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Study results support timely nonoperative management of grade 3 AC joint injuries
Successful outcomes may be expected with this approach, even in patients who opt for surgery, according to investigators.
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Orthopaedists should first consider a trial of nonoperative treatment for patients with grade 3 acromioclavicular joint injuries, according to results presented at the European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress.
“According to our results, one, a trial of nonoperative treatment is warranted because successful outcomes can be expected even in patients who eventually opt for surgery, and two, patients who presented more than 30 days after their injury were less likely to complete nonoperative treatment successfully,” Maximilian Petri, MD, of the Medizinische Hochshule Hannover in Hannover, Germany, told Orthopaedics Today Europe.
Surgical treatment of grade 3 acromioclavicular (AC) joint injuries is challenging, with complication rates of 30% or higher, according to recently published literature on the subject.
Petri, who presented the results, said at the meeting, “It seems attractive to offer the patient a first approach of a nonoperative treatment, but still, we have to keep in mind that not 100% of these patients will be satisfied.”
Patients underwent physical therapy
In the retrospective study, the researchers compared clinical outcomes of 38 patients with grade 3 AC joint injuries who first underwent a trial of nonoperative management, which consisted of a recommended schedule of physical therapy, according to Petri. For this study, which was conducted at the Steadman Clinic in Vail, Colo., U.S.A, Petri and colleagues collected common U.S. clinical outcome measures, including the physical component of the SF-12, the American Shoulder and Elbow Surgeons (ASES), the QuickDASH and the Single Assessment Numerical Evaluation scores.
The mean age of the patient population, which included high-level athletes and heavy workers, was 38 years. Minimum follow-up was 2 years with a mean follow-up of just more than 3 years. The researchers defined failure as any patient who underwent surgical reconstruction of the AC joint before the final follow-up.
Good success rate reported
The study results indicated a trial of nonoperative treatment can be effective.
“We had a success rate of nonoperative management of 74%,” Petri said at the meeting.
Of the 10 patients who failed nonoperative treatment, nine of the patients initially presented to a shoulder specialist more than 30 days after their injury. Late presentation made them nearly 14-times more likely to fail nonoperative management, according to Petri.
From the analysis, investigators saw significant improvements in clinical outcome scores from baseline to final follow-up. The mean ASES score, which Petri identified as a key score for this study, was 95 points out of 100 points. The mean patient satisfaction score was 9 points out of 10 points.
All clinical outcome scores were similar between the two groups, according to Petri. For instance, the ASES was 95 points for the group that went on to failure vs. 97 points for group treated successfully with nonoperative care.
One point, which could not be investigated in the study because of its intention-to-treat nonoperatively design, was whether early reconstruction provided better results.
“Still, that is a matter of debate,” Petri said at the meeting.
This study was the National Award-winner from the German Arthroscopy Association. – by Colleen Owens
- References:
- Petri M, et al. Abstract #FP-05-6181. Presented at: European Society of Sports Traumatology, Knee Surgery and Arthroscopy Congress; May 4-7, 2016; Barcelona.
- Petri M, et al. Arthroscopy. 2016;doi:10.1016/j.arthro.2015.11.024.
- For more information:
- Maximilian Petri, MD, can be reached at Unfallchirurgische Klinik Medizinische Hochschule Hannover Carl-Neuberg-Str., 30625 Hannover, Germany; email: petri.maximilian@mh-hannover.de.
Disclosure: The study was supported by funding by the German Arthroscopy Association.