​Primerjava rezultatov pri zdravljenju poškodovancev z različnimi načini kirurške stabilizacije ključnice pri akromioklavikularni sindezmolizi

Ambrožič, Miha (author), Cimerman, Matej (mentor), Kralj Iglič, Veronika (comentor)

Izhodišče: Optimalno kirurško zdravljenje visoke stopnje AC sindezmolize še vedno ni uniformno in novi načini učvrstitve se še naprej razvijajo. V zadnjih letih se poudarja pomemben vpliv zaostale horizontalne nestabilnosti, ki naj bi bila razlog za slabše klinične rezultate. Biomehanske raziskave in računalniške simulacije so pokazale, da lahko dodatna povezava preko AC sklepa pomembno izboljša stabilnost sklepa. S to raziskavo smo želeli prospektivno ugotoviti, ali dodatna stabilizacija z AC augmentacijo pripomore k pomembno boljšim kliničnim in radiološkim rezultatom. Zasnova raziskave in metode: V raziskavo smo vključili 70 pacientov s povprečno (± SD) starostjo 42 ± 11 let, ki so utrpeli akutno AC sindezmolizo višje stopnje – III b ali V po Rockwoodu. Randomizirali smo jih v dve enakomerni skupini. Pri vseh pacientih smo opravili artroskopsko asistirano stabilizacijo AC sklepa, kjer smo uporabili dva suspenzijska sistema v korakoklavikularnem predelu. Pri skupini N (Ni traku) dodatne povezave preko AC sklepa nismo napravili, pri skupini T (augmentacija s Trakom) pa smo AC sklep še dodatno učvrstili z močnejšim neresorbilnim trakom. Paciente smo pregledali 3, 6 in 12 mesecev po operaciji. Pacienti so izpolnili vprašalnike, opravili smo funkcionalne točkovnike; primarna klinična točkovnika sta bila Constant–Murley točkovnik in SACS (Specific AC Score) točkovnik, sekundarni pa Subjective Shoulder Value (SSV), Simple Shoulder Test (SST), Disabilities of the Arm, Shoulder, and Hand (DASH) vprašalnik, in AC Joint Instability (ACJI) točkovnik. Ob pregledu smo naredili rentgenske slike in izmerili vrednosti za oceno horizontalne stabilnosti – overlapping length (OL) in overlapping area (OA) – ter CC razdaljo za oceno vertikalne stabilnosti. Vse izmerjene vrednosti smo primerjali z nepoškodovano stranjo in izrazili v odstotkih kot relativne vrednosti. Rezultati: Po enem letu sledenja ni bilo statistično pomembnih razlik v primarnih točkovnikih Constant–Murley (p = 0.664) in SACS (p = 0.518) ali v sekundarnih kliničnih točkovnikih. Med skupinama prav tako ni bilo statistično značilnih razlik v bolečini ali moči po enem letu (p = 0.664 in p = 0.217). Klinično testiranje horizontalne stabilnosti s posteriornim predalčnim testom je pokazalo tendenco k boljši stabilnosti v skupini T, p vrednost pa je bila statistično mejno neznačilna (p = 0.061). Radiološki rezultati so prikazali boljšo vertikalno stabilnost z manjšo izgubo repozicije v CC razdalji za skupino T pri 6 in 12 mesecih (p = 0.047 in p = 0.046). Dodatno je testiranje z dvosmernim ANOVA testom pokazalo statistično značilno manjšo razliko v CC razdalji za skupino T (p = 0.032), vendar je bilo postopno večanje CC razdalje podobno za obe skupini tekom časa sledenja (p = 0.869). V merjenju OL in OA ni bilo pomembnih razlik med skupinama (p = 0.619 in p = 0.236). Zaključki: Rezultati naše študije kažejo, da sta oba načina učvrstitve – samo stabilizacija CC predela z dvojnim suspenzijskim sistemom kot tudi stabilizacija CC predela z dodatno AC fiksacijo – učinkoviti kirurški metodi zdravljenja akutnih izpahov AC sklepa z dobrimi rezultati, brez pomembnih razlik v funkcionalnih točkovnikih. Razdalja CC se je v enem letu v obeh skupinah podobno večala, vendar je bila bolje ohranjena v skupini z AC augmentacijo, ki je kazala tudi klinično tendenco k bolj stabilni učvrstitvi. Zaradi tega AC augmentacijo v večini primerov priporočamo.

• Language: Slovenian
• Keywords: akromioklavikularna sindezmoliza, horizontalna nestabilnost akromioklavikularnega sklepa, korakoklavikularna razdalja, overlapping length (OL) in overlapping area (OA), artroskopsko-asistirana operacija
• Work type: Doctoral dissertation
• Organization: MF - Faculty of Medicine
• Year: 2026
• PID: 20.500.12556/RUL-189840
• Publication date in RUL: 17.10.2026

Secondary language

• Language: English
• Title: Outcome comparison between different types of surgical clavicle stabilisation after acromioclavicular syndesmolysis

Abstract

Background: Optimal surgical treatment for high-grade acromioclavicular (AC) joint dislocations is still not unanimous. Improving horizontal AC stability has been emphasized in recent years. Biomechanical studies and computer simulations have demonstrated that adequate horizontal stability could be restored with an additional AC fixation. We aim to prospectively investigate if AC augmentation leads to better clinical and radiological results. Methods: A total of 70 patients with a mean (± SD) age of 42 ± 11 years with acute AC joint dislocation Rockwood type IIIb and V were prospectively randomized into two equal groups. All patients underwent arthroscopically assisted stabilization using a double coracoclavicular (CC) suspensory system. Group N (No-augmentation group) had no additional fixation across the AC joint, while group T (tape-augmentation group) had additional fixation with tape. Patients were evaluated at 3, 6, and 12 months postoperatively. Primary clinical outcome measures included the Constant–Murley score and the Specific AC Score (SACS). Secondary outcome measures included the Subjective Shoulder Value (SSV), the Simple Shoulder Test (SST), the Disabilities of the Arm, Shoulder, and Hand (DASH) outcome measure, and the AC Joint Instability (ACJI) Score. Horizontal stability was radiologically measured with overlapping length (OL) and overlapping area (OA). Vertical alignment was measured with the CC distance. All radiological measurements were compared to the uninjured side and expressed in percentages as relative values. Results: There were no significant differences found between groups regarding the Constant score (p = 0.664), SACS (p = 0.518), or any other outcome measure at the one-year follow-up. Pain level (p = 0.635) and strength (p = 0.217) at the one-year mark also showed no significant differences. Clinical drawer testing for residual horizontal instability was non-significant (p = 0.061), but showed a tendency for a more stable AC joint in group T. The CC distance was smaller in group T at 6 and 12 months (p = 0.047 and p = 0.046, respectively). A two-way mixed factorial ANOVA test showed significantly lower CC differences for group T (p = 0.032); however, the gradual increase in CC distance was similar for both groups over time (p = 0.869). No significant differences were found in OL (p = 0.619) or OA (p = 0.236). Conclusions: The results of our study show that both CC stabilization with the double suspensory system alone and with additional AC fixation are effective surgical treatment options for acute AC joint dislocations, without any important clinical differences. CC distance similarly increased over one year in both groups but was better retained in the AC-augmented group, which showed a tendency toward a more stable fixation.

• Keywords: acromioclavicular joint dislocation, horizontal acormioclavicular instability, acromioclavicular augmentation, overlapping length (OL), overlapping area (OA), coracoclavicular distance, arthroscopic assisted surgery