Abstract
Purpose
Sports activity after surgical AC joint stabilisation has not been comprehensively evaluated to date. The aim of this study was to determine rate, level and time to return to sports after AC joint stabilisation and to identify the influence of overhead sports on post-operative sports activity.
Methods
In this retrospective case series, a total of 68 patients with a high-grade AC joint dislocation (Rockwood type V) were stabilised using a single TightRope technique. Fifty-five patients (80.9 %) with median age of 42.0 (range, 18–65) years completed questionnaires regarding sports activity before and after surgery. Clinical outcome and complications were also evaluated. Forty-three patients participated in sports regularly before injury. Their sports activity was rated according to Allain, and non-overhead and overhead sports were differentiated.
Results
At median follow-up of 24 (18–45) months, 41 of 43 patients (95.3 %) had returned to sports. 63 % returned to the same sports activity as before injury. 16.3 % needed to adapt the type of sports to reduce demanding activities. 11.6 % reduced the frequency and 32.5 % the intensity of sports. The median time to return to sports was 9.5 (3–18) months. Overhead athletes (Allain Type III and IV) had to reduce their sports activity significantly more often (11.8 vs. 53.8 %; p = 0.011) and needed more time to return to sports (9.5 vs. 4.5 months; p = 0.009).
Conclusion
After stabilisation of AC joint dislocation, the majority of patients returned to sports after a substantial period of time. Overhead athletes, in particular, required more time and had to considerably reduce their sports activity. The findings impact therapeutic decision-making after AC joint injury and help with the prognosis and assessment of rehabilitation progress.
Level of evidence
IV.
Similar content being viewed by others
References
Allain J, Goutallier D, Glorion C (1998) Long-term results of the Latarjet procedure for the treatment of anterior instability of the shoulder. J Bone Joint Surg Am 80:841–852
Balke M, Schneider MM, Shafizadeh S, Bathis H, Bouillon B, Banerjee M (2015) Current state of treatment of acute acromioclavicular joint injuries in Germany: is there a difference between specialists and non-specialists? A survey of German trauma and orthopaedic departments. Knee Surg Sports Traumatol Arthrosc 23:1447–1452
Bannister GC, Wallace WA, Stableforth PG, Hutson MA (1989) The management of acute acromioclavicular dislocation. A randomised prospective controlled trial. J Bone Joint Surg Br 71:848–850
Beitzel K, Cote MP, Apostolakos J, Solovyova O, Judson CH, Ziegler CG, Edgar CM, Imhoff AB, Arciero RA, Mazzocca AD (2013) Current concepts in the treatment of acromioclavicular joint dislocations. Arthroscopy 29:387–397
Beris A, Lykissas M, Kostas-Agnantis I, Vekris M, Mitsionis G, Korompilias A (2013) Management of acute acromioclavicular joint dislocation with a double-button fixation system. Injury 44:288–292
Boehm D, Wollmerstedt N, Doesch M, Handwerker M, Mehling E, Gohlke F (2004) Development of a questionnaire based on the Constant–Murley-score for self-evaluation of shoulder function by patients. Unfallchirurg 107:397–402
Cardone D, Brown JN, Roberts SN, Saies AD, Hayes MG (2002) Grade III acromioclavicular joint injury in Australian Rules Football. J Sci Med Sport 5:143–148
Chillemi C, Franceschini V, Dei Giudici L, Alibardi A, Salate Santone F, Ramos Alday LJ, Osimani M (2013) Epidemiology of isolated acromioclavicular joint dislocation. Emerg Med Int 2013:171609
Cohen G, Boyer P, Pujol N, Hamida Ferjani B, Massin P, Hardy P (2011) Endoscopically assisted reconstruction of acute acromioclavicular joint dislocation using a synthetic ligament. Outcomes at 12 months. Orthop Traumatol Surg Res 97:145–151
Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164
De Carli A, Lanzetti RM, Ciompi A, Lupariello D, Rota P, Ferretti A (2015) Acromioclavicular third degree dislocation: surgical treatment in acute cases. J Orthop Surg Res 10:13
Dick R, Ferrara MS, Agel J, Courson R, Marshall SW, Hanley MJ, Reifsteck F (2007) Descriptive epidemiology of collegiate men’s football injuries: National Collegiate Athletic Association Injury Surveillance System, 1988–1989 through 2003–2004. J Athl Train 42:221–233
