Osteoarthritis ng AC Joint Impormasyon

Ano ang nararamdaman mo

Maaaring mararamdaman mo ang matulis o nakakalumbong na sakit tepat sa itaas ng iyong balikat. Dito nagtatagpo ang iyong collarbone at shoulder blade. Masakit kapag pinindot ang lugar na ito. Maaaring mapansin mo ang pamamaga o maliit na buntot sa lugar na iyon.

Karaniwang lumalala ang sakit kapag gumagalaw ka ng iyong braso patungo sa ibang bahagi ng katawan. Maaaring maging mahirap ang mga simpleng gawain sa araw-araw. Maaaring masaktan ang pag-abot sa likod upang isara ang bra o ipasok ang damit. Maaaring magdulot ng hindi komportableng pakiramdam ang pag-angat ng mga bagay sa itaas ng ulo o ang pag-abot sa mga gamit sa mataas na shelf. Karaniwang masakit ang pagtulog sa apektadong gilid at maaari itong makagambala sa iyong pahinga.

Maaari ring mararamdaman mo ang katigasan kapag gising ka pa lang. Karaniwang humihina ang katigasan habang gumagalaw ka sa loob ng araw. Gayunpaman, maaaring bumalik ang nakakalumbong na sakit matapos ang mahabang araw ng aktibidad. May mga taong nakikita na nakakatulong ang pagpapahinga ng braso, habang may iba naman na nakikita na mas nakakapagpahinga ang banayad na paggalaw.

Mahalagang malaman na hindi lahat ng may pagbabago sa X-ray ay nararamdaman ang sakit. Sa katunayan, ang asymptomatic wear-and-tear arthritis ay nanatiling asymptomatic sa 90% ng mga pasyente sa loob ng 7 na taon. Kung wala kang mga sintomas, malamang na hindi inirerekomenda ng iyong doktor ang operasyon. Kahit na ikaw ay may ibang operasyon sa balikat, tulad ng rotator cuff repair, ang hindi naaayos na arthritis na walang sakit ay may kaugnayan sa mababang porsyento ng pagkabigo.

Tutuunan ng pansin ng iyong doktor ang paggamot sa sakit na talagang nararamdaman mo, hindi lamang sa ipinapakita ng imahe. Hindi kinakailangan ang pagkakaiba-iba sa pagitan ng symptomatic at asymptomatic radiographic changes dahil ang kasiyahan ng pasyente sa mga paggamot tulad ng mga injeksyon ay pantay-pantay anuman ang itsura ng X-ray. Kung hindi tumutugon ang mga konservatibong paggamot, maaaring pag-usapan ng iyong doktor ang mga opsyon sa operasyon. Parehong ang bukas na teknika at arthroscopic resection ay nagbibigay ng maayos na pagpapagaan ng sakit para sa mga symptomatic na kaso.

Ano ang nangyayari talaga

Ang iyong acromioclavicular joint ay matatagpuan sa itaas ng iyong balikat, kung saan nagtatagpo ang iyong collarbone at shoulder blade. Isipin mo ito bilang isang maliit, matibay na bisagra na nagpapahintulot sa iyong braso na gumalaw nang maayos. Sa paglipas ng panahon, ang makinis na patong sa mga dulo ng buto—tinatawag na cartilage—ay maaaring magkasira. Ito ang osteoarthritis, o arthritis na dulot ng pagkasira dahil sa paggamit. Kapag nipis na ang protektibong patong na ito, maaaring magkuskusan ang mga buto, na nagdudulot ng sakit at stiffness.

Ang proseso ng pagkasira dahil sa paggamit ay napakadalas. Madalas itong mangyari nang walang babala. Sa katunayan, ang asymptomatic AC-OA ay nanatiling asymptomatic sa 90% ng mga pasyente sa loob ng 7 taon. Ibig sabihin, para sa karamihan ng mga tao, ang mga makikita na pagbabago sa X-ray ay hindi awtomatikong nagdudulot ng sakit o limitasyon sa galaw. Maaari kang magkaroon ng arthritis sa isang scan ngunit hindi mararamdaman ng pagkakaiba.

