The acromioclavicular ligament shows an early and dynamic healing response following acute traumatic rupture
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(2020) 21:593
RESEARCH ARTICLE
Open Access
The acromioclavicular ligament shows an early and dynamic healing response following acute traumatic rupture Dirk Maier1* , Lars-Rene Tuecking2, Anke Bernstein3, Gernot Lang1, Ferdinand Christian Wagner1, Martin Jaeger1, Peter Ogon4, Norbert Paul Südkamp1 and Kaywan Izadpanah1
Abstract Purpose: Symptomatic horizontal instability is clinically relevant following acute acromioclavicular joint dislocations. However, the intrinsic healing response is poorly understood. The present study sought to investigate timedependent healing responses of the human acromioclavicular ligament following acute traumatic rupture. Methods: Biopsies of the acromioclavicular ligament were obtained from patients undergoing surgical treatment for acute acromioclavicular joint dislocations. Specimens were stratified by time between trauma and surgery: group 1, 0–7 days (n = 5); group 2, 8–14 days (n = 6); and group 3, 15–21 days (n = 4). Time-dependent changes in cellularity, collagen (type 1 and 3) concentration, and histomorphological appearance were evaluated for the rupture and intact zone of the acromioclavicular ligament. Results: Group 1 was characterized by cellular activation and early inflammatory response. The rupture zone exhibited a significantly higher count of CD68-positive cells than the intact zone (15.2 vs 7.4; P ≤ 0.05). Consistently, synovialization of the rupture end was observed. Within the second week, the rupture zone was subject to proliferation showing more fibroblast-like cells than the intact zone (66.8 vs 43.8; P ≤ 0.05) and a peak of collagen type 3 expression (group 1: 2.2 ± 0.38, group 2: 3.2 ± 0.18, group 3: 2.8 ± 0.57; P ≤ 0.05). Signs of consolidation and early remodeling were seen in the third week. Conclusions: The acromioclavicular ligament exhibits early and dynamic healing responses following acute traumatic rupture. Our histological findings suggest that surgical treatment of acute ACJ dislocations should be performed as early as possible within a timeframe of 1 week after trauma to exploit the utmost biological healing potential. Prospective clinical studies are warranted to investigate whether early surgical treatment of ACJ dislocations translates into clinical benefits.
Introduction Acromioclavicular joint (ACJ) dislocations account for 3–12% of shoulder girdle injuries and occur with an incidence of about 5/100,000 individuals per year [1]. The optimal therapeutic management has been * Correspondence: [email protected] 1 Department of Orthopaedics and Trauma Surgery, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany Full list of author information is available at the end of the article
controversially discussed over the past decades. In most European countries, acute high-grade ACJ injuries (Rockwood type IV and V) are routinely treated surgically, whereas non-operative therapeutic approaches are common in Northern America [2, 3]. According to a survey am
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