Dragoo JL, Braun HJ, Bartlinski SE, Harris AH (2012) Acromioclavicular joint injuries in National Collegiate Athletic Association football: data from the 2004–2005 through 2008–2009 National Collegiate Athletic Association Injury Surveillance System. Am J Sports Med 40:2066–2071
Ekstrand J, Hagglund M, Tornqvist H, Kristenson K, Bengtsson H, Magnusson H, Walden M (2013) Upper extremity injuries in male elite football players. Knee Surg Sports Traumatol Arthrosc 21:1626–1632
Flik K, Lyman S, Marx RG (2005) American collegiate men’s ice hockey: an analysis of injuries. Am J Sports Med 33:183–187
Glanzmann MC, Buchmann S, Audige L, Kolling C, Flury M (2013) Clinical and radiographical results after double flip button stabilization of acute grade III and IV acromioclavicular joint separations. Arch Orthop Trauma Surg 133:1699–1707
Grantham C, Heckmann N, Wang L, Tibone JE, Struhl S, Lee TQ (2014) A biomechanical assessment of a novel double endobutton technique versus a coracoid cerclage sling for acromioclavicular and coracoclavicular injuries. Knee Surg Sports Traumatol Arthrosc 24:1918–1924
Gstettner C, Tauber M, Hitzl W, Resch H (2008) Rockwood type III acromioclavicular dislocation: surgical versus conservative treatment. J Shoulder Elbow Surg 17:220–225
Headey J, Brooks JH, Kemp SP (2007) The epidemiology of shoulder injuries in English professional rugby union. Am J Sports Med 35:1537–1543
Hou Z, Graham J, Zhang Y, Strohecker K, Feldmann D, Bowen TR, Chen W, Smith W (2014) Comparison of single and two-tunnel techniques during open treatment of acromioclavicular joint disruption. BMC Surg 14:53
Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). Am J Ind Med 29:602–608
Jensen G, Katthagen JC, Alvarado LE, Lill H, Voigt C (2014) Has the arthroscopically assisted reduction of acute AC joint separations with the double tight-rope technique advantages over the clavicular hook plate fixation? Knee Surg Sports Traumatol Arthrosc 22:422–430
Kaplan LD, Flanigan DC, Norwig J, Jost P, Bradley J (2005) Prevalence and variance of shoulder injuries in elite collegiate football players. Am J Sports Med 33:1142–1146
Kelly BT, Barnes RP, Powell JW, Warren RF (2004) Shoulder injuries to quarterbacks in the national football league. Am J Sports Med 32:328–331
Korsten K, Gunning AC, Leenen LPH (2014) Operative or conservative treatment in patients with Rockwood type III acromioclavicular dislocation: a systematic review and update of current literature. Int Orthop 38:831–838
Kraus N, Haas NP, Scheibel M, Gerhardt C (2013) Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations in a coracoclavicular Double-TightRope technique: V-shaped versus parallel drill hole orientation. Arch Orthop Trauma Surg 133:1431–1440
Kraus N, Scheibel M (2011) Arthroskopisch-assistierte Stabilisierung der akuten Schultereckgelenkinstabilität. Obere Extremität 6:90–98
Liu X, Huangfu X, Zhao J (2015) Arthroscopic treatment of acute acromioclavicular joint dislocation by coracoclavicular ligament augmentation. Knee Surg Sports Traumatol Arthrosc 23:1460–1466
Loriaut P, Moreau PE, Dallaudiere B, Pelissier A, Vu HD, Massin P, Boyer P (2015) Outcome of arthroscopic treatment for displaced lateral clavicle fractures using a double button device. Knee Surg Sports Traumatol Arthrosc 23:1429–1433
Lu N, Zhu L, Ye T, Chen A, Jiang X, Zhang Z, Zhu Q, Guo Q, Yang D (2014) Evaluation of the coracoclavicular reconstruction using LARS artificial ligament in acute acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc 22:2223–2227
Ludewig PM, Phadke V, Braman JP, Hassett DR, Cieminski CJ, LaPrade RF (2009) Motion of the shoulder complex during multiplanar humeral elevation. Journal Bone Joint Surg Am 91:378–389
Lynch TS, Saltzman MD, Ghodasra JH, Bilimoria KY, Bowen MK, Nuber GW (2013) Acromioclavicular joint injuries in the National Football League: epidemiology and management. Am J Sports Med 41:2904–2908
Mall NA, Foley E, Chalmers PN, Cole BJ, Romeo AA, Bach BR Jr (2013) Degenerative joint disease of the acromioclavicular joint: a review. Am J Sports Med 41:2684–2692
Mazzocca AD, Arciero RA, Bicos J (2007) Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med 35:316–329
McFarland EG, Blivin SJ, Doehring CB, Curl LA, Silberstein C (1997) Treatment of grade III acromioclavicular separations in professional throwing athletes: results of a survey. Am J Orthop (Belle Mead NJ) 26:771–774
