Posture after surgery for AC dislocation does not impact coracoclavicular distance
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A patient’s postoperative posture has no effect on arthroscopically treated acromioclavicular dislocation, as no significant changes were found in coracoclavicular distance, according to published results.
Researchers randomly categorized 60 patients with acute acromioclavicular (AC) dislocation injuries into either a supine rehabilitation group (SRG) or an erect rehabilitation group (ERG). After patients underwent arthroscopic stabilization with a suspensory fixation device, researchers assessed postoperative VAS, Constant-Murley score (CMS) and coracoclavicular (CC) distance, according to the study abstract.
In both groups, CC distance was reduced, from 29.34 mm (ERG) and 28.65 mm (SRG) preoperatively to 10.44 mm (ERG) and 10.11 mm (SRG) on postoperative day 1, according to the abstract. However, a “statistically significant” rewidening in CC distance occurred after 6 months postoperatively.
“No significant differences were found between the two groups in terms of the VAS, CMS scores and CC distance changes,” the researchers wrote in the abstract. “A significant improvement over the follow-up phase was identified in the VAS and CMS of both groups.”
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Anthony A. Romeo, MD
Surgical management of acute AC joint injuries remains controversial. Reported clinical outcomes for surgical vs. nonsurgical treatment are often the same. When surgery is implemented, both arthroscopic and open procedures have been described, with similar outcomes.
The authors of this study evaluated 60 patients who presented with either a Rockwood type 3 or 5 AC separation who desired to return to their pre-injury level of activity and consented for surgery. All patients had the same fixation. After surgery, they were all treated with immobilization in sling for 6 weeks combined with passive range of motion (PROM) of the shoulder. During this phase, patients were then randomized to two groups: PROM in the upright position vs. PROM in the supine position. All other aspects of care were the same. There were no significant differences between the two groups in any outcome measure.
As with many other AC joint studies, with numerous methodological challenges, this investigation unfortunately does not provide any conclusive evidence that would influence a change in the method that surgeons currently use to treat AC joint repair patients after acute fixation following a type 3 or 5 AC separation. The most important question is the necessity for surgery which remains elusive due to the similarity of outcomes and was not the question that this study attempted to answer.
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