Search Results (35)

Background/Objectives: Acromioclavicular (AC) joint injuries account for 9–12% of shoulder injuries, predominantly affecting young male athletes. While conservative treatment is established for Rockwood type I–II injuries and surgery is widely regarded as indicated for type V–VI, management of type III–IV injuries remains controversial. Biomechanical studies have shown superior results in combined reconstruction of the coracoclavicular and AC ligament complex, however clinical data is scarce. Therefore, the present study aimed to assess whether the addition of an acromioclavicular ligament reconstruction to an isolated coracoclavicular repair offers superior clinical and radiographic outcomes in the treatment of acute AC joint dislocations. Methods: A retrospective multicenter study was conducted on patients with Rockwood type III–VI AC joint injuries who underwent surgical treatment between 2019 and 2024. Patients were divided into two groups: isolated CC reconstruction (group I) and combined CC and AC ligament reconstruction (group II). Clinical outcome was assessed using patient-reported outcome measures (American Shoulder and Elbow Surgeons Score, Simple Shoulder Test, Single Assessment Numeric Evaluation, Visual Analogue Scale) and radiographic evaluations were performed regularly up to 6 months postoperatively. Results: Fifty-five patients (94.5% male, mean age 33.5 ± 10.9 years) were included in the present study. High patient satisfaction (group I: ASES 96.3 ± 7.9, SST 99.2 ± 3.3, SANE 95.3 ± 7.0; group II: ASES 95.8 ± 8.8, SST 96.8 ± 8.2, SANE 93.6 ± 12.8) was documented in both groups, but no significant differences were observed. The median coracoclavicular loosening ratio was 24.7% in the CC group and 32.6% in the CC and AC ligament reconstruction group (p = 0.830). Five complications occurred: two infections and three revision surgeries due to excessive secondary dislocations. Conclusions: Both surgical techniques demonstrated excellent clinical outcomes. In this study combined CC and AC ligament reconstruction did not yield superior clinical or radiological results compared to isolated coracoclavicular reconstruction. Our findings suggest that a routine AC ligament augmentation may not be necessary in all patients. Further randomized controlled trials are needed to validate these results. Full article

Background: Acromioclavicular joint (ACJ) injuries are common in athletes, particularly in contact and collision sports, and frequently cause time lost from play. Although functional outcomes are well described, return to sport (RTS) is inconsistently reported, and the influence of treatment modality, surgical technique, and rehabilitation strategy on RTS outcomes remains uncertain. Methods: A systematic review was conducted following PRISMA guidelines registered in PROSPERO (ID 1155609). PubMed, Embase, Scopus, Web of Science, and Cochrane were searched for studies from 2015–2025 reporting at least one RTS metric (time, rate, or return to pre-injury level) after ACJ injury. Data on injury classification, surgical technique, rehabilitation protocols, and RTS outcomes were extracted. Results: Twenty-five studies (1077 patients) were included. The pooled RTS rate was 90.8% (95% CI, 88.6–93.0), with 87.7% (95% CI, 84.5–90.9) returning to their pre-injury level. The overall mean RTS time was 125.0 ± 63.05 days (4.5 months). Non-operative treatment was associated with faster RTS (52 days [95% CI, 47–58]) compared with operative management (127 days [95% CI, 114–140]). Among surgical techniques, allograft reconstruction demonstrated slightly higher rates of RTS at pre-injury level (84.2%) versus non-allograft approaches (78.9%). Rehabilitation timing was also influential: protocols initiating strengthening within 6 weeks were associated with faster RTS (93 vs. 132 days) and higher pre-injury RTS rates (86.8% vs. 72.7%). Conclusions: Most athletes return to sport after ACJ injury, with high RTS rates across treatment approaches. Earlier surgery, allograft reconstruction, and early strengthening show associative trends toward faster and more complete RTS, though these findings should be interpreted cautiously due to heterogeneity and confounding with existing data. Standardized RTS definitions, consistent rehabilitation reporting, and prospective comparative studies are needed to clarify which modifiable factors most influence recovery and return to play. Full article

