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Loss of Reduction and Clavicle Fractures Commonly Occur in Patients Undergoing Acromioclavicular Joint Reconstruction

Scott Fong¹, Arthur Saroyan², Rajiv S Vasudevan³

¹Case Western Reserve University School of Medicine Cleveland Ohio U.S.A.

Arthroscopy, Sports Medicine, and Rehabilitation

|July 26, 2026

Abstract

Purpose:

To use a large, multi-institutional database to characterize the outcomes and complication profile after primary acromioclavicular (AC) joint reconstruction and to evaluate potential sex-related differences in outcomes and complications.

Methods:

The TriNetX national database was queried for patients undergoing AC joint reconstruction between January 2015 and October 2022. Ninety-day and 2-year outcomes including shoulder-related complications, secondary surgeries, and medical resource use were evaluated. Propensity-matched analysis assessed the association between sex and these outcomes, reported as odds ratios (ORs) with 95% confidence intervals (CIs). A 2-year Kaplan-Meier analysis compared revision probability between men and women.

Results:

In patients undergoing primary AC joint reconstruction, the revision rate was 3.9%, with loss of reduction in 13.4% and distal clavicle fractures in 15.7% within 2 years of surgery. On sex-based analysis, women had higher reported rates of postoperative antidepressant use (15.8% vs 11.2%; OR 1.495, 95% CI 1.048-2.132, P = .026), opioid prescriptions (52.7% vs 46.4%; OR 1.289, 95% CI 1.014-1.637, P = .038), and clavicle fractures within both 90 days (19.6% vs 12.8%; OR 1.647, 95% CI 1.185-2.294, P = .003) and 2 years (22.2% vs 16.0%; OR 1.493, 95% CI 1.098-2.032, P = .010) postoperatively. Men had higher reported rates of loss of reduction within 90 days (14.2% vs 9.7%; OR 1.538, 95% CI 1.057-2.237, P = .024), which was not significantly different within 2 years postoperatively.

Conclusions:

After primary AC joint reconstruction, loss of reduction (2 years, 13.4%) and distal clavicle fractures (2 years, 15.7%) were frequently reported complications in the postoperative period, with a 3.9% revision reconstruction rate within 2 years. Women reported higher rates of distal clavicle fracture in the postoperative period, and the high fracture rate in the female cohort (90 days, 19.6%) highlights a potentially under-recognized clinical consideration.

Level Of Evidence:

Level III, retrospective cohort study.

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