Arthroscopically Assisted Acromioclavicular Joint Stabilization in Patients Aged ≥50 Years Results in a Low Rate of Clinical Failure, Favorable Outcomes, and High Return to Activity and Work.

Abstract

To evaluate clinical outcomes as well as return to activity and work following an arthroscopically assisted suspensory fixation technique for acromioclavicular joint (ACJ) instability in patients aged ≥50 years and to compare these outcome parameters between surgery in the acute (≤3 weeks) and chronic setting of ACJ instability. Patients aged ≥50 years who underwent arthroscopically assisted ACJ stabilization with a suspensory fixation between January 2011 and June 2020 were included. The American Shoulder and Elbow Surgeons score; Single Assessment Numerical Evaluation (SANE); the Disabilities of the Arm, Shoulder, and Hand score; and visual analog scale for pain were collected at a minimum of 24 months. Return to activity and return to work were evaluated by a questionnaire. Outcomes were compared between undergoing surgery for acute or chronic (≤3 weeks/>3 weeks) ACJ instability. Of 55 eligible patients, 44 with a mean age of 59.9 ± 7.8 (50-76) years were included. At a minimum 37 months after surgery (mean, 74.8 ± 31.4; range, 37-142 months), patients reported an American Shoulder and Elbow Surgeons score of 89.4 ± 15.6 (38-100), SANE of 89.8 ± 13.9 (40-100), and Disabilities of the Arm, Shoulder, and Hand questionnaire score of 9.8 ± 13.3 (0-47.7), along with a visual analog scale for pain score of 0.9 ± 1.7 (0-7), with 73.3% of the patients reaching the patient acceptable symptom state. There was no revision for subsequent recurrent instability. Postoperatively, 87.2% of patients returned to athletic activity after 4.1 ± 2.3 (1-12) months, but to fewer disciplines (2.4 ± 1.2 vs 2.1 ± 1.4; P = .025). Of the patients, 97% returned to work at a mean of 7.3 ± 8.8 (0-40) weeks, with 90% reporting a similar or superior working ability. While the overall outcome was comparable in the chronic and the acute setting, patients in the chronic situation of ACJ instability reported a significantly inferior SANE compared to the contralateral shoulder (P = .024) and returned to fewer athletic disciplines (P = .007) compared to the acute situation. Patients aged ≥50 years undergoing arthroscopically assisted ACJ stabilization experienced favorable clinical outcomes at mid-term follow-up, with high rates of return to athletic activity and work. Outcomes were comparable in patients undergoing surgery in acute and chronic situations. Level IV, retrospective case series.