Arthroscopic treatment of acromioclavicular (AC) joint separations has evolved significantly over the past two decades. Modern anatomical repair methods frequently rely on suspensory fixation devices to reconstruct the coracoclavicular ligaments and, in some cases, to stabilize the AC joint itself. Background/Objectives: Arthroscopy offers a minimally invasive option that ensures excellent visualization of the joint, facilitates management of concomitant intra-articular injuries, and provides direct access to the undersurface of the coracoid process for implant placement. Methods: Over the past seven years, we have managed 30 AC separation cases using this arthroscopic approach. Results: The distinctive feature of our technique is the use of only two portals—one posterior and one anterosuperior—which proved adequate for optimal visualization and accurate implant positioning. Conclusions: In this article, we outline the benefits and limitations of the technique, identify current knowledge gaps, and propose avenues for future clinical research. Full article

Background: For high-grade dislocation of the acromioclavicular (AC) joint, surgical treatment is widely recommended. This study aimed to evaluate the clinical and radiological outcomes after arthroscopic-assisted stabilization of acute high-grade AC joint dislocations using a low-profile suture button (LPSB) combined with percutaneous AC cerclage fixation. A secondary objective was to quantify clavicular tunnel widening (cTW) and explore its correlation with clinical and radiological outcomes. Methods: This retrospective study included 45 patients with acute Rockwood type V injuries treated with the LPSB technique and additional AC cerclage. Clinical outcomes were the Constant Score (CS), Subjective Shoulder Value (SSV), Taft Score (TF), AC Joint Instability Score (ACJI), and VAS for pain upon palpation. Radiological assessment included coracoclavicular (CC) distance and percentage deviations compared to the contralateral side, reclassified according to Rockwood, dynamic posterior translation (DPT), cTW measurements, and assessment of ossifications and AC joint osteoarthritis. Results: After 35.3 months, significant improvements were observed in CC distance and percentage deviation. A total of 27.3% were reclassified as Rockwood type III and 2.3% as type V. Initial overreduction persisted in 18.2%. DPT was observed in 34.1% of cases. The mean CS was 89.64, the SSV was 91.1, and the VAS was 0.8. cTW occurred only below the superior button and increased significantly over time, showing a negative correlation with the SSV but no correlation with any radiological outcome parameter. No implant-related revision surgery was reported. Conclusions: Arthroscopic-assisted stabilization of acute high-grade AC joint dislocations using the LPSB technique with AC cerclage fixation provides excellent clinical outcomes and high patient satisfaction, with minimal implant-related complications and no need for revision surgery due to implant issues. Although cTW occurs, its clinical impact appears limited within this procedure. Full article

Background: Acromioclavicular joint (ACJ) injuries frequently result from trauma to the shoulder girdle and are particularly common among young, physically active individuals. These injuries account for approximately 9% of all traumatic shoulder girdle injuries and often lead to functional impairment and pain. The TightRope^® system, LARS™ band, and Bosworth screw are among over 160 currently described surgical techniques for managing ACJ dislocations. However, there is no consensus regarding the optimal surgical approach, particularly for the management of moderate Rockwood Type III ACJ dislocations. Materials and Methods: In this retrospective study, data from 246 patients who underwent surgery for ACJ dislocation between 2010 and 2018 at the Department of Orthopedics and Trauma Surgery, Medical University of Vienna, were analyzed. Patients were divided into four cohorts based on the surgical technique used: Bosworth screw, LARS (acute), LARS (chronic), and TightRope. Clinical and radiological outcomes were assessed pre- and postoperatively using the Visual Analog Scale (VAS), Constant, Disability of the Arm, Shoulder and Hand Score (DASH), Simple Shoulder Test (SST), University of California—Los Angeles Shoulder Score (UCLA), Short Form Health Survey (SF-36), and American Shoulder and Elbow Surgeons score (ASES), as well as radiographic analysis. Radiological measurements of the acromioclavicular (AC) and coracoclavicular (CC) joint spaces were taken on both the injured and uninjured shoulders to analyze and compare the reduction in joint gaps. Results: All surgical methods resulted in significant reductions in AC and CC joint gaps. The TightRope and LARS acute groups showed the greatest reductions, with minimal complication rates. Complication analysis revealed significant differences in clavicular elevation (p < 0.001) and CC-ligament ossification (p = 0.006), which were most frequent in the Bosworth group and least common in TightRope^® patients, with LARS showing intermediate values. AC joint arthrosis was uncommon in all four groups and did not differ significantly (p = 0.13). Overall, TightRope^® was associated with the most favorable complication profile. The postoperative VAS score in the TightRope group was 1.52 ± 2.06, and the Constant score was 96.83 ± 5.41, reflecting high patient satisfaction. Conclusions: All systems led to satisfactory radiological and clinical outcomes, with the LARS™ band showing particular effectiveness in chronic ACJ dislocations. While all techniques provided good results, the TightRope^® system demonstrated the most favorable overall profile in our cohort and may therefore be considered a promising contemporary option. Further studies are needed to determine the optimal treatment for moderate ACJ dislocations and to assess the cost-effectiveness of these surgical techniques. Full article

