High degree of consensus achieved regarding diagnosis and treatment of acromioclavicular joint instability among ESA-ESS
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SHOULDER
High degree of consensus achieved regarding diagnosis and treatment of acromioclavicular joint instability among ESA‑ESSKA members Claudio Rosso1,2,8 · Frank Martetschläger3,4,8 · Maristella F. Saccomanno5,8 · Andreas Voss6,4,8 · Lucca Lacheta7,4,8 · ESA DELPHI Consensus Panel · Knut Beitzel8,9 · Giuseppe Milano8,10,11 Received: 29 March 2020 / Accepted: 14 September 2020 © The Author(s) 2020
Abstract Purpose To develop a consensus on diagnosis and treatment of acromioclavicular joint instability. Methods A consensus process following the modified Delphi technique was conducted. Panel members were selected among the European Shoulder Associates of ESSKA. Five rounds were performed between October 2018 and November 2019. The first round consisted of gathering questions which were then divided into blocks referring to imaging, classifications, surgical approach for acute and chronic cases, conservative treatment. Subsequent rounds consisted of condensation by means of an online questionnaire. Consensus was achieved when ≥ 66.7% of the participants agreed on one answer. Descriptive statistic was used to summarize the data. Results A consensus was reached on the following topics. Imaging: a true anteroposterior or a bilateral Zanca view are sufficient for diagnosis. 93% of the panel agreed on clinical override testing during body cross test to identify horizontal instability. The Rockwood classification, as modified by the ISAKOS statement, was deemed valid. The separation line between acute and chronic cases was set at 3 weeks. The panel agreed on arthroscopically assisted anatomic reconstruction using a suspensory device (86.2%), with no need of a biological augmentation (82.8%) in acute injuries, whereas biological reconstruction of coracoclavicular and acromioclavicular ligaments with tendon graft was suggested in chronic cases. Conservative approach and postoperative care were found similar Conclusion A consensus was found on the main topics of controversy in the management of acromioclavicular joint dislocation. Each step of the diagnostic treatment algorithm was fully investigated and clarified. Level of evidence Level V. Keywords Acromioclavicular joint · Ac joint instability · Instability · Ac joint · Treatment · Diagnosis · Consensus · Delphi · European shoulder associates
Introduction Injuries of the acromioclavicular (AC) joint are quite common, accounting for 3–12% of all shoulder injuries [9]. The incidence even rises up to 40–50% when it comes to contact sports [14], with the highest prevalence in men in their second or third decade of life [7]. It seems evident that Claudio Rosso and Frank Martetschläger contributed equally. Knut Beitzel and Giuseppe Milano supervised and contributed equally. * Claudio Rosso [email protected] Extended author information available on the last page of the article
diagnosis and management of acute and chronic AC joint dislocations need to be well stated. However, although a plethora literature is available, a clear consensus has still not be
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