Concomitant glenohumeral pathologies associated with acute and chronic grade III and grade V acromioclavicular joint injuries

Authors:

Gunnar Jensen & Peter J. Millett & Dimitri S. Tahal & Mireille Al Ibadi &
Helmut Lill & Jan Christoph Katthagen

Abstract:

Injuries of the acromioclavicular (AC) joint are among the most common injuries of the shoulder girdle with an estimated incidence of 1.8 per 1000 per year. The male-female ratio is as high as 8.5:1 and more than half of all AC joint injuries occur in individuals between the ages of 20 and 39 years, mainly during sport activities. Accordingly, 30% of all shoulder injuries in the NFL are AC joint injuries, with an incidence of 2.6/1000 athletes per year. AC joint injuries are typically classified according to Rockwood. More recently, the ISAKOS upper extremity committee introduced a new sub-classification of Rockwood grade III injuries into grade IIIA (horizontally stable) and IIIB (horizontally unstable). Present controversy concerning the treatment of Rockwood grade III injuries may possibly be solved with use of this sub-classification. Evidence in the literature suggests that Rockwood grades I, II, and IIIA injuries can usually be treated non-operatively whereas Rockwood grades IIIB, IV, V, and VI injuries are typically treated with surgical reconstruction.

Many authours classify the first 21 days after an AC joint injury as the acute injury phase, with symptoms persisting for more than three weeks being classified as chronic. If surgical treatment is performed acutely, some surgeons prefer AC joint stabilization without additional graft augmentation and, in such instances, rely on the healing of the original coracoclavicular (CC) and AC ligaments. While the use of an additional allo- or autograft augmentation is done by some for acute injuries graft use is clearly recommended for surgical stabilization performed more than three weeks after the injury (chronic AC joint injuries). Addressing both the CC and AC ligaments may be important to restore horizontal as well as vertical AC joint stability, independent of the duration between injury and surgical treatment.

The prevalence of concomitant glenohumeral pathologies (CGP) associated with surgically treated AC joint injuries has been described to lie somewhere between 15 and 43%, and several authors have emphasized glenohumeral arthroscopy prior to AC joint stabilization. Most studies with evaluation of CGP have focused on acute AC joint injuries, and some evidence suggests that concomitant lesions may be more common in higher grade injuries. Arrigoni found a significantly higher rate of CGP for older versus younger patients with the cutoff age arbitrarily set at 45 years. Furthermore, the authors observed more CGP in patients with chronic injuries (41%) compared to patients with acute injuries (23%) but this difference was not statistically significant. Despite these previous observations, the probability of missing a CGP if AC joint stabilization surgery is performed without glenohumeral arthroscopy remains unclear for individual patients.

The purpose of this study was to identify the risk of con-comitant glenohumeral pathologies with acromioclavicular joint injuries grade III and V. We hypothesized that CGP would be more common in patients with grade V injuries compared to patients with grade III injuries. It was furthermore hypothesized that CGP would be more common in patients with chronic versus acute AC joint injuries, and that the probability of CGP would be associated with increasing age.

For the complete study: Concomitant glenohumeral pathologies associated with acute and chronic grade III and grade V acromioclavicular joint injuries

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

Submit your review
Name:
Email:
Website:
Review Title:
Rating:	1 2 3 4 5
Review:

Check this box to confirm you are human.
Submit Cancel

Concomitant glenohumeral pathologies associated with acute and chronic grade III and grade V acromioclavicular joint injuries

Authors:

Abstract:

About the Author: Peter Millett, MD