Midterm Functional Outcomes after Arthroscopically Assisted Stabilization for Acute Versus Chronic Type 5 Acromioclavicular Joint Injuries

Background: There is limited and inconsistent evidence pertaining to comparative studies examining functional outcomes after acromioclavicular joint (ACJ) stabilization in either the acute or chronic setting for high-grade injuries. Purpose/Hypothesis: The purpose of the study was to compare functional outcomes of patients undergoing arthroscopically assisted ACJ stabilization for isolated acute or chronic type 5 ACJ injuries. It was hypothesized that patients would achieve similar functional outcomes at midterm follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: Consecutive patients who underwent ACJ stabilization using coracoclavicular (CC) suspensory fixation with an additional acromioclavicular (AC) cerclage for isolated acute or chronic type 5 ACJ injuries from January 2015 to August 2021 and had a minimum follow-up of 2 years were identified and their records analyzed. Chronic ACJ injuries were defined as an interval of ≥3 weeks from injury to surgery according to the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine consensus statement and received an additional biological augmentation using a gracilis autograft. Functional outcome measures included the Constant-Murley (CM), American Shoulder and Elbow Surgeons (ASES), and Nottingham Clavicle (NC) scores as well as the visual analog scale (VAS) score for pain, which were compared between groups at the final follow-up. Results: A total of 82 patients (mean age at surgery, 40.3 ± 12.7 years; 54 acute and 28 chronic injuries) with a mean follow-up of 5.5 ± 2.0 years (range, 2.0-9.9 years) were included in the study. At the final follow-up, patients with acute or chronic injuries showed similar CM (acute: 85.3 ± 13.3; chronic: 85.5 ± 12.0; P = .98), ASES (acute: 94.3 ± 10.1; chronic: 93.5 ± 14.4; P = .69), and NC (acute: 85.6 ± 14.2; chronic: 86.8 ± 14.0; P = .68) scores. Furthermore, there was no difference in VAS score for pain (acute: 1.9 ± 1.1; chronic: 2.0 ± 1.6; P = .47) and postoperative subjective satisfaction with the cosmetic appearance of the ACJ ( P = .753). Five patients in the acute group and 2 patients in the chronic group experienced failure and underwent revision surgery (acute: 9.3%; chronic: 7.1%; P = .75). Conclusion: Patients who underwent ACJ stabilization using CC suspensory fixation with an additional AC cerclage for isolated type 5 ACJ injuries in the acute setting achieved similar midterm functional outcomes, satisfaction with the cosmetic appearance of the ACJ, and failure rates to those who underwent delayed surgery with additional biological augmentation using a gracilis autograft ≥3 weeks after injury.