Minsan, natutuklasan ang isyu sa joint na ito habang pinoproseso ang ibang problema sa balikat. Halimbawa, ang hindi pinapagamot na ACJ osteoarthritis, maging may sintomas man o wala, na natuklasan sa panahon ng arthroscopic rotator cuff repair, ay may kaugnayan sa mababang antas ng pagkabigo. Ipinapahiwatig nito na ang pagkakaroon ng arthritis sa joint na ito ay karaniwang hindi nasasakripisyo ang resulta ng ibang operasyon sa balikat. Gayunpaman, sa ilang kaso, ang matinding acromioclavicular joint osteoarthritis ay may kaugnayan sa acromial stress fractures pagkatapos ng reverse shoulder arthroplasty. Susuriin ng iyong surgeon ang mga panganib na ito bago ang anumang prosedura.

Kapag ang joint ay nagdudulot ng mga sintomas, madalas ito ay dahil ang mga istruktura sa paligid nito ay nasa ilalim ng stress. Ang joint capsule ay ang manggas sa paligid ng balikat na nagpapanatili ng lahat sa tamang posisyon. Kung ang mga ligamento na nagpapatibay sa lugar na ito ay naunat o nasira, maaaring lumipat nang bahagya ang joint. Ang maling pagkakahanay na ito ay maaaring magbago ng paraan ng paggalaw ng iyong shoulder blade, na nagdudulot ng sakit at dysfunction.

Naunawaan ng iyong surgeon na hindi lahat ng arthritis ay nangangailangan ng operasyon. Parehong ang bukas na (open) at arthroscopic na resection arthroplasty techniques ay nagbibigay ng maasahang pagpapagaan ng sakit para sa symptomatic AC osteoarthritis. Ang mga prosedurang ito ay kinabibilangan ng pag-alis ng maliit na bahagi ng buto upang lumikha ng mas maraming espasyo. Tumutulong ito upang bawasan ang friction at payagan ang mas maayos na paggalaw. Ang layunin ay alisin ang iyong sakit habang pinapanatili ang functional na balikat.

Ano ang maaari naming gawin para dito

Sa Mater Private Hospital Rockhampton, pinamamahalaan ni Dr. Kieran Hirpara ang iyong paggamot sa pamamagitan ng pagpili ng tratong angkop sa iyong mga tiyak na sintomas at istilo ng buhay. Nagsisimula kami sa mga pinakamababang antas ng invasibong proseso upang makita kung maaari naming kontrolin ang iyong sakit nang walang operasyon. Ang ganitong hakbang-hakbang na pamamaraan ay tumutulong upang maiwasan ang hindi kinakailangang mga proseso habang binibigyan ang iyong balikat ng pinakamahusay na pagkakataon na gumaling nang natural.

Para sa maraming tao, ang mga simpleng pagbabago ay nagdudulot ng malaking pagkakaiba. Maaaring kailanganin mong baguhin ang mga gawain na nagdudulot ng sakit, tulad ng pagbuhat ng mabibigat na bagay o pag-abot pataas. Ang pisyoterapiya ay isang mahalagang bahagi ng prosesong ito. Gabayin ka ng aming mga terapistang sa pamamagitan ng mga ehersisyo upang palakasin ang mga kalamnan sa paligid ng iyong balikat at itaas na braso. Ang suportang ito ay nagbabawas ng presyon sa kasukasuan. Karaniwan naming inirerekomenda ang pagsisimula sa konservatibong paggamot sa loob ng isang takdang panahon upang makita kung nababawasan nito ang iyong hindi komportableng pakiramdam. Kung mayroon kang arthritis na dulot ng pagkasira, ang pagbabago sa paraan ng paggamit ng iyong braso ay makakatulong upang panatilihin ang mga sintomas na kontrolado sa mas matagal na panahon.

