[Acute acromioclavicular joint injuries. Changes in diagnosis and therapy over the last 10 years].

BACKGROUND: The goal of the present study was to summarize current treatment for acute acromioclavicular (AC) joint dislocations.

METHOD: In all, 796 orthopedics and/or trauma departments in Germany were identified in the national hospital directory (www.dka.de). Using the respective hospital web sites, the email addresses of the responsible shoulder/sports surgeon or, if not available, the head of department (successful in 746 cases) were identified. Emails with a link to an online survey with 36 questions and two reminders were sent; 60 were undeliverable. Thus, 686 emails probably reached the addressee. A total of 203 colleagues (30%) participated in the survey. Findings were compared to results of the survey published by Bäthis et al. in 2001.

RESULTS: More than 90% treat Rockwood I or II injuries conservatively and Rockwood IV to VI injuries surgically. However, 34% answered having never seen a Rockwood VI injury. Of those replying, 73% prefer surgical treatment for Rockwood III injuries. Favored surgical techniques were the hook plate in 44% and the arthoscopic TightRope® in 27%, while 11% prefer coracoclavicular cerclage, 6% AC joint transfixation, 3% minimally invasive AC joint reconstruction (MINAR), 1% coracoclavicular screw fixation, and 8% a completely different procedure. Concerning acute Rockwood III injuries, orthopedics and/or trauma surgeons still prefer surgical treatment but less often than 10 years ago (84%).

CONCLUSIONS: Favored techniques have completely changed since 2001 when the majority of physicians preferred AC joint transfixation or coracoclavicular cerclages, both techniques that are hardly used today. The hook plate appears to have become "standard therapy". The arthroscopic TightRope® is the second most common despite being the newest technique.