Department of Orthopedics, OLVG, Amsterdam, the Netherlands.
Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands.
JBJS Rev. 2024 Sep 3;12(9). doi: 10.2106/JBJS.RVW.24.00085. eCollection 2024 Sep 1.
It is currently unknown to what degree surgical or nonoperative treatment of acromioclavicular (AC) dislocation influences the development of osteoarthritis (OA). The aim of this study was to evaluate AC OA after surgical and nonoperative treatment for AC dislocations, compare OA prevalence between treatment options, and compare OA prevalence between the injured and contralateral shoulder.
Articles reporting on the prevalence of OA after surgical or nonoperative treatment of an AC dislocation with a minimal 2-year follow-up were included. AC OA presence was extracted for the injured and contralateral shoulder. Treatment categories were defined based on anatomical variation in the reattachment of ligaments: AC fixation, coracoclavicular (CC) fixation, AC and CC fixation, Bosworth screw synthetic graft, tendon graft, and conservative. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria.
Ninety-four articles were included for qualitative analysis, and 7 articles were included for meta-analysis (n = 3,812; follow-up = 2.0-24.2 years; mean age 37.6 ± 10.4 years). A total of 3,483 patients underwent surgical treatment, and 329 patients underwent conservative treatment. OA prevalence ranged from 6.7%-29.3% between 7 pooled treatment categories. Most included studies had a follow-up <10 years (94%) and OA prevalence increased with time, regardless of treatment option. There was no difference in OA prevalence between the injured and contralateral shoulder (p = 0.120). MINORS scores were varied, ranging from poor to very good.
The pooled AC OA prevalence of the 7 treatment categories ranged from 6.7% for the CC fixation surgical group to 29.3% for the conservative treatment group. However, the included studies were predominantly of low quality and had varying follow-up periods, with most having relatively short follow-up durations. No difference in AC OA prevalence was found between the injured and contralateral shoulder. Based on the available evidence, treatment choice for AC dislocation should not be influenced by the potential development of AC AO.
Level IV. See Instructions for Authors for a complete description of levels of evidence.
目前尚不清楚手术或非手术治疗肩锁关节（AC）脱位在多大程度上影响骨关节炎（OA）的发展。本研究旨在评估手术和非手术治疗 AC 脱位后的 AC OA，并比较治疗选择之间的 OA 患病率，以及受伤和对侧肩部之间的 OA 患病率。
纳入了报告至少 2 年随访的手术或非手术治疗 AC 脱位后 OA 患病率的文章。提取受伤和对侧肩部的 AC OA 存在情况。根据韧带再附着的解剖学变化定义治疗类别：AC 固定、喙锁（CC）固定、AC 和 CC 固定、Bosworth 螺钉合成移植物、肌腱移植物和保守治疗。使用非随机研究方法学指数（MINORS）标准评估研究质量。
纳入了 94 篇文章进行定性分析，纳入了 7 篇文章进行荟萃分析（n = 3812；随访时间为 2.0-24.2 年；平均年龄为 37.6 ± 10.4 岁）。共有 3483 例患者接受了手术治疗，329 例患者接受了保守治疗。7 个汇总治疗类别之间的 OA 患病率从 6.7%到 29.3%不等。大多数纳入的研究随访时间<10 年（94%），并且无论治疗选择如何，OA 患病率随时间增加。受伤和对侧肩部的 OA 患病率无差异（p = 0.120）。MINORS 评分差异较大，从差到很好。
7 种治疗类别的汇总 AC OA 患病率范围为 CC 固定手术组的 6.7%至保守治疗组的 29.3%。然而，纳入的研究主要质量较低，随访时间不同，大多数随访时间相对较短。受伤和对侧肩部的 AC OA 患病率无差异。基于现有证据，AC 脱位的治疗选择不应受 AC AO 发展的影响。
IV 级。有关证据水平的完整描述，请参见作者说明。