Kung hindi nagbibigay ng sapat na ginhawa ang sariling pamamahala at terapiya, maaaring pag-usapan namin ang mga medikal na opsyon. Ang mga gamot pang-alis ng sakit at anti-inflammatory na gamot ay makakatulong upang kontrolin ang pamamaga at sakit. Nag-aalok din kami ng mga injeksyon sa loob ng kasukasuan. Ang mga suntok na ito ay nagdadala ng gamot direkta sa pinagmulan ng sakit upang paiti ang pamamaga. Ipinaliliwanag ng pananaliksik na ang mga injeksyon na ito ay may 1-taong tagumpay na rate na 47% sa mga pasyenteng may acromioclavicular osteoarthritis. Ibig sabihin, halos kalahati ng mga pasyente ay nakakakuha ng malaking ginhawa sa loob ng isang taon, bagaman magkakaiba ang resulta. Ginagamit namin ang mga injeksyon na ito upang matulungan kang manatiling aktibo at magpatuloy sa iyong rehabilitasyon.

Ang operasyon ay isinasalang-alm lahat lamang kapag ang konservatibong paggamot ay hindi nagbigay ng sapat na pag-unlad. Ang pinakakaraniwang operasyon ay ang distal clavicle excision. Sa operasyong ito, tinatanggal namin ang isang maliit na bahagi ng dulo ng collarbone upang hindi na ito magkuskos sa balikat. Binubuo nito ng mas maraming espasyo at binabawasan ang sakit. Ipinapayo namin ito para sa mga pasyenteng nananatiling may sakit kahit na subukan na ang ibang mga tratong. Para sa mga akutong pinsala o kronikong dislokasyon kung saan ang mga ligamento ay naputol, maaaring irekomenda namin ang rekonstruksyon upang ibalik ang katatagan. Pinag-uusapan namin ang lahat ng mga opsyon sa iyo upang matiyak na ang pagpili ay angkop sa iyong mga layunin at pangangailangan sa kalusugan.

Ano ang inaasahan

Ang iyong prognosis ay nakadepende sa malaking bahagi kung ang iyong mga sintomas ay aktibo o tahimik. Kung mayroon kang wear-and-tear arthritis sa AC joint ngunit walang sakit, madalas ay nananatili itong ganito. Sa 90% ng mga pasyente, ang asymptomatic arthritis ay nanatiling asymptomatic sa loob ng isang 7-taong panahon. Maaaring hindi mo na kailanganin ang anumang paggamot kung hindi ito nakakaabala.

Kung mayroon ka man ng sakit, ang conservative care ay karaniwang unang hakbang. Nakakatulong ang mga injection, ngunit hindi ito permanenteng solusyon. Ang mga acromioclavicular injection ay may 1-taong success rate na 47%. Ibig sabihin, halos kalahati ng mga pasyente ay nakakakuha ng ginhawa sa loob ng isang taon, habang ang iba ay maaaring kailanganin ang karagdagang mga opsyon. Kung nananatiling may sakit kahit pagpahinga at gamot, ang surgery ay isang opsyon.

Ang layunin ng surgery ay alisin ang iritadong bahagi ng collarbone. Ito ay nagbibigay ng predictable na pagpapagaan ng sakit para sa symptomatic AC osteoarthritis. Parehong ang open at arthroscopic techniques ay epektibo sa pagbawas ng sakit at pagpapabuti ng function ng balikat sa midterm follow-up. Inaasahan mong mararamdaman mo ang mas kaunting sakit at mas malayang paggalaw. Gayunpaman, ang ilang persistent na sakit at pag-unlad ng osteoarthritis ay nananatiling mga alalahanin sa mga revision cases.

Mahalagang malaman na ang arthritis ay maaaring makaapekto sa ibang mga prosedura sa balikat. Ang untreated AC joint osteoarthritis, maging symptomatic man o hindi, na natuklasan sa arthroscopic rotator cuff repair ay nauugnay sa mababang percentage ng failure. Ang osteoarthritis ay nauugnay din sa mas masamang final na clinical outcomes pagkatapos ng rotator cuff repair. Ang hindi gumagaling o muling napunit na rotator cuff cuff ay nagpapataas ng risk ng pag-unlad ng osteoarthritis.