Background: Acromioclavicular (AC) joint dislocations are frequent, especially kocsisamong young male athletes. While over 150 surgical techniques exist, consensus on optimal treatment—particularly for Rockwood type III injuries—remains elusive. This study evaluates the Lockdown procedure’s efficacy, safety, and patient satisfaction, a synthetic ligament technique for AC joint stabilization. Methods: A multicenter prospective study was conducted on 39 patients across three Hungarian hospitals (2018–2023). Outcomes included shoulder function, pain levels, and complication rates, with subgroup analysis of acute (≤3 weeks) versus chronic (>3 weeks) cases. A systematic review of nine studies (205 cases) was also performed to assess broader outcomes and complications. Results: Significant improvements were observed in functional scores (OSS, Constant, DASH, SST, ASES, Nottingham, Imitani) and pain reduction, especially in acute cases with no prior shoulder surgery. The mean patient age was 38.9 ± 12.68 years, with a 24.5-month average follow-up. OSS improvement between acute and chronic cases was 14.96 (95% CI: 6.45–23.47; p = 0.0017). Complications (30.8%) occurred in eleven patients, mainly minor infections; implant failure necessitated revision in 5.1%. The systematic review reported a 34.6% complication rate (predominantly minor complications, like asymptomatic subluxation −16%) and 5.4% implant removal due to failure. A meta-analysis was not feasible due to data heterogeneity. Conclusions: The Lockdown procedure significantly enhances shoulder function and reduces pain, particularly in acute dislocations. However, the procedure showed a moderate complication rate, underscoring the need for careful patient selection and postoperative management. Full article

Background: Optimal treatment for high-grade acromioclavicular (AC) joint dislocations is still not unanimous. Improving horizontal AC stability has been emphasized in recent years. Biomechanical studies and computer simulations have demonstrated that adequate horizontal stability could be restored with an additional AC fixation. We aim to prospectively investigate if AC augmentation leads to better clinical and radiological results. Methods: A total of 70 patients with a mean (± SD) age of 42 ± 11 years with acute AC joint dislocation Rockwood type IIIb and V were prospectively randomized into two equal groups. All patients underwent arthroscopically assisted stabilization using a double coracoclavicular (CC) suspensory system. Group N (No-augmentation group) had no additional fixation across the AC joint, while group T (tape-augmentation group) had additional fixation with tape. Patients were evaluated at 3, 6, and 12 months postoperatively. Primary clinical outcome measures included the Constant–Murley score and the Specific AC Score (SACS). Secondary outcome measures included the Subjective Shoulder Value (SSV), the Simple Shoulder Test (SST), the Disabilities of the Arm, Shoulder, and Hand (DASH) outcome measure, and the AC Joint Instability (ACJI) Score. Horizontal stability was radiologically measured with overlapping length (OL) and overlapping area (OA). Vertical alignment was measured with the CC distance. All radiological measurements were compared to the uninjured side and expressed in percentages as relative values. Results: There were no significant differences found between groups regarding the Constant score (p = 0.664), SACS (p = 0.518), or any other outcome measure at the one-year follow-up. Pain level (p = 0.635) and strength (p = 0.217) at the one-year mark also showed no significant differences. Clinical drawer testing for residual horizontal instability was non-significant (p = 0.061), but showed a tendency for a more stable AC joint in group T. The CC distance was smaller in group T at 6 and 12 months (p = 0.047 and p = 0.046, respectively). A two-way mixed factorial ANOVA test showed significantly lower CC differences for group T (p = 0.032); however, the gradual increase in CC distance was similar for both groups over time (p = 0.869). No significant differences were found in OL (p = 0.619) or OA (p = 0.236). Conclusions: The results of our study show that both CC stabilization with the double suspensory system alone and with additional AC fixation are effective surgical treatment options for acute AC joint dislocations, without any important clinical differences. CC distance similarly increased over one year in both groups but was better retained in the AC-augmented group, which showed a tendency toward a more stable fixation. Full article

