Van Eecke Eduard, Struelens Bernard, Muermans Stijn
Department of Orthopedic Surgery, AZ Delta Roeselare, Roeselare, Belgium.
Department of Orthopedic Surgery, AZ West Veurne, Veurne, Belgium.
Clin Shoulder Elb. 2024 Jun;27(2):219-228. doi: 10.5397/cise.2023.01060. Epub 2024 May 10.
Standard open acromioclavicular (AC) stabilization is associated with increased postoperative complications including deltoid injury, infection, tunnel complications, loss of reduction, and wound/cosmetic concerns. Arthroscopy may offer superior visualization and advantages that limit these risks. The aim of this prospective non-randomized study is to evaluate advantages and long-term reliability of arthroscopic AC stabilization.
Thirty-two patients with acute grade III, IV and V AC dislocations underwent arthroscopic AC reconstruction with long-term assessment by clinical AC examination, Simple Shoulder Test, American Shoulder and Elbow Surgeons scores, visual analog scale, Specific AC Score and Quick Disabilities of the Arm, Shoulder and Hand scores. Radiographs verified conservation of initial reduction and presence of coracoclavicular (CC) ossifications. Complications, revision rate, and satisfaction were assessed and compared to the literature.
Mean follow-up time was 67.6 months. All clinical outcome scores improved and differences were statistically significant (P<0.001). Initial postoperative radiographs consistently showed complete reduction. Two patients experienced relapse to grade II AC dislocation without clinical implications. In total, 71.8% showed CC ossifications without functional impairment, and in 31.3% concomitant injuries were observed. Reintervention rate was 9.4%, and 96.9% of patients were satisfied with procedure outcomes.
Arthroscopic stabilization for acute AC joint dislocations offers satisfactory clinical and radiographic outcomes, and our results show that the arthroscopic technique is reliable in the long run. We report better reduction in maintenance, fewer complications, and similar reoperation rates compared to other techniques. Level of evidence: III.
标准的开放性肩锁关节（AC）稳定术与术后并发症增加相关，包括三角肌损伤、感染、隧道并发症、复位丢失以及伤口/美观问题。关节镜检查可能提供更好的视野并具有降低这些风险的优势。这项前瞻性非随机研究的目的是评估关节镜下AC稳定术的优势和长期可靠性。
32例急性III、IV和V级AC脱位患者接受了关节镜下AC重建，并通过临床AC检查、简单肩部试验、美国肩肘外科医师评分、视觉模拟量表、特定AC评分以及手臂、肩部和手部快速残疾评分进行长期评估。X线片证实了初始复位的维持情况以及喙锁（CC）骨化的存在。评估了并发症、翻修率和满意度，并与文献进行比较。
平均随访时间为67.6个月。所有临床结局评分均有所改善，差异具有统计学意义（P<0.001）。术后初期X线片始终显示完全复位。2例患者出现复发至II级AC脱位，但无临床影响。总体而言，71.8%显示有CC骨化但无功能障碍，31.3%观察到合并损伤。再次干预率为9.4%，96.9%的患者对手术结果满意。
关节镜下稳定急性AC关节脱位可提供令人满意的临床和影像学结果，我们的结果表明，从长远来看，关节镜技术是可靠的。与其他技术相比，我们报告的复位维持效果更好、并发症更少且再次手术率相似。证据级别：III。