Kung mayroon kang severe arthritis, mayroong karagdagang mga risk na isaalang-alang. Ang severe AC joint osteoarthritis ay nauugnay sa acromial stress fractures pagkatapos ng reverse shoulder arthroplasty. Ang radiographic ACJ osteoarthritis ay karaniwan sa mga pasyente na nagsasagawa ng ganitong uri ng surgery. Timbangin ng iyong surgeon ang mga salaping ito kapag nagpaplano ng iyong pag-aalaga.

Sa kabuuan, iba-iba ang daloy. Maraming tao ang magagaling na pamahalaan nang walang surgery. Ang iba ay nakakakuha ng lasting na ginhawa pagkatapos alisin ang problematic na buto. Ang iyong surgeon ay tutulong sa iyo upang desisyunin kung aling landas ang angkop sa iyong buhay at mga sintomas.

Kailan makipag-ugnayan sa doktor

Kumonsulta sa iyong doktor kung mayroon kang patuloy na sakit sa itaas ng balikat na hindi gumagaling kahit pahinga. Humingi ng pagsusuri ng espesyalista kung napapansin mo ang kahinaan, kawalan ng katatagan, o pakiramdam ng pagkakasara o pagbagsak. Maghanap ng medikal na tulong kung ang mga sintomas ay nakakaapekto sa iyong tulog o tungkulin sa trabaho, o kung may biglaang paglala ng sakit. Bagama’t maraming kaso ng arthritis na dulot ng pagkasira ay walang sakit sa loob ng mga taon, ang patuloy na discomfort ay nangangailangan ng pagsusuri. Ang iyong surgeon ay makakatulong upang matukoy kung kailangan pa ng karagdagang paggamot upang ma-manage nang epektibo ang iyong mga sintomas.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

Asymptomatic AC-OA remained asymptomatic in 90% of patients over a 7-year period [2].
Untreated ACJ osteoarthritis, whether symptomatic or not, encountered during arthroscopic rotator cuff repair is associated with a low percentage of failure [3].
Radiographic ACJ osteoarthritis is common in patients undergoing reverse shoulder arthroplasty [7].
Severe acromioclavicular joint osteoarthritis is associated with acromial stress fractures after reverse shoulder arthroplasty [7].
Both open and arthroscopic resection arthroplasty techniques provide predictable pain relief for symptomatic AC osteoarthritis [8].
Open and arthroscopic resection arthroplasty techniques have unique sets of potential complications that may be minimized with improved understanding of anatomy, biomechanics, and meticulous surgical technique [8].
Limited distal clavicle excision reduced pain and improved shoulder function at midterm follow-up in patients with AC joint osteoarthritis resistant to conservative treatment [9].
A distinction between symptomatic and asymptomatic radiographic AC OA is unnecessary as all patients were equally satisfied with the outcome of preoperative acromioclavicular injection [6].
Further characterisation of patients in whom mild arthroscopic findings of OA of the AC joint are clinically significant and warrant resection is needed [1].
Acromioclavicular joint arthritis is not an indication for routine distal clavicle excision in arthroscopic rotator cuff repair [3].
Clinicians should consider overreduction of the AC joint because it may lead to favorable radiological results [5].
The authors recommend anatomic reconstruction procedures for the treatment of chronic complete AC dislocations [21].

Anatomy & Pathophysiology

Anatomic techniques that address both coracoclavicular ligaments and the AC capsule are recommended to restore horizontal and vertical stability while allowing physiological rotation [10].
None of the reconstruction strategies completely restored the shoulder girdle to its preinjured state [26].
Kinematic changes resulting from AC joint dislocation could be a potential source of pain and dysfunction in the shoulder [27].
Scapular and clavicular kinematics were affected in AC separation models [28].
The position of the hook portion of a clavicle hook plate can predispose anatomic structures to post-operative complications of subacromial impingement and bony erosion [29].
Future research should focus on addressing horizontal and rotational instability to restore native physiological and biomechanical properties of the AC joint [35].
Coracoclavicular reconstruction with augmentation of the acromioclavicular joint provides improved horizontal stability compared to isolated coracoclavicular reconstruction [41].
Adding a fixation of the AC joint minimizes lateral tilting of the scapula and maintains a more anatomic reposition result over time [45].

