Acromioclavicular Joint Stabilisaton for instability following distal clavicle excision
J Phadnis, P Robinson, L Funk
Acromioclavicular joint (ACJ) instability following distal clavicle excision is an under-appreciated entity, which can result in considerable pain and dysfunction. There is a paucity of data reporting the results of ACJ stabilization in this specific group of patients.
Thirteen patients (8 male, 5 female) underwent ACJ stabilization for chronic pain and dysfunction following one or more prior distal clavicle excision procedures. All procedures utilised a synthetic ligament (LARS), and were anatomic coraco-clavicular ligament reconstructions with a modification to improve antero-posterior stability of the ACJ. Outcome data was collected using the disabilities of arm, shoulder and hand (DASH) score and the Constant Murley (CM) score. All patients had post-operative outcome data collected. Eight patients had pre- and post-operative outcome scores available for comparison.
Mean time to stabilization from the original procedure was 25 months (6-80 months). Mean follow up was 28 months (12-62 months). The overall mean DASH and CM scores were 26 (0-57) and 73 (46-100) respectively. In the eight patients who had pre-operative outcome scores measured, there was a significant improvement in the mean CM score (33 to 70, p=0.001). The mean DASH score also improved but was not statistically significant (40 to 25, p=0.12). All patients reported an improvement in the pain component of their CM score and 7/8 reported improvement in the work component of the DASH score. There was radiographic evidence of re-subluxation in one patient. Two patients had continued chronic pain and two patients developed adhesive capsulitis requiring hydrodilatation procedures.
ACJ stabilization to treat instability following distal clavicle excision resulted in improved functional scores, pain scores and facilitated return to work in most patients. However, it is uncommon for patients to have full resolution of their symptoms. This is likely related to the chronicity of their symptoms and multiple previous procedures.