Murena L, Vulcano E, Ratti C, Cecconello L, Rolla PR, Surace MF (2009) Arthroscopic treatment of acute acromioclavicular joint dislocation with double flip button. Knee Surg Sports Traumatol Arthrosc 17:1511–1515
Nordqvist A, Petersson CJ (1995) Incidence and causes of shoulder girdle injuries in an urban population. J Shoulder Elbow Surg 4:107–112
Pallis M, Cameron KL, Svoboda SJ, Owens BD (2012) Epidemiology of acromioclavicular joint injury in young athletes. Am J Sports Med 40:2072–2077
Pauly S, Kraus N, Greiner S, Scheibel M (2013) Prevalence and pattern of glenohumeral injuries among acute high-grade acromioclavicular joint instabilities. J Shoulder Elbow Surg 22:760–766
Ranalletta M, Rossi LA, Piuzzi NS, Bertona A, Bongiovanni SL, Maignon G (2015) Return to sports after plate fixation of displaced midshaft clavicular fractures in athletes. Am J Sports Med 43:565–569
Rangger C, Hrubesch R, Paul C, Reichkendler M (2002) Capacity to participate in sports after injuries of the acromioclavicular joint. Orthopaede 31:587–590
Rockwood CA (1984) Injuries in the acromioclavicular joint: subluxations and dislocations about the shoulder. In: Rockwood CA, Green DP (eds) Fractures in Adults, 2nd edn, vol 1. JB Lippincott, Philadelphia, pp 860–910
Rosslenbroich SB, Schliemann B, Schneider KN, Metzlaff SL, Koesters CA, Weimann A, Petersen W, Raschke MJ (2015) Minimally invasive coracoclavicular ligament reconstruction with a flip-button technique (MINAR): clinical and radiological midterm results. Am J Sports Med 43:1751–1757
Saier T, Venjakob AJ, Minzlaff P, Fohr P, Lindell F, Imhoff AB, Vogt S, Braun S (2015) Value of additional acromioclavicular cerclage for horizontal stability in complete acromioclavicular separation: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 23:1498–1505
Salzmann GM, Walz L, Buchmann S, Glabgly P, Venjakob A, Imhoff AB (2010) Arthroscopically assisted 2-bundle anatomical reduction of acute acromioclavicular joint separations. Am J Sports Med 38:1179–1187
Scheibel M, Droschel S, Gerhardt C, Kraus N (2011) Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations. Am J Sports Med 39:1507–1516
Schwarting T, Lechler P, Bockmann B, Debus F, Ziring E, Frink M (2015) The benefit of arthroscopically assisted therapy for concomitant glenohumeral injuries in patients with unstable lateral clavicle fractures. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3909-9
Taft TN, Wilson FC, Oglesby JW (1987) Dislocation of the acromioclavicular joint. An end-result study. J Bone Joint Surg Am 69:1045–1051
Tamaoki MJ, Belloti JC, Lenza M, Matsumoto MH, Gomes Dos Santos JB, Faloppa F (2010) Surgical versus conservative interventions for treating acromioclavicular dislocation of the shoulder in adults. Cochrane Database Syst Rev:Cd007429
Venjakob AJ, Salzmann GM, Gabel F, Buchmann S, Walz L, Spang JT, Vogt S, Imhoff AB (2013) Arthroscopically assisted 2-bundle anatomic reduction of acute acromioclavicular joint separations: 58-month findings. Am J Sports Med 41:615–621
Weaver JK (1987) Skiing-related injuries to the shoulder. Clin Orthop Relat Res 216:24–28
Weiser L, Nuchtern JV, Sellenschloh K, Puschel K, Morlock MM, Rueger JM, Hoffmann M, Lehmann W, Grossterlinden LG (2015) Acromioclavicular joint dislocations: coracoclavicular reconstruction with and without additional direct acromioclavicular repair. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3920-1
Yi Y, Kim JW (2015) Coronal plane radiographic evaluation of the single TightRope technique in the treatment of acute acromioclavicular joint injury. J Shoulder Elbow Surg 24:1582–1587
Yian EH, Ramappa AJ, Arneberg O, Gerber C (2005) The Constant score in normal shoulders. J Shoulder Elbow Surg 14:128–133
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Funding
All costs arising for this clinical study was funded by the internal clinic-budget for scientific follow up.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Porschke, F., Schnetzke, M., Aytac, S. et al. Sports activity after anatomic acromioclavicular joint stabilisation with flip-button technique. Knee Surg Sports Traumatol Arthrosc 25, 1995–2003 (2017). https://doi.org/10.1007/s00167-016-4287-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-016-4287-7