Classification

Asymptomatic acromioclavicular osteoarthritis diagnosed by MRI remained asymptomatic in 90% of patients over a 7-year period [2].
Untreated acromioclavicular joint osteoarthritis, whether symptomatic or not, encountered during arthroscopic rotator cuff repair is associated with a low percentage of failure [3].
Mild arthroscopic findings of acromioclavicular joint osteoarthritis may be clinically significant and warrant resection, but further characterization of such patients is needed [1].
Radiographic acromioclavicular joint osteoarthritis is common in patients undergoing reverse shoulder arthroplasty [7].
Osteolytic changes in the acromioclavicular joint seemed to be associated with incongruity of the joint but did not correlate with clinical results [11].
The acromial center line to dorsal clavicle radiographic measurement and the use of the Alexander view provide a more realistic appreciation of true acromioclavicular joint displacement, especially in defining watershed cases (Rockwood types IIIA, IIB, and IV) [12].
Evaluating the integrity of the capsuloligamentous structures stabilizing the acromioclavicular joint is reproducible and provides additional information on the severity of the injury [24].
Injuries to the sternoclavicular joint are uncommon, and recognition and classification are critical to proper management to minimize long-term sequelae [16].
Some persistent pain and osteoarthritis progression remain concerns in the arthroscopic revision of failed open anterior stabilization of the shoulder [4].

Clinical Presentation

Preventive arthroscopic distal clavicle resection is not recommended in patients with radiological but asymptomatic ACJ arthritis [19].
Osteolytic changes seemed to be associated with incongruity of the AC joint, but did not correlate with clinical results [11].
Additional research is needed to determine the main cause of pain in isolated acromioclavicular osteoarthritis and to compare clinical outcomes of intra-articular versus extra-articular injections [13].
Risk factors for subsequent distal clavicle excision after rotator cuff repair include tenderness to palpation at the AC joint, female sex, and surgery on the dominant side [18].
Subsequent distal clavicle excision was performed in 40% of cases with a combination of the three identified risk factors (tenderness to palpation, female sex, dominant side surgery) [18].
Recurrence of the initial dislocation after arthroscopically assisted reduction appears to be related to the onset of degenerative ACJ arthropathy [14].
Some persistent pain and osteoarthritis progression remain concerns in the revision of failed open anterior stabilization of the shoulder [4].

Investigations

Preventive arthroscopic distal clavicle resection (DCR) is not recommended in patients with radiological but asymptomatic ACJ arthritis [19].
Further characterization is needed to determine which patients with mild arthroscopic findings of AC joint OA are clinically significant and warrant resection [1].
Radiographic ACJ osteoarthritis is common in patients undergoing reverse shoulder arthroplasty (RSA) [7].
Severe ACJ osteoarthritis is associated with acromial stress fractures after reverse shoulder arthroplasty [7].
Osteolytic changes in the AC joint seemed to be associated with incongruity but did not correlate with clinical results [11].
Patients with edema on MRI were more likely to present with pain than patients without edema [43].
Subchondral bone edema on histologic examination was more frequent in patients with pain [43].
The outcomes of a preoperative AC injection suggest that a distinction between symptomatic and asymptomatic radiographic AC OA is unnecessary, as all patients were equally satisfied with the outcome [6].
Additional research is needed to determine the main cause of pain and to compare clinical outcomes of intra-articular versus extra-articular steroid injections for isolated AC osteoarthritis [13].
Subsequent distal clavicle excision was performed in 40% of cases with a combination of the three identified risk factors (tenderness, female sex, dominant side) [18].
The arthroscopic approach offers an advantage in diagnosing and treating occult intra-articular pathology during distal clavicle excision [20].
Some persistent pain and osteoarthritis progression remain concerns in the revision of failed open anterior stabilization of the shoulder using arthroscopy [4].
Evaluating the integrity of the capsuloligamentous structures stabilizing the AC joint is reproducible and provides additional information on injury severity, which may influence treatment decisions [24].
The AC-DC measurement and use of the Alexander view provide a more realistic appreciation of true AC joint displacement, particularly in defining watershed cases (IIIA/IIB/IV) [12].
Radiological failures were observed in 41% of cases in a prospective multicenter study of arthroscopic acute AC dislocation fixation [50].

