Long-term Follow-up After Arthroscopically Assisted 2-Bundle Anatomic Reduction of Acute Acromioclavicular Joint Separations.

Abstract

Arthroscopically assisted techniques for acromioclavicular joint reconstruction have increasingly been used over the past 15 years. Long-term results are lacking. Patients will continue to show good clinical function and sustained anatomic reduction at long-term follow-up. Cohort study; Level of evidence, 3. Twenty patients (67%) with a known endpoint were followed up at a mean of 15 years (range, 14-16 years) postoperatively. Twelve patients (60%) had Rockwood type 5, 6 (30%) type 4, and 2 (10%) type 3 injuries. Clinical evaluation included the Simple Shoulder Test, Constant score, pain score of 0 to 10, and satisfaction graded 0 (not satisfied) to 4 (very satisfied). Fourteen patients had complete outcome scores at the final follow-up. Nine patients underwent radiographic examination and were assessed for coracoclavicular distance, posterior acromioclavicular subluxation, arthritis, ossification, and hardware displacement by 3 observers. The respective mean preoperative, 2-year, 5-year, and 15-year outcome scores were as follows: 34.5 ± 6.9, 94.3 ± 3.2 (<i>P</i> < .05), 91.5 ± 4.7, and 91.2 ± 4.8 (<i>P</i> > .05) for the Constant score; 2.8 ± 2.1, 12.0 ± 0 (<i>P</i> < .05), 11.8 ± 0.5, and 11.7 ± 0.4 (<i>P</i> > .05) for Simple Shoulder Test; and 4.5 ± 1.9, 0.3 ± 0.5 (<i>P</i> < .05), 0.3 ± 0.6, and 0.4 ± 0.8 (<i>P</i> > .05) for pain. The 2-year satisfaction was 4.0 ± 0; the 5-year score, 3.8 ± 0.5; and the 15-year score, 3.7 ± 0.4 (<i>P</i> > .05). Coracoclavicular distance (mm) decreased from 20.5 ± 4.6 preoperatively to 10.5 ± 3.6 at 2 years (<i>P</i> < .05), 11 ± 3.2 at 5 years, and 11.3 ± 4.3 at 15 years of follow-up (<i>P</i> > .05). Acromioclavicular posterior subluxation remained unchanged (<i>P</i> > .05). Six patients (67%) had asymptomatic ossification of the coracoclavicular ligaments; their Constant score was 93.3. One patient developed acromioclavicular arthritis radiologically with clinical correlation but did not require further surgery. Three patients (10%) underwent revision stabilization within 3 months, 1 for infection and 2 for mechanical failure. Fifteen years postoperatively, good clinical results persisted and anatomic reduction was overall maintained, often with asymptomatic ossification of the coracoclavicular ligaments.