Le traitement des disjonctions acromio-claviculaires chroniques reste un sujet confidentiel et controversé. Face aux multiples options chirurgicales, il n’est pas toujours aisé de choisir parmi les étapes indispensables.

Background: The primary objective was to evaluate correlations linking anatomical to functional outcomes after endoscopically assisted repair of acute acromioclavicular joint dislocation (ACJD).Hypothesis: Combined acromioclavicular and coracoclavicular stabilisation improves radiological outcomes compared to coracoclavicular stabilisation alone.Material and methods: A prospective multicentre study was performed. Clinical outcome measures were pain intensity on a visual analogue scale (VAS), subjective functional impairment (QuickDASH score), and Constant's score. Anatomical outcomes were assessed on standard radiographs (anteroposterior view of the acromioclavicular girdle and bilateral axillary views) obtained preoperatively and postoperatively and on postoperative dynamic radiographs taken as described by Tauber et al.Results: Of 116 patients with acute ACJD included in the study, 48% had type III, 30% type IV, and 22% type V ACJD according to the Rockwood classification. Coracoclavicular stabilisation was achieved using a double endobutton in 93% of patients, and concomitant acromioclavicular stabilisation was performed in 50% of patients. The objective functional outcome was good, with an unweighted Constant's score >= 85/100 and a subjective QuickDASH functional disability score <= 10 in 75% of patients. The radiographic analysis showed significant improvements from the preoperative to the 1-year postoperative values in the vertical plane (decrease in the coracoclavicular ratio from 214 to 128%, p = 10(-6)) and in the horizontal plane (decrease in posterior displacement from 4 to 0 mm, p = 5 x 10(-5)). The anatomical outcome correlated significantly with the functional outcome (absolute R value = 0.19 and p = 0.045). We found no statistically significant differences across the various types of constructs used. Intra-operative control of the acromioclavicular joint did not improve the result. Implantation of a biological graft significantly improved both the anatomical outcome in the vertical plane (p = 0.04) and acromioclavicular stabilisation in the horizontal plane (p = 0.02). The coracoclavicular ratio on the anteroposterior radiograph was adversely affected by a longer time from injury to surgery (p = 0.02) and by a higher body mass index (BMI) (p = 0.006). High BMI also had a negative effect on the difference in the distance separating the anterior edge of the acromion from the anterior edge of the clavicle between the injured and uninjured sides, as assessed on the axillary views (p = 0.009).Conclusion: This study demonstrates that acute ACJD requires stabilisation in both planes, i.e., at the coracoclavicular junction and at the acromioclavicular joint. Coracoclavicular stabilisation alone is not sufficient, regardless of the type of implant used. Implantation of a biological graft should be considered when the time from injury to surgery is longer than 10 days. The weight of the upper limb should be taken into account, with 6 weeks of immobilisation to unload the construct in patients who have high BMI values. (C) 2015 Elsevier Masson SAS. All rights reserved.

Introduction: Treatment of chronic acromioclavicular joint dislocation (ACJD) remains a poorly known and controversial subject. Given the many surgical options, it is not always easy to determine which steps are indispensable.Methods: This article reports a multicenter prospective study. The clinical and radiological follow-up involved a comparative analysis of the preoperative and postoperative data at 1 year, including pain (visual analogue scale), subjective functional incapacity (QuickDASH), and the objective Constant score, as well as a comparative analysis of vertical and horizontal movements measured on simple x-rays.Results: Based on a series of 140 operated ACJDs, we included 24 chronic ACJDs. The mean time to surgery was 46 weeks (range, 1 month to 4 years). The patients' mean age was 41 years, with a majority of males (75%), 72% of whom participated in recreational sports. Professionally, 40% of the subjects had jobs involving manual labor. We noted 40% grade III, 24% grade IV, and 36% grade V injury according to the Rockwood classification. In 92% of cases, coracoclavicular stabilization was provided by a double button implant, reinforced with a biological graft in 88% of the cases. In 29%, millimeters to centimeters of the distal clavicle were resected and acromioclavicular stabilization was associated in 54%. We observed complications in 33% of the cases. At 1 year postoperative, 21 patients underwent clinical and radiological follow-up (87.5%). Only 35% of the patients were satisfied or very satisfied, whereas 100% of them would recommend the operation. Full-time work was resumed in 91% of the cases and all sports could be resumed in 86%. The pre- and postoperative values at 1 year changed as follows: the mean Constant score improved from 61 to 87 (p = 0.00002); the subjective QuickDASH score decreased from 41 to 9 (p = 0.00002); and radiologically significant reduction of the initial displacement was observed in the vertical plane (p < 10(-3)) and the horizontal plane (p = 0.022).Conclusion: In this study, the favorable prognostic factors found were: time to surgery less than 3 months (p = 0.02), associated acromioclavicular stabilization, and postoperative immobilization with a sling extended to 6 weeks. However, resection of the distal clavicle did not influence the final result. (C) 2015 Elsevier Masson SAS. All rights reserved.

Introduction: Treatment of chronic acromioclavicular joint dislocation (ACJD) remains a poorly known and controversial subject. Given the many surgical options, it is not always easy to determine which steps are indispensable. Methods: This article reports a multicenter prospective study. The clinical and radiological follow-up involved a comparative analysis of the preoperative and postoperative data at 1 year, including pain (visual analogue scale), subjective functional incapacity (QuickDASH), and the objective Constant score, as well as a comparative analysis of vertical and horizontal movements measured on simple x-rays. Results: Based on a series of 140 operated ACJDs, we included 24 chronic ACJDs. The mean time to surgery was 46 weeks (range, 1 month to 4 years). The patients’ mean age was 41 years, with a majority of males (75%), 72% of whom participated in recreational sports. Professionally, 40% of the subjects had jobs involving manual labor. We noted 40% grade III, 24% grade IV, and 36% grade V injury according to the Rockwood classification. In 92% of cases, coracoclavicular stabilization was provided by a double button implant, reinforced with a biological graft in 88% of the cases. In 29%, millimeters to centimeters of the distal clavicle were resected and acromioclavicular stabilization was associated in 54%. We observed complications in 33% of the cases. At 1 year postoperative, 21 patients underwent clinical and radiological follow-up (87.5%). Only 35% of the patients were satisfied or very satisfied, whereas 100% of them would recommend the operation. Full-time work was resumed in 91% of the cases and all sports could be resumed in 86%. The preand postoperative values at 1 year changed as follows: the mean Constant score improved from 61 to 87 (p = 0.00002); the subjective QuickDASH score decreased from 41 to 9 (p = 0.00002); and radiologically significant reduction of the initial displacement was observed in the vertical plane (p < 10−3) and the horizontal plane (p = 0.022). ∗ Corresponding author. E-mail address: jrhbarth@yahoo.fr (J. Barth). http://dx.doi.org/10.1016/j.otsr.2015.09.002 877-0568/© 2015 Elsevier Masson SAS. All rights reserved. S306 J. Barth et al. / Orthopaedics & Traumatology: Surgery & Research 101 (2015) S305–S311 Conclusion: In this study, the favorable prognostic factors found were: time to surgery less than 3 months (p = 0.02), associated acromioclavicular stabilization, and postoperative immobilization with a sling extended to 6 weeks. However, resection of the distal clavicle did not influence the final result. Level of proof: Level II prospective non-randomized comparative study.

L’objectif principal était de corréler les résultats anatomiques et fonctionnels des réparations de DAC sous contrôle endoscopique et de démontrer la supériorité radiologique de l’association d’une fixation acromio-claviculaire à une stabilisation coracoclaviculaire.