Noninvasive bracing of acromioclavicular joint dislocations is not superior to early functional rehabilitation and not inferior to surgical stabilization in Rockwood type III and V injuries

IF 2.9 2区医学 Q1 ORTHOPEDICS Journal of Shoulder and Elbow Surgery Pub Date : 2025-05-01 Epub Date: 2024-10-21 DOI:10.1016/j.jse.2024.08.040

Tazio Maleitzke MD , Nicolas Barthod-Tonnot MD , Nina Maziak MD , Natascha Kraus MD , Mark Tauber MD , Alexander Hildebrandt MD , Jonas Pawelke MD , Larissa Eckl , Lukas Mödl MSc , Kathi Thiele MD , Doruk Akgün MD , Philipp Moroder MD

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Abstract

Background

Treatment of acromioclavicular joint (ACJ) separations remains controversial. Yet, conservative treatment has become more common even for high-grade injuries. Available conservative treatment does currently however not address the loss of anatomical joint integrity in Rockwood (RW) III and V injuries. In a recent case report, we outlined the concept of restoring ACJ integrity by noninvasively bracing a RW V injury.

Aim

The purpose of this study was to prospectively evaluate the clinical and radiological efficacy of a modern Kenny-Howard splint like brace and compare it to early functional rehabilitation or surgery in RW III and V injuries after a minimum of 12 months.

Methods

Patients with acute RW III injuries (n = 18) and patients with RW V injuries who refused surgery (n = 7) were prospectively enrolled and treated with an ACJ brace and followed up clinically and radiologicalally for 12 months. Endpoint results were compared to injury grade-, sex-, age-, and follow-up-period-matched patients treated with early functional rehabilitation (n = 23) or surgical TightRope stabilization (n = 23). Clinical outcomes included Constant Score (CS), Subjective Shoulder Value (SSV), Taft Score (TS), and modified Acromioclavicular Joint Instability Score (mAJIS) and radiological outcome included coracoclavicular index.

Results

CS, SSV, TS, and mAJIS improved in RW III and CS and SSV in RW V patients over time, when treated with the ACJ brace. Significance was only reached in RW III patients (P < .001). Radiological indices did not improve over time in RW III and V patients. No differences were found when comparing functional and cosmetic outcomes (CS, SSV, TS, mAJIS) after a minimum of 12 months between bracing, surgery, and early functional rehabilitation in RW III and V patients. The coracoclavicular index was most improved in patients treated with surgery compared to bracing after a minimum of 12 months (P = .0011 for RW III).

Conclusion

Brace treatment led to comparable clinical and cosmetic outcomes as early functional rehabilitation or surgery in patients with high grade ACJ injuries after a minimum of 12 months. However, no sustainably improved reduction of the ACJ resulted from bracing, when compared to early functional rehabilitation, thus questioning its utility. While surgery ensured radiological improvement compared to bracing, no benefit was seen over early functional rehabilitation.

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在 Rockwood III 型和 V 型损伤中，肩锁关节脱位的非侵入性支撑不优于早期功能康复，也不劣于手术稳定。

背景：肩锁关节（ACJ）分离的治疗仍存在争议。然而，保守治疗已变得越来越普遍，即使是对高级别损伤也是如此。然而，现有的保守疗法至今仍无法解决洛克伍德（RW）III级和V级损伤中解剖关节完整性丧失的问题。在最近的一份病例报告中，我们概述了通过对 RW V 型损伤进行非侵入性支撑来恢复 ACJ 完整性的概念。目的：本研究旨在前瞻性地评估现代 Kenny-Howard 夹板支撑的临床和放射学疗效，并在至少 12 个月后将其与早期功能康复或手术治疗 RW III 和 V 型损伤进行比较：对急性RW III损伤患者（18人）和拒绝手术的RW V损伤患者（7人）进行前瞻性登记，使用ACJ支具进行治疗，并进行为期12个月的临床和放射学随访。终点结果与接受早期功能康复治疗（23 人）和手术 TightRope 稳定治疗（23 人）的受伤等级、性别、年龄和随访时间相匹配的患者进行了比较。临床结果包括康斯坦茨评分（CS）、主观肩关节值（SSV）、塔夫脱评分（TS）和改良肱骨锁关节不稳定性评分（mAJIS），放射学结果包括冠状锁关节（CC）指数：结果：接受 ACJ 支架治疗的 RW III 患者的 CS、SSV、TS 和 mAJIS 均有所改善，而接受 ACJ 支架治疗的 RW V 患者的 CS 和 SSV 均有所改善。只有 RW III 期患者的 CS 和 SSV 有明显改善（p < 0.001）。随着时间的推移，RW III 和 V 患者的放射学指标没有改善。在至少 12 个月后，比较 RW III 和 V 期患者的功能和外观效果（CS、SSV、TS、mAJIS），发现支撑、手术和早期功能康复之间没有差异。与支具治疗相比，手术治疗患者在至少 12 个月后的 CC 指数改善最大（RW III 的 p=0.0011）：结论：在至少 12 个月后，支具治疗与早期功能康复或手术治疗对高位 ACJ 损伤患者的临床和美容效果相当。然而，与早期功能康复治疗相比，支具治疗并不能持续改善 ACJ 的缩小，因此其实用性受到质疑。虽然与支具相比，手术可确保放射学方面的改善，但与早期功能康复相比，手术并无益处。

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来源期刊

Journal of Shoulder and Elbow Surgery 医学-外科

CiteScore

6.50

自引率

23.30%

发文量

604

审稿时长

11.2 weeks

期刊介绍： The official publication for eight leading specialty organizations, this authoritative journal is the only publication to focus exclusively on medical, surgical, and physical techniques for treating injury/disease of the upper extremity, including the shoulder girdle, arm, and elbow. Clinically oriented and peer-reviewed, the Journal provides an international forum for the exchange of information on new techniques, instruments, and materials. Journal of Shoulder and Elbow Surgery features vivid photos, professional illustrations, and explicit diagrams that demonstrate surgical approaches and depict implant devices. Topics covered include fractures, dislocations, diseases and injuries of the rotator cuff, imaging techniques, arthritis, arthroscopy, arthroplasty, and rehabilitation.