Treatment

Non-Operative Management

Conservative therapy is a valid initial treatment option for Rockwood Type V acromioclavicular dislocations [15].
Non-operative reduction and stabilization is a valuable treatment option for acute high-grade acromioclavicular joint separations [33].
Nonoperative treatment is helpful for most patients with painful conditions of the acromioclavicular joint, although those with osteolysis may need to modify their activities [44].
Conservative and surgical treatments are both effective in the management of acromioclavicular joint osteoarthritis [17].
Acromioclavicular injections offer a 1-year success rate of 47% in patients with acromioclavicular osteoarthritis [22].
Additional research is needed to determine the main cause of pain and to compare clinical outcomes of intra-articular versus extra-articular steroid injections for isolated acromioclavicular osteoarthritis [13].

Operative Management

Both open and arthroscopic resection arthroplasty techniques provide predictable pain relief for symptomatic acromioclavicular osteoarthritis [8].
Limited distal clavicle excision reduces pain and improves shoulder function at midterm follow-up in patients with acromioclavicular joint osteoarthritis resistant to conservative treatment [9].
Further characterization is needed to identify patients in whom mild arthroscopic findings of acromioclavicular joint osteoarthritis are clinically significant and warrant resection [1].
Conversion to anatomic coracoclavicular ligament reconstruction shows similar clinical outcomes compared to successful non-operative treatment in chronic primary type III to V acromioclavicular joint injuries at a minimum 5-year follow-up [49].
The authors recommend anatomic reconstruction procedures for the treatment of chronic complete acromioclavicular dislocations [21].
Osteoarthritis is associated with poorer final clinical outcomes after rotator cuff repair, and an unhealed or re-torn cuff increases the risk of osteoarthritis [23].

Diagnostic Considerations

A distinction between symptomatic and asymptomatic radiographic acromioclavicular osteoarthritis appears unnecessary, as all patients were equally satisfied with the outcome of preoperative acromioclavicular injection [6].
Asymptomatic acromioclavicular osteoarthritis diagnosed by MRI remained asymptomatic in 90% of patients over a 7-year course [2].
Some persistent pain and osteoarthritis progression remain concerns following arthroscopy in the revision of failed open anterior stabilization of the shoulder [4].

Complications

Osteoarthritis is associated with poorer final clinical outcomes after rotator cuff repair [23].
An unhealed or re-torn rotator cuff increases the risk of developing osteoarthritis [23].
Severe AC joint osteoarthritis is associated with acromial stress fractures after reverse shoulder arthroplasty [7].
Some persistent pain and osteoarthritis progression remain concerns following arthroscopy in revision of failed open anterior stabilization of the shoulder [4].
Recurrence of the initial dislocation after arthroscopically assisted reduction of acute AC joint dislocation appears to be related to the onset of degenerative ACJ arthropathy [14].
Treatment of acute grade III and IV AC dislocations by synthetic ligament reconstruction carries a risk of significant early osteolysis [25].
Open and arthroscopic AC joint reconstruction techniques have no differences in loss of reduction, complication rate, or revision rate [38].
Both open and arthroscopic resection arthroplasty techniques provide predictable pain relief for symptomatic AC osteoarthritis but each has a unique set of potential complications [8].