Background/Objectives: Dislocation of the acromioclavicular joint (ACJ) is a common injury for which numerous operative fixation and reconstructive techniques have been described. This technique combines a coracoclavicular ligament (CC) repair with an acromioclavicular ligament (AC) and CC reconstruction with an additional ACJ internal brace to address both horizontal and vertical instability. Methods: The surgery is performed through a superior approach in the following sequence: (1) CC ligaments are repaired using a TightRope construct, (2) CC reconstruction is performed using a peroneus longus tendon allograft, (3) AC ligaments are repaired using an internal brace, and (4) AC reconstruction is performed with a second peroneus longus tendon allograft. The results of consecutive patients with grade IIIB, IV, and V AC joint dislocations were included. Results: Six patients with acute and six patients with chronic injuries were eligible for inclusion. The Constant–Murley Score improved significantly from 27.6 (8.0–56.5) to 61.5 (42.0–92.0) (p = 0.006 paired t-test) at 12 months of follow-up. There was one complication (frozen shoulder) from which the patient recovered spontaneously; no other complications were observed with this technique. The coracoclavicular distance (CCD) was reduced from 18.7 mm (13.0–24.0) to 10.0 mm (6.0–16.0, p < 0.001) and 10.5 mm (8.0–14.0, p = 0.002) at 12 weeks and 12 months, respectively. Conclusions: This study describes a new technique to treat acute and chronic Rockwood stage IIIB–V ACJ dislocations with promising short-term clinical and radiological results. The results suggest that the combined repair and reconstruction of the AC and CC ligaments is a safe procedure with low complication risk in experienced hands. Addressing the vertical and horizontal stability in ACJ dislocation is key to achieving optimal long-term results. Further, follow-up is required to investigate the long-term outcomes. Full article

Acromioclavicular joint osteoarthritis is prevalent in middle-aged and older people, causing shoulder pain and functional limitations. Despite its prevalence, there are inconsistencies in the physical diagnosis procedures practiced in clinical tests. A recent study introduced a novel hand-behind-the-back (HBB) test, a promising alternative to the traditional cross-body adduction (CBA) test. However, further study was suggested to validate the results obtained. So, this study predicted muscle forces for the cross-body adduction and hand-behind-the-back tests using OpenSim and the AnyBody Modeling System™. This work redefined the joint kinematics for the tests and performed an inverse dynamics analysis to solve the muscle redundancy problem using the generic upper extremity dynamic models available in OpenSim and AnyBody Modeling System™. The results revealed some agreements and significant discrepancies in most muscle force predictions between the OpenSim and AnyBody Modeling System^TM. Thus, this study underscores the necessity of integrating multiple modeling approaches and comprehensive validation, including experimental data, to enhance the accuracy and reliability of muscle force predictions in shoulder biomechanics during CBA and HBB tests. Full article

