LeVasseur Matthew R, Mancini Michael R, Berthold Daniel P, Cusano Antonio, McCann Grace P, Cote Mark P, Gomlinski Gregg, Mazzocca Augustus D
Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA.
Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany.
Open Access J Sports Med. 2021 May 28;12:73-85. doi: 10.2147/OAJSM.S244283. eCollection 2021.
To perform a review of the literature focusing on rehabilitation protocols in patients with acromioclavicular (AC) joint injuries treated operatively and nonoperatively and to provide an updated rehabilitation treatment algorithm.
Studies were identified by searching the MEDLINE database from 01/1995 to 09/2020. Included studies contained detailed rehabilitation protocols with physiologic rationale for AC joint injuries. Biomechanical studies, technique articles, radiographic studies, systematic reviews, case studies, editorials, and studies that compared nonoperative versus operative treatment without focus on rehabilitation were excluded. Following identification of the literature, an updated treatment algorithm was created.
The search strategy yielded 1742 studies, of which 1654 studies were excluded based on title, 60 on the abstract, and 25 on the full manuscript. One study was manually identified using article reference lists, yielding four publications presenting detailed rehabilitation protocols based on physiologic rationale. No randomized controlled trials or comparative studies were identified or cited as a basis for these rehabilitation protocols.
Few detailed rehabilitation protocols in patients with AC joint injuries have been published. These protocols are limited by their standardization, arbitrary timelines, and provide minimal assessment of individual patient characteristics. The quality of patient care can be improved with more practical guidelines that are goal-oriented and allow for critical thinking among clinicians to address individual patient needs. Three common barriers preventing successful rehabilitation were identified and addressed: Pain, Apprehension, and (anterior chest wall) Stiffness to regain Scapular control, effectively termed "PASS" for AC joint rehabilitation.
Rehabilitation protocols for AC joint injuries should be less formulaic and instead allow for critical thinking and effective communication among clinicians and therapists to address individual patient needs.
对有关肩锁关节（AC）损伤患者手术及非手术治疗康复方案的文献进行综述，并提供最新的康复治疗算法。
通过检索1995年1月至2020年9月的MEDLINE数据库来确定研究。纳入的研究包含针对AC关节损伤的详细康复方案及生理原理。排除生物力学研究、技术文章、影像学研究、系统评价、病例研究、社论以及比较非手术与手术治疗但未聚焦于康复的研究。在确定文献后，创建了最新的治疗算法。
检索策略共获得1742项研究，其中基于标题排除1654项研究，基于摘要排除60项，基于全文排除25项。通过文章参考文献列表手动识别出1项研究，产生了4篇基于生理原理呈现详细康复方案的出版物。未识别出或引用随机对照试验或比较研究作为这些康复方案的依据。
已发表的AC关节损伤患者详细康复方案较少。这些方案在标准化、任意的时间线方面存在局限，且对个体患者特征的评估极少。采用更具实用性、以目标为导向且能让临床医生进行批判性思考以满足个体患者需求的指南，可提高患者护理质量。识别并解决了阻碍成功康复的三个常见障碍：疼痛、恐惧以及（前胸壁）僵硬，以恢复肩胛控制，在AC关节康复中有效地称为“PASS”。
AC关节损伤的康复方案不应过于程式化，而应允许临床医生和治疗师进行批判性思考和有效沟通，以满足个体患者的需求。
