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Is horizontal stabilization necessary in chronic acromioclavicular reconstructions?
Maxime Antoni1, Grégoire Ciais2, Anselme Billaud3
1Clinique de l'Orangerie, ELSAN, Strasbourg, France.
Insights
Adding horizontal acromioclavicular (AC) stabilization to coracoclavicular (CC) ligament reconstruction for chronic AC dislocations did not improve clinical outcomes or reduce failures. However, it did lower complication rates and enhance radiographic reduction.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Traumatology
Background:
- The necessity of horizontal acromioclavicular (AC) stabilization in chronic AC dislocation reconstructions alongside coracoclavicular (CC) ligament repair is not well-defined.
- Current surgical practices often prioritize CC ligament reconstruction, leaving the added value of horizontal AC stabilization unclear.
Purpose of the Study:
- To investigate if incorporating horizontal AC stabilization into CC ligament reconstruction for chronic AC dislocations improves clinical results.
- To assess the impact on failure rates, complications, revisions, and radiographic joint alignment.
Main Methods:
- A retrospective multicenter study analyzed 209 patients who underwent CC ligament reconstruction with or without horizontal AC stabilization.
- Propensity score matching and multivariate regression were employed to compare outcomes, including Constant scores, Subjective Shoulder Value, pain, and radiographic AC distance.
Main Results:
- Horizontal AC stabilization did not significantly alter Constant scores, Subjective Shoulder Value, or pain levels.
- Failure and revision rates were similar between groups.
- A notable finding was a reduction in complications and improved radiographic reduction (decreased AC distance) with horizontal AC stabilization.
Conclusions:
- While horizontal AC stabilization does not appear to enhance clinical outcomes or reduce failure rates in chronic AC dislocations treated with CC reconstruction, it is associated with fewer complications.
- The procedure demonstrated superior radiographic reduction, suggesting a potential benefit for joint stability that warrants further investigation in prospective trials.
Background:
The role of horizontal acromioclavicular (AC) stabilization in chronic AC dislocation reconstructions remains uncertain. While commonly used techniques focus on coracoclavicular (CC) ligament reconstruction, the potential benefit of adding horizontal AC stabilization has not been clearly established. The aim of this study was to evaluate whether horizontal AC stabilization in chronic AC dislocations treated with CC ligament reconstruction improves clinical outcomes, reduces failure, complications, or revisions, and enhances radiographic reduction.
Methods:
A retrospective multicenter study included 209 patients (mean age 44.5 ± 14.1 years, 90.9% male) who underwent CC ligament reconstruction (Weaver-Dunn, anatomic biologic reconstruction, or synthetic ligament) between 2006 and 2024. Patients were stratified according to the addition of horizontal AC stabilization. Primary outcome was the Constant score at final follow-up. Secondary outcomes included Subjective Shoulder Value, visual analog scale pain, radiographic AC distance, failures, complications, and revisions. Multivariate linear regression and 1:1 propensity score matching were performed.
Results:
Horizontal AC stabilization was not associated with higher Constant scores (β = -1.2, P = .62), Subjective Shoulder Value (β = -5.77, P = .09), or lower visual analog scale pain (β = -0.28, P = .37). Failure (15% vs. 15%, P > .99) and revision rates (5% vs. 12.5%, P = .43) were comparable between groups. However, horizontal stabilization was associated with fewer complications (12.5% vs. 45%, P = .003) and improved radiographic reduction, with lower AC distance at last follow-up (β = -4.99, P = .029).
Conclusion:
Horizontal AC stabilization in chronic AC dislocations treated with CC ligament reconstruction does not significantly improve clinical outcomes or reduce failures, but it appears to lower complication rates and provide superior radiographic reduction. These results suggest a potential stabilizing benefit of horizontal AC fixation, although further prospective studies are needed to validate its clinical relevance.