Background/Objectives: Clavicle injuries are common and seem to be frequently subject to diagnostic misclassification. The accurate identification of clavicle fractures is essential, particularly for registry and Big Data analyses. This study aims to assess the frequency of diagnostic errors in clavicle injury classifications. Methods: This retrospective study analyzed patient data from two Level 1 trauma centers, covering the period from 2008 to 2019. Included were cases with ICD-coded diagnoses of medial, midshaft, and lateral clavicle fractures, as well as sternoclavicular and acromioclavicular joint dislocations. Radiological images were re-evaluated, and discharge summaries, radiological reports, and billing codes were examined for diagnostic accuracy. Results: A total of 1503 patients were included, accounting for 1855 initial injury diagnoses. In contrast, 1846 were detected upon review. Initially, 14.4% of cases were coded as medial clavicle fractures, whereas only 5.2% were confirmed. The misclassification rate was 82.8% for initial medial fractures (p < 0.001), 42.5% for midshaft fractures (p < 0.001), and 34.2% for lateral fractures (p < 0.001). Billing codes and discharge summaries were the most error-prone categories, with error rates of 64% and 36% of all misclassified cases, respectively. Over three-quarters of the cases with discharge summary errors also exhibited errors in other categories, while billing errors co-occurred with other category errors in just over half of the cases (p < 0.001). The likelihood of radiological diagnostic error increased with the number of imaging modalities used, from 19.7% with a single modality to 30.5% with two and 40.7% with three. Conclusions: Our findings indicate that diagnostic misclassification of clavicle fractures is common, particularly between medial and midshaft fractures, often resulting from errors in multiple categories. Further prospective studies are needed, as accurate classification is foundational for the reliable application of Big Data and AI-based analyses in clinical research. Full article

Background/Objectives: Shoulder pain is a common treatment outcome in breast cancer survivors. While various risk factors and mechanisms for shoulder pain have been proposed, evidence is inconsistent. Increased risk of subacromial pain syndrome exists, which can lead to disability and reduced quality of life if untreated. Ultrasound is a valuable tool for detecting rotator cuff changes aiding in timely diagnosis of subacromial pain syndrome. This study aimed to assess the prevalence of rotator cuff changes to better understand chronic shoulder pain in breast cancer survivors. Methods: This cross-sectional study included 74 breast cancer survivors from the University Hospital Split. Data were collected via questionnaires and clinical interviews. Bilateral shoulder ultrasounds were performed by two blinded investigators. Categorical variables were analyzed using Chi-squared tests, and continuous variables were analyzed with T-tests or Mann–Whitney tests. Results: Pathological findings were similarly prevalent on the operated and non-operated sides (p = 0.3 and p = 0.6). Among participants with shoulder pain, ultrasound-detected pathology was present in 91% of right shoulders and 96% of left shoulders (p < 0.005). Non-painful shoulders exhibited pathology in 59% of right and 57% of left shoulders. Ipsilateral pain to the site of breast surgery was reported by 57.7% of participants, with supraspinatus pathology in 56%, acromioclavicular joint pathology in 39%, and subacromial–subdeltoid bursitis in 41%. Conclusions: Similar pathology distribution on operated and non-operated sides and frequent asymptomatic findings highlight unresolved causes of shoulder pain in breast cancer survivors. Ultrasound is valuable but requires integration with clinics for accurate diagnosis of the underlying causes of shoulder pain. Full article

Objectives: This study aimed to compare 24-month radiographic follow-ups of clavicular tunnel widenings (CTWs) and coracoclavicular distances (CCDs) and examine correlations between these measurements in patients following combined coracoclavicular stabilization and acromioclavicular capsule repair in treatment of acute high-grade acromioclavicular joint injury. Methods: This retrospective study reviewed the records of patients with acute Rockwood type V acromioclavicular joint injury who underwent surgery within 3 weeks after their injury. All patients had follow-ups at 3 and 6 months and 1 and 2 years. The CTWs were measured on anteroposterior radiographs between the medial and lateral borders at the superior, middle and inferior levels of the tunnels. On anteroposterior radiographs of both clavicles, the CCDs were measured at the shortest distance between the upper border of the coracoid process and the inferior border of the clavicle and reported as the CCD ratio, which was defined as the ratio of the affected and unaffected clavicles. At the final follow-ups, clinical outcomes were assessed using American Shoulder and Elbow Surgeons (ASES) scores. Results: This study included seventeen men and six women with a mean age of 47.26 ± 10.68 years. At the final follow-ups, the mean ASES score of all patients was 95.28 ± 3.62. We found a significant correlation between the increase in the CTWs and the increase in the CCD ratios (Spearman’s rho correlation coefficient range 0.578–0.647, all p-values < 0.001). Conclusions: We found long-term postoperative widening of the clavicular tunnels, which correlated positively with a gradual postoperative decline in the acromioclavicular joint alignment reductions. Full article