Recovery

Limited distal clavicle excision for acromioclavicular joint osteoarthritis resistant to conservative treatment reduced pain and improved shoulder function at midterm follow-up [9].
A preoperative acromioclavicular injection study suggested that distinguishing between symptomatic and asymptomatic radiographic acromioclavicular osteoarthritis is unnecessary, as all patients were equally satisfied with the outcome [6].
Osteolytic changes in the acromioclavicular joint seemed to be associated with incongruity but did not correlate with clinical results [11].
Recurrence of initial acromioclavicular joint dislocation appears to be related to the onset of degenerative acromioclavicular joint arthropathy [14].
Treatment of acute grade III and IV acromioclavicular dislocations using synthetic ligament reconstruction gave satisfactory results in terms of recovery of strength, but evolution is not risk-free due to the onset of significant early osteolysis [25].
Arthroscopic coracoclavicular ligament reconstruction with double-bundle soft tissue allograft for chronic type V acromioclavicular dislocations showed sustained and statistically significant improvements in functional outcomes, high rates of return to sport, and maintenance of active-duty military status at minimum 10-year follow-up [39].
Minimally invasive coracoclavicular ligament augmentation with a flip button/polydioxanone repair for total acromioclavicular joint dislocation revealed excellent radiologic and clinical results with no subluxations or dislocations noted in short-term follow-up [48].
Type V acromioclavicular dislocations may be given a trial of conservative therapy [15].

