Abstract：
Acromioclavicular (AC) joint separation is a common shoulder injury. When the injury is graded as type III or higher in the Rockwood classification, surgical treatment can be proposed. However, an increasing number of practitioners are shifting back to conservative treatment as it is associated with fewer complications and seemingly close functional outcomes. The aim of our study was to evaluate the functional recovery of operated and non-operated patients with grade III or higher AC joint injuries. Secondarily, the reliability and relevance of the Rockwood classification was evaluated within and between raters.
We did a retrospective two-center study of 38 patients treated between 2014 and 2020. The clinical evaluation involved various functional outcome scores (Constant, QuickDASH, ASES, UCLA, SSV, STT) and a pain assessment (VAS). Return to sports and to work was also documented. The radiological evaluation consisted of Zanca AP and lateral axillary views immediately after the injury and at each radiographic follow-up visit until the final visit. An intra- and inter-rater analysis was also done for the Rockwood classification.
There was no significant difference in the functional scores (Constant score surgery group=91, nonoperative group=83; p=0.09) or the pain on VAS at the final assessment. Return to work and to sports was significantly faster in patients treated non-operatively. No complication was found in the non-operated patients, while nine of the operated patients suffered a complication. The inter-rater reliability of the Rockwood classification was found to be poor (kappa=0.08) to fair (kappa=0.35), while the intra-rater reliability was moderate (kappa=0.6) to good (kappa=0.63).
No matter which treatment is used, the functional outcomes and patient satisfaction level a minimum of 1 year after the injury appear to be identical. Thus, surgery should be only for patients whose AC joint is painful 7 days after the injury (VAS>7) and whose function has not improved. For young and athletic patients or for patients who simply want to regain nearly normal function, it is important to remember that the time to return to work and sports is longer with surgical management and to take into consideration the potential postoperative complications. While none of the patients who received the non-operative treatment required a secondary stabilizing surgery, this is a possible recourse.
III.
We did a retrospective two-center study of 38 patients treated between 2014 and 2020. The clinical evaluation involved various functional outcome scores (Constant, QuickDASH, ASES, UCLA, SSV, STT) and a pain assessment (VAS). Return to sports and to work was also documented. The radiological evaluation consisted of Zanca AP and lateral axillary views immediately after the injury and at each radiographic follow-up visit until the final visit. An intra- and inter-rater analysis was also done for the Rockwood classification.
There was no significant difference in the functional scores (Constant score surgery group=91, nonoperative group=83; p=0.09) or the pain on VAS at the final assessment. Return to work and to sports was significantly faster in patients treated non-operatively. No complication was found in the non-operated patients, while nine of the operated patients suffered a complication. The inter-rater reliability of the Rockwood classification was found to be poor (kappa=0.08) to fair (kappa=0.35), while the intra-rater reliability was moderate (kappa=0.6) to good (kappa=0.63).
No matter which treatment is used, the functional outcomes and patient satisfaction level a minimum of 1 year after the injury appear to be identical. Thus, surgery should be only for patients whose AC joint is painful 7 days after the injury (VAS>7) and whose function has not improved. For young and athletic patients or for patients who simply want to regain nearly normal function, it is important to remember that the time to return to work and sports is longer with surgical management and to take into consideration the potential postoperative complications. While none of the patients who received the non-operative treatment required a secondary stabilizing surgery, this is a possible recourse.
III.
摘要：
背景：肩锁关节分离是一种常见的肩关节损伤。当损伤在Rockwood分类中被分级为III型或更高等级时，可以提出手术治疗。然而,越来越多的从业者正转向保守治疗,因为它与更少的并发症和看似接近的功能结局相关.我们研究的目的是评估III级或更高AC关节损伤的手术和非手术患者的功能恢复。其次，在评估者内部和评估者之间评估了Rockwood分类的可靠性和相关性。
方法：我们对2014年至2020年间接受治疗的38例患者进行了一项回顾性的双中心研究。临床评估涉及各种功能结局评分(Constant，QuickDASH,ASES,加州大学洛杉矶分校,SSV,STT）和疼痛评估（VAS）。还记录了重返运动和工作的过程。放射学评估包括受伤后立即进行的ZancaAP和腋窝侧视以及每次影像学随访直至最后一次访视。还对Rockwood分类进行了内部和内部分析。
结果：在最终评估时，功能评分（Constant评分手术组=91，非手术组=83；p=0.09）或VAS疼痛没有显着差异。非手术治疗的患者恢复工作和运动的速度明显更快。非手术患者均未发现并发症,而9名手术患者出现并发症。Rockwood分类的评分者间可靠性较差（kappa=0.08）至一般（kappa=0.35），而评分者内部可靠性中等(kappa=0.6)至良好(kappa=0.63)。
结论：无论采用哪种治疗方法，损伤后至少1年的功能结局和患者满意度似乎相同.因此，手术应仅适用于受伤后7天AC关节疼痛（VAS>7）且功能未改善的患者。对于年轻和运动的患者，或者只是想恢复正常功能的患者，重要的是要记住，恢复工作和运动的时间更长的手术管理，并考虑到潜在的术后并发症。虽然没有接受非手术治疗的患者需要二次稳定手术，这是一个可能的追索权。
方法：III.
方法：我们对2014年至2020年间接受治疗的38例患者进行了一项回顾性的双中心研究。临床评估涉及各种功能结局评分(Constant，QuickDASH,ASES,加州大学洛杉矶分校,SSV,STT）和疼痛评估（VAS）。还记录了重返运动和工作的过程。放射学评估包括受伤后立即进行的ZancaAP和腋窝侧视以及每次影像学随访直至最后一次访视。还对Rockwood分类进行了内部和内部分析。
结果：在最终评估时，功能评分（Constant评分手术组=91，非手术组=83；p=0.09）或VAS疼痛没有显着差异。非手术治疗的患者恢复工作和运动的速度明显更快。非手术患者均未发现并发症,而9名手术患者出现并发症。Rockwood分类的评分者间可靠性较差（kappa=0.08）至一般（kappa=0.35），而评分者内部可靠性中等(kappa=0.6)至良好(kappa=0.63)。
结论：无论采用哪种治疗方法，损伤后至少1年的功能结局和患者满意度似乎相同.因此，手术应仅适用于受伤后7天AC关节疼痛（VAS>7）且功能未改善的患者。对于年轻和运动的患者，或者只是想恢复正常功能的患者，重要的是要记住，恢复工作和运动的时间更长的手术管理，并考虑到潜在的术后并发症。虽然没有接受非手术治疗的患者需要二次稳定手术，这是一个可能的追索权。
方法：III.
