of reduction, was measured as = 64.0%.
Open and arthroscopic AC joint reconstruction techniques have no differences in loss of reduction, the complication rate, and the revision rate based on the available literature. Complications are significant, and profiles vary between surgical techniques, which should be evaluated in the decision making of selecting the technique.
肩锁关节（AC）不稳定是一种常见的损伤，影响年轻和运动人群。有症状的、高级别的脱位可以通过多种手术技术来治疗，这些技术使用不同的移植物来实现复位。关于这些技术在实现优秀的患者结果、稳定的 AC 复位和最小化并发症方面的能力，缺乏比较数据。
系统回顾不同 AC 关节重建技术的结果和并发症。
系统回顾和荟萃分析。
通过 PRISMA（系统评价和荟萃分析的首选报告项目）标准，使用“acromioclavicular”和“reconstruction”等关键词，从 2000 年至 2018 年在 MEDLINE、Scopus、Embase 和 Cochrane 图书馆数据库中检索科学文献，进行系统评价。纳入的文章根据失复位率、并发症发生率、翻修率和喙锁距离的变化进行评估。文章根据使用的移植物和手术材料进行分层：仅缝线、Endobutton 加缝线、TightRope、GraftRope、合成人工韧带、肌腱移植物和 Weaver-Dunn 肩锁韧带转移。使用随机效应模型对这些结果进行汇总，并根据手术技术和关节镜与开放重建进行分层。
共纳入 58 篇文章，其中 63 个同质人群由 1704 名患者组成。平均年龄为 37.1 岁（范围 15-80 岁），平均随访时间为 34.3 个月（范围 1.5-186 个月）。总体失败率为 20.8%（95%CI，16.9%-25.2%）。总体并发症发生率为 14.2%（95%CI，10.5%-18.8%）。最常见的并发症是感染（6.3%[95%CI，4.7%-8.2%]）、喙突或锁骨远端骨折（5.7%[95%CI，4.3%-7.6%]）和硬件/按钮故障（4.2%[95%CI，3.1%-5.8%]）。关节镜与开放技术在失复位率（ =.858）、总体并发症发生率（ =.774）和翻修率（ =.390）方面无差异。开放性手术锁骨/喙突骨折的发生率高于关节镜手术（ =.048）。基于可获得的文献，从汇总的失复位评估，异质性最好用 = 64.0%来衡量。
根据现有文献，AC 关节重建的开放和关节镜技术在失复位率、并发症发生率和翻修率方面没有差异。并发症是显著的，并且在手术技术之间存在差异，在选择技术时应进行评估。
