Arthroscopic Acromioclavicular Joint Stabilization in Patients Aged ≥50 Years Results in a Low Rate of Clinical Failure, Favorable Outcomes and High Return to Activity and Work.
Marco-Christopher Rupp, Lorenz Fritsch, Lukas N Muench, Yannick Ahlheit, Yannick Ehmann, Daniel Berthold, Lucca Lacheta, Sebastian Siebenlist, Bastian Scheiderer
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引用次数: 0
Abstract
Purpose: To evaluate clinical outcomes as well as return-to-activity (RTA) and -work (RTW) following an arthroscopically-assisted suspensory fixation technique for ACJ instability in patients aged ≥50 years and to compare these outcome parameters between surgery in the acute (≤3 weeks) and chronic setting of ACJ instability.
Methods: Patients aged ≥50 years who underwent arthroscopic ACJ stabilization via suspensory fixation between 01/2011 and 06/2020 were included. The American Shoulder and Elbow Surgeons (ASES), Single Assessment Numerical Evaluation (SANE), the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), visual analogue scale (VAS) for pain were collected at a minimum of 24 months. RTA and RTW were evaluated by a questionnaire. Outcomes were compared between undergoing surgery for acute or chronic (≤/>3 weeks) ACJ instability.
Results: Of 55 eligible patients, 44 patients with a mean age of 59.9±7.8(50-76) years were included. At a minimum 37 months after surgery (mean, 74.8±31.4, range 37-142 months), patients reported an ASES of 89.4±15.6 (38-100), SANE of 89.8±13.9(40-100), and Quick-DASH of 9.8±13.3(0-47.7), along with a VAS pain score of 0.9±1.7(0-7); with 73.3% of the patients reaching the PASS. There was no revision for subsequent recurrent instability. Postoperatively, 87.2% of patients returned to athletic activity after 4.1±2.3(1-12) months, however to fewer disciplines (2.4±1.2 vs. 2.1±1.4 p=0.025). 97% of the patients returned to work at a mean of 7.3±8.8(0-40) weeks, with 90% reporting a similar or superior working ability. While the overall outcome was comparable in the chronic and the acute setting, patients in the chronic situation of ACJ instability reported significantly inferior SANE scores compared to the contralateral shoulder (p=0.024) and returned to fewer athletic disciplines (p=0.007) compared to the acute situation.
Conclusion: Patients aged ≥50 years undergoing arthroscopic ACJ stabilization experienced favorable clinical outcomes at mid-term follow-up, with high rates of return to athletic activity and work. Outcomes were comparable in patients undergoing surgery in the acute and chronic situation.
目的：评估关节镜辅助悬吊固定技术治疗≥50岁ACJ不稳定患者的临床结果以及恢复活动（RTA）和工作（RTW），并比较急性（≤3周）和慢性ACJ不稳定患者手术的这些结果参数。方法：纳入2011年1月至2020年6月期间接受关节镜悬吊固定稳定的年龄≥50岁的患者。收集至少24个月的美国肩肘外科医生（ASES）、单一评估数值评估（SANE）、手臂、肩膀和手的残疾问卷（QuickDASH）、视觉模拟疼痛量表（VAS）。RTA和RTW采用问卷评估。比较急性或慢性（≤3周）ACJ不稳定手术的结果。结果：55例符合条件的患者中，44例平均年龄59.9±7.8（50-76）岁。在术后至少37个月（平均74.8±31.4，范围37-142个月），患者报告的asa为89.4±15.6 (38-100)，SANE为89.8±13.9(40-100)，Quick-DASH为9.8±13.3(0-47.7)，VAS疼痛评分为0.9±1.7(0-7)；73.3%的患者达到PASS。随后的复发性不稳定没有进行翻修。术后，87.2%的患者在4.1±2.3（1-12）个月后恢复运动活动，但在较少的学科（2.4±1.2 vs 2.1±1.4 p=0.025）。97%的患者在平均7.3±8.8（0-40）周后恢复工作，90%的患者报告工作能力相似或更好。虽然慢性和急性情况下的总体结果相当，但慢性ACJ不稳定患者报告的SANE评分明显低于对侧肩关节（p=0.024），并且与急性情况相比，更少的运动训练（p=0.007）。结论：≥50岁接受关节镜下ACJ稳定的患者在中期随访中获得了良好的临床结果，恢复运动和工作的比例很高。在急性和慢性情况下接受手术的患者的结果具有可比性。证据水平：回顾性病例系列。
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Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.
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