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High degree of consensus achieved regarding diagnosis and treatment of acromioclavicular joint instability among ESA-ESSKA members

2020; Springer Science+Business Media; Volume: 29; Issue: 7 Linguagem: Inglês

10.1007/s00167-020-06286-w

1433-7347

Claudio Rosso, Frank Martetschläger, Maristella F. Saccomanno, Andreas Voß, Lucca Lacheta, Ana Catarina Ângelo, Emmanuel Antonogiannakis, Clara de Campos Azevedo, Klaus Bak, Semin Bećirbegovic, Knut Beitzel, Kerem Bilsel, Roman Brzóska, Ángel C. Moreu Calvo, Christophe Charousset, Felix Dyrna, Emmanouil Brilakis, Francesco Franceschi, Jean Marc Glasson, P. Gleyze, Nuno Gomes, Roger Hackney, Michael Hantes, Orestis Karargyris, Mustafa Karahan, Ladislav Kovačič, А. А. Кубашев, Lucca Lacheta, Olaf Lorbach, Benjo Maben, Benjamin Marjanovič, Frank Martetschlaeger, Christos Yiannakopolus, Roman C. Ostermann, Ανδρέας Παναγόπουλος, Perikles Papadopoulos, Boris Poberaj, Claudio Rosso, Maristella F. Saccomanno, Daniel Smolen, Francesc Soler Romagosa, Ettore Taverna, B. Toussaint, Patrick Vavken, Andreas Voß, Néstor Zurita, Knut Beitzel, Giuseppe Milano,

Trauma Management and Diagnosis

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.