Acute high-grade acromioclavicular joint injuries: quality of life comparison between patients managed operatively with a hook plate versus patients managed non-operatively.

INTRODUCTION: Surgical indication for acromioclavicular joint (ACJ) injuries still represents a reason for shoulder and trauma debate. In high-grade injuries, surgery is advocated because some of the non-operatively managed patients may have persistent shoulder pain that could make them unable to return to their previous activity. It has been shown that many of the patients with high-grade ACJ injuries that are managed non-operatively involve the development of scapular dyskinesis, situation that may result in loss of strength and weakness. On the other side, it has been widely reported that the period while the hook plate is present involves functional limitations and pain. The purpose of this study was to compare the quality of life (QoL) of patients with acute high-grade ACJ injuries (Rockwood grade III-V), managed operatively with a hook plate versus the QoL of patients managed non-operatively, 24 months or more after shoulder injury.

PATIENTS AND METHODS: Patients with acute high-grade ACJ injuries managed operatively (hook plate) or non-operatively, between 2008 and 2012 were included. The QoL was evaluated by means of the Health Survey questionnaire (SF36), the Visual Analogue Scale (VAS) for pain, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Constant score and the Global Satisfaction (scale from 0 to 10) assessed at the last follow-up visit. The presence of scapular dyskinesis was assessed. Comparison between groups was made.

RESULTS: Thirty-two patients were included: 11 hook plate-group (PLATE group) (5 Rockwood III and 6 V) and 21 conservative-group (CONS group) (4 Rockwood III and 17 V). The mean age was 41 [19-55] years old for the PLATE group and 38 [19-55] for the CONS group (p = 0.513). The mean follow-up was 32.50 ± 11.64 months for the PLATE group and 34.77 ± 21.98 months for the CONS group (p = 0.762). The mean results of the questionnaires assessed at the last follow-up visit were: (1) physical SF36 score (PLATE group 53.70 ± 4.33 and CONS group 52.10 ± 6.11, p = 0.449); (2) mental SF36 score (PLATE group 53.06 ± 6.10 and CONS group 56.99 ± 6.47, p = 0.110); (3) VAS for pain (PLATE group 1.45 ± 1.51 and CONS group 1.50 ± 1.79, p = 0.943); (4) DASH score (PLATE group 4.79 ± 5.60 and CONS group 5.83 ± 6.76, p = 0.668); (5) Constant score (PLATE group 91.36 ± 6.84 and CONS group 91.05 ± 7.35, p = 0.908); (6) Global Satisfaction (PLATE group 8.00 ± 1.18 and CONS group 8.45 ± 1.73, p = 0.449). There was evidence of scapular dyskinesis in 18 % (2/11) of the patients of the PLATE group and in 52.4 % (11/21) of the patients of the CONS group (p = 0.127).

CONCLUSIONS: Patients with acute high-grade ACJ injuries managed operatively with a hook plate may have the same QoL and self-reported questionnaires than patients with high-grade ACJ injuries managed non-operatively, 24 months or more after shoulder injury. If surgery is advocated for this type of injury, the orthopedic population must be aware that the hook-plate system might not represent the most suitable option.

LEVEL OF EVIDENCE: Level IV therapeutic; retrospective comparative study.