Muench Lukas N, Berthold Daniel P, Rupp Marco-Christopher, Dorsey Caitlin G, Hawthorne Benjamin, Trudeau Maxwell T, Wolf John D, Wellington Ian, Mazzocca Augustus D
Department of Sports Orthopaedics, Technical University of Munich, Germany.
Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Munich, Germany.
Orthop J Sports Med. 2024 Feb 1;12(2):23259671241227224. doi: 10.1177/23259671241227224. eCollection 2024 Feb.
Promising short- and midterm outcomes have been seen after anatomic coracoclavicular ligament reconstruction (ACCR) for chronic acromioclavicular joint (ACJ) injuries.
PURPOSE/HYPOTHESIS: To evaluate long-term outcomes and shoulder-related athletic ability in patients after ACCR for chronic type 3 and 5 ACJ injuries. It was hypothesized that these patients would maintain significant functional improvement and sufficient shoulder-sport ability at a long-term follow-up.
Case series; Level of evidence, 4.
Included were 19 patients (mean age, 45.9 ± 11.2 years) who underwent ACCR for type 3 or 5 ACJ injuries between January 2003 and August 2014. Functional outcome measures included the American Shoulder and Elbow Surgeons (ASES), Rowe, Constant-Murley, Simple Shoulder Test (SST), and Single Assessment Numeric Evaluation (SANE) scores as well as the visual analog scale (VAS) for pain, which were collected preoperatively and at the final follow-up. Postoperative shoulder-dependent athletic ability was assessed using the Athletic Shoulder Outcome Scoring System (ASOSS). Shoulder activity level was evaluated using the Shoulder Activity Scale (SAS), while the Subjective Patient Outcome for Return to Sports (SPORTS) score was collected to assess the patients' ability to return to their preinjury sporting activity.
The mean follow-up time was 10.1 ± 3.8 years (range, 6.1-18.8 years). Patients achieved significant pre- to postoperative improvements on the ASES (from 54.2 ± 22.6 to 83.5 ± 23.1), Rowe (from 66.6 ± 18.1 to 85.3 ± 19), Constant-Murley (from 64.6 ± 20.9 to 80.2 ± 22.7), SST (from 7.2 ± 3.4 to 10.5 ± 2.7), SANE (from 30.1 ± 23.2 to 83.6 ± 26.3), and VAS pain scores (from 4.7 ± 2.7 to 1.8 ± 2.8) ( < .001 for all), with no significant differences between type 3 and 5 injuries. At the final follow-up, patients achieved an ASOSS of 80.6 ± 32, SAS level of 11.6 ± 5.1, and SPORTS score of 7.3 ± 4.1, with no significant differences between type 3 and 5 injuries. Four patients (21.1%) had postoperative complications.
Patients undergoing ACCR using free tendon allografts for chronic type 3 and 5 ACJ injuries maintained significant improvements in functional outcomes at the long-term follow-up and achieved favorable postoperative shoulder-sport ability, activity, and return to preinjury sports participation.
解剖学喙锁韧带重建术（ACCR）治疗慢性肩锁关节（ACJ）损伤后已取得了良好的短期和中期疗效。
目的/假设：评估慢性3型和5型ACJ损伤患者接受ACCR后的长期疗效及与肩部相关的运动能力。假设这些患者在长期随访中能保持显著的功能改善和足够的肩部运动能力。
病例系列；证据等级，4级。
纳入2003年1月至2014年8月间因3型或5型ACJ损伤接受ACCR的19例患者（平均年龄45.9±11.2岁）。功能结局指标包括美国肩肘外科医师学会（ASES）、Rowe、Constant-Murley、简单肩部测试（SST）和单项评估数字评定（SANE）评分以及疼痛视觉模拟量表（VAS），于术前和最终随访时收集。术后肩部相关运动能力采用运动肩部结局评分系统（ASOSS）进行评估。肩部活动水平采用肩部活动量表（SAS）进行评估，同时收集主观患者恢复运动结局（SPORTS）评分以评估患者恢复伤前体育活动的能力。
平均随访时间为10.1±3.8年（范围6.1 - 18.8年）。患者在ASES评分（从54.2±22.6提高到83.5±23.1）、Rowe评分（从66.6±18.1提高到85.3±19）、Constant-Murley评分（从64.6±20.9提高到80.2±22.7）、SST评分（从7.2±3.4提高到10.5±2.7）、SANE评分（从30.1±23.2提高到83.6±26.3）和VAS疼痛评分（从4.7±2.7降低到1.8±2.8）方面均取得了术前到术后的显著改善（所有P<0.001），3型和5型损伤之间无显著差异。在最终随访时，患者的ASOSS评分为80.6±32，SAS水平为11.6±5.1，SPORTS评分为7.3±4.1，3型和5型损伤之间无显著差异。4例患者（21.1%）出现术后并发症。
采用游离肌腱同种异体移植进行ACCR治疗慢性3型和5型ACJ损伤的患者在长期随访中功能结局保持显著改善，术后肩部运动能力、活动水平良好，并能恢复到伤前的体育活动参与度。