Background: Movement feedback is used to promote anatomically correct movement patterns. Two primary forms of movement feedback exist: verbal cues and visual cues. There is ongoing debate regarding which type of feedback yields superior effects for learning desired movements. This study investigated how a combination of visual and verbal cues improved shoulder stability in four arm movements, Biceps Curls, Reverse Flys, Rowing, and Shoulder Extensions. Methods: Twelve participants were allocated to three different conditions and instructed to perform four different arm movements: Condition 1 (no specific instructions), Condition 2 (image only), and Condition 3 (verbal cues and image). Measurements of acromioclavicular (AC) joint displacement, and electromyography (EMG) peak and burst duration were taken for each arm movement within each condition. Results: Condition 3 exhibited a significant reduction in AC displacement and prolonged EMG burst duration. Variations in EMG peak and burst duration across different arm movements were attributed to anticipated muscle activation specific to each movement. Conclusions: The combination of visual and verbal cues through the “reConnect Your Dots” movement language was found to improve scapular stabilization and associated muscle activation. This approach to movement patterns practice holds promise for injury rehabilitation and risk mitigation for future occurrences. Full article

Background: The arthroscopically assisted stabilization of AC joint dislocations with a suture button system is an established procedure that is widely and successfully used in everyday practice. The main advantages of this one-step method are the minimally invasive procedure and the anatomical reconstruction of the ruptured coracoclavicular ligaments with a permanent implant. With this technical note study, for the first time, the new method of navigated suture button implantation in everyday clinical practice is described with the future goal of further reducing invasiveness and increasing precision. Materials and Methods: The surgical technique is explained using precise descriptions and illustrations, photos, X-rays, and 3D reconstructions based on clinical cases. The step-by-step system setup and patient positioning, AC joint reduction and retention, 3D scan and drill tunnel planning, stab incision and Kirschner wire navigation, and cannulated drilling and implant positioning, as well as closure and documentation are described in detail. Results: The standard coracoclavicular stabilization of AC joint dislocations with the 3D C-arm navigated suture button method is described in detail. Furthermore, the feasibility of an additive horizontal acromioclavicular suture cerclage, the implantation of an additional coracoclavicular suture button system, and the single-stage cannulated screw fixation of non-displaced fractures is demonstrated. Conclusion: The navigated suture button method aims to be simple, safe, minimally invasive, and precise. Prospective clinical studies with a long follow-up should be carried out to determine the clinical and radiological outcome in comparison with current methods. Full article

Background: Concomitant glenohumeral pathologies may be present in patients with acromioclavicular joint (ACJ) dislocations. This study aims to record and compare the prevalence and treatment of CGP in cases with acute and chronic ACJ dislocations. Methods: This retrospective cross-sectional binational, bicentric study included patients that underwent arthroscopically assisted stabilization for acute (group A) and chronic (group C) ACJ dislocations. Intraoperatively, CGPs and eventual treatments (debridement and reconstructive measures) were recorded. Results: The study included 540 patients (87% men; mean age 39.4 years), with 410 (75.9%) patients in group A and 130 (24.1%) in group C. Patients in group C were older (p < 0.001). The CGP prevalence was 30.7%, without a difference between groups A and C (p = 0.19). Supraspinatus tendon (SSP) and labral lesions were most common. Within group C, CGPs were more prevalent in surgery-naïve patients (p = 0.002). Among 49 patients with previous surgical treatment, CGPs tended to be more common in patients with prior open surgery than arthroscopically assisted surgery (p = 0.392). Increased CGP prevalence was associated with higher age (r = 0.97; p = 0.004) (up to 63% in the oldest age group, but also 17% for youngest age group) and higher in cases with Rockwood type-IIIB injuries compared to type-V injuries (p = 0.028), but type-IIIB injuries included more group C cases (p < 0.001). The most frequently found CGPs were treated by debridement rather than reconstructive interventions (SSP and labrum: p < 0.001, respectively). Conclusions: This study shows that one in three patients with ACJ instabilities has a CGP, especially elderly patients. Most of the CGPs were treated by debridement rather than constructive interventions. Full article