Hi everyone, I'm Ryan Paul, I'm a second year medical student at Hackensack Meridian, and I did two research years at Rothman Orthopedics. And I'll be presenting our study, acute versus chronic surgical treatment of high grade acromioclavicular joint injuries. Me and my co-authors have no disclosures to this talk. High grade AC joint lesions may produce long-term pain and dysfunction and are often repaired surgically. Possible benefits of performing this surgery early include decreased scar tissue and easier joint reduction. There have been several studies done that compare outcomes between acute versus chronic AC joint surgery. And these sample sizes were 22 versus 15, 29 versus 20, and another 29 versus 20. Because of these small sample sizes, we felt that a larger study was warranted. Therefore, the purpose of this study was to compare post-operative outcomes between patients who undergo high grade AC joint surgery acutely, less than six weeks, versus chronically greater than six weeks. And we hypothesized that patients who underwent AC joint surgery acutely would have better outcomes. This was a retrospective cohort study. We looked at patients who underwent primary AC joint surgery from 2010 to 2019. Grade three lesions were considered to be patients with horizontal instability with cross-body adduction as well as vertical displacement. And we only included patients with a minimum of two-year follow-up. We excluded patients with concomitant distal clavicle fracture, scapula fractures, and severe glenohumeral joint osteoarthritis. We performed retrospective chart review for the variables time from injury to surgery, Rockwood injury grade, and surgical technique. We assessed radiographs preoperatively, immediately post-op at two-week follow-up, and three-month follow-up as standard of care. And we calculated coracoclavicular distance with these measurements. We also evaluated revision rate, complication rate, ASCS scores, and SANE scores with red cap surveys sent at long-term follow-up. For statistical analysis, we split patients into an acute group and a chronic group based on the six-weeks cutoff. And we performed these same analyses after isolating grade three injuries and after isolating grade five injuries. And we performed two independent multivariate regressions, one for post-operative ASCS scores and one for SANE scores. We included 225 patients, 113 in the acute group, 112 in the chronic group, and we had statistically significant demographic differences in regards to age, BMI, injury grade, surgical technique, and preoperative CC distance. More specifically, the acute patients were younger, had a lower BMI, had a higher injury grade, were more likely to undergo repair, and had a higher preoperative coracoclavicular distance than patients in the chronic group. Here are the post-operative outcomes of these two groups with acute on the left and chronic on the right. There were significant differences in regards to post-operative SANE scores, post-operative loss of reduction, and overall improvement in coracoclavicular distance with the acute patients having better SANE scores, a lower post-operative loss of reduction, and a higher overall improvement in coracoclavicular distance compared to the chronic group. When isolating grade three injuries, the acute group still had higher post-operative SANE scores and had a lower post-operative loss of reduction than the chronic group. After isolating grade five injuries, the only statistically significant difference was in post-operative loss of reduction, which was lower in the acute group than the chronic group. In the multivariate regression analysis, the time from injury to repair was not statistically significant with a p-value of .563. However, female sex was statistically significant with a p-value of .039, finding that females had an ASCS score and long-term follow-up about eight points lower than males. And when performing that multivariate regression for post-operative SANE scores, there was no significant variables. Several significant limitations of this study need to be mentioned, such as the retrospective study design. This led to differences in surgical technique and a lack of standardization of the surgical techniques. The surgical technique of the acute versus chronic groups was up to surgeon discretion, and we included about 12 surgeons across our institution. There were significant demographic differences between these groups, and this is why we performed the multivariate analysis to hopefully control for those demographic differences a little better. And there was no long-term coracoclavicular distance measurements because we only looked at radiographs through standard of care. In conclusion, when controlling for confounding variables, there was no difference in functional or radiographic outcomes based on the timing of AC joint surgery. It's possible that patient and surgical factors and not the timing of surgery itself are the truly important variables. Thank you.

Ryan Paul

medical student

acute versus chronic surgical treatment

high grade acromioclavicular joint injuries

post-operative outcomes