Key Evidence

[L2] Further characterisation of patients in whom mild arthroscopic findings of OA of AC joint are clinically significant and warrant resection is needed. [1] (10.1007/s00167-014-3114-2)
[L2] Asymptomatic AC-OA remained asymptomatic in 90% over 7 years. [2] (10.1016/j.jse.2019.04.004)
[L2] Untreated ACJ osteoarthritis, symptomatic or not, encountered during arthroscopic RCR is associated with a low percentage of failure. [3] (10.1007/s00167-020-06098-y)
[L4] Some persistent pain and osteoarthritis progression remain concerns. [4] (10.1016/j.arthro.2009.04.073)
[L3] Clinicians should consider overreduction of the AC joint because it may lead to favorable radiological results. [5] (10.1177/0363546519862850)
[L4] The outcomes of this study seem to suggest that a distinction between symptomatic and asymptomatic radiographic AC OA is unnecessary, as all patients were equally satisfied with the outcome. [6] (10.5397/cise.2023.00073)
[L3] Radiographic ACJ osteoarthritis is common in patients undergoing RSA. [7] (10.1016/j.jseint.2021.11.008)
[L5] Both open and arthroscopic resection arthroplasty techniques provide predictable pain relief for symptomatic AC osteoarthritis, though each has a unique set of potential complications that may be minimized with improved understanding of anatomy, biomechanics, and meticulous surgical technique. [8] (10.1177/0363546513485359)
[L4] Limited distal clavicle excision of patients with AC joint osteoarthritis resistant to conservative treatment reduced pain and improved shoulder function at midterm follow-up. [9] (10.1016/j.otsr.2016.01.008)
[L5] Anatomic techniques that address both coracoclavicular ligaments and the AC capsule are recommended to restore horizontal and vertical stability while allowing physiological rotation. [10] (10.1016/j.arthro.2019.01.038)
[L4] The AC-DC measurement and use of the Alexander view provides the clinician with a more realistic appreciation of true AC joint displacement, especially in defining watershed cases (ie, IIIA/IIB/IV) and may better inform the decision-making process regarding management options and recommendations. [12] (10.1016/j.jse.2019.12.014)
[L4] Additional research is needed to determine the main cause of pain and compare clinical outcomes of intra-articular versus extra-articular injections. [13] (10.5397/cise.2023.00311)
[L4] Recurrence of the initial dislocation appears to be related to onset of degenerative ACJ arthropathy. [14] (10.1016/j.otsr.2017.11.001)
[L4] This suggests that Type V AC dislocations may be given a trial of conservative therapy. [15] (10.1177/2325967115s00017)
[L1] Injuries to the SC joint are uncommon, and recognition and classification are critical to proper management to minimize long-term sequelae. [16] (10.1177/0363546513498990)
[L4] Conservative and surgical treatments are both effective in acromioclavicular joint osteoarthritis management. [17] (10.1007/s00167-020-06377-8)
[L3] Risk factors for subsequent DCE included tenderness to palpation at the AC joint, female sex, and surgery on the dominant side, with subsequent DCE performed in 40% of cases with a combination of these 3 factors. [18] (10.1177/2325967119844295)
[L1] Preventive arthroscopic DCR is not recommended in patients with radiological but asymptomatic ACJ arthritis. [19] (10.1177/0363546514547254)
[L1] The arthroscopic approach offers a unique advantage in diagnosing and treating occult intra-articular pathology. [20] (10.1016/j.jse.2006.10.006)
[L4] The authors recommend this procedure for the treatment of chronic complete AC dislocations. [21] (10.1016/j.injury.2010.09.023)
[L4] AC injections offer a 1-year success rate of 47%. [22] (10.5397/cise.2023.00031)
[L4] Osteoarthritis is associated with poorer final clinical outcomes, and an unhealed or re-torn cuff increases the risk of osteoarthritis. [23] (10.1016/j.otsr.2017.03.007)
[L1] Evaluating the integrity of the capsuloligamentous structures stabilizing the AC joint is reproducible and gives additional information on the severity of the injury, which might also influence the treatment decision. [24] (10.1016/j.jse.2020.10.026)
[L4] Treatment of ACD by synthetic ligament reconstruction gave satisfactory results, notably in terms of recovery of strength, but evolution is not risk-free with onset of significant early osteolysis. [25] (10.1016/j.otsr.2010.06.004)
[L5] Although each technique was able to restore different elements of the joint kinematics, none of the strategies completely restored the shoulder girdle to its preinjured state. [26] (10.1177/03635465221095231)
[L5] The kinematic changes could be a potential source of pain and dysfunction in the shoulder with AC joint dislocation. [27] (10.1177/0363546512458571)
[L5] Scapular and clavicular kinematics were affected in AC separation models. [28] (10.1016/j.jse.2013.01.004)
[L5] The observed frequency of hook contact with surrounding subacromial structures in a static shoulder confirms that the position of the hook portion of the implant can predispose anatomic structures to the post-operative complications of subacromial impingement and bony erosion. [29] (10.1016/j.injury.2009.12.012)
[L4] Non-operative reduction and stabilization of high-grade AC joint separations seems to be a valuable treatment option. [33] (10.1007/s00402-020-03630-0)
[L5] Future research should focus on addressing horizontal and rotational instability, to restore native physiological and biomechanical properties of the AC joint. [35] (10.1186/s12891-022-05935-0)
[L1] Open and arthroscopic AC joint reconstruction techniques have no differences in loss of reduction, the complication rate, and the revision rate based on the available literature. [38] (10.1177/0363546518795147)
[L4] Outcomes after arthroscopic CC reconstruction for chronic, type V AC dislocations in an active-duty military patient population show sustained and statistically significant improvements in functional outcomes as well as high rates of return to sport and maintenance of active-duty military status at long-term follow-up. [39] (10.1016/j.arthro.2025.05.008)
[L1] Coracoclavicular reconstruction with augmentation of the acromioclavicular joint has been shown to provide improved horizontal stability in both biomechanical and clinical studies compared to isolated coracoclavicular reconstruction. [41] (10.1007/s00167-018-5152-7)
[L4] Patients with edema on MRI were more likely to present pain than patients without edema, and subchondral bone edema on histologic examination was more frequent in patients with pain. [43] (10.1016/j.jseint.2020.03.007)
[L5] Nonoperative treatment is helpful for most patients, although those with osteolysis may have to modify their activities. [44] (10.5435/00124635-199905000-00004)
[L3] The presented data suggest adding a fixation of the AC joint to minimize lateral tilting of the scapula and maintain a more anatomic reposition result over time. [45] (10.1007/s00402-021-03761-y)
[L4] The short-term follow-up of 15 recently operated patients reveals excellent radiologic and clinical results, with no subluxations or dislocations of the acromioclavicular joint noted. [48] (10.1016/j.arthro.2006.12.015)
[L4] At a minimum 5-year follow-up, patients with successful non-operative treatment for type III-V ACJ injuries achieved similar clinical outcomes compared to those who were converted to ACCR. [49] (10.1007/s00167-020-06159-2)
[L4] Surgery for AC dislocations is difficult with radiological results that must still be improved, as radiological failures were observed in 41% of cases. [50] (10.1016/j.otsr.2015.09.012)

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