title: Prognostic factors to succeed in surgical treatment of chronic acromioclavicular dislocations.
abstract: BACKGROUND
  Treatment of chronic acromioclavicular joint dislocation (ACJD) remains a poorly known and controversial subject. Given the many surgical options, it is not always easy to determine which steps are indispensable.
  
  
  METHODS
  This article reports a multicenter prospective study. The clinical and radiological follow-up involved a comparative analysis of the preoperative and postoperative data at 1 year, including pain (visual analogue scale), subjective functional incapacity (QuickDASH), and the objective Constant score, as well as a comparative analysis of vertical and horizontal movements measured on simple x-rays.
  
  
  RESULTS
  Based on a series of 140 operated ACJDs, we included 24 chronic ACJDs. The mean time to surgery was 46 weeks (range, 1 month to 4 years). The patients' mean age was 41 years, with a majority of males (75%), 72% of whom participated in recreational sports. Professionally, 40% of the subjects had jobs involving manual labor. We noted 40% grade III, 24% grade IV, and 36% grade V injury according to the Rockwood classification. In 92% of cases, coracoclavicular stabilization was provided by a double button implant, reinforced with a biological graft in 88% of the cases. In 29%, millimeters to centimeters of the distal clavicle were resected and acromioclavicular stabilization was associated in 54%. We observed complications in 33% of the cases. At 1 year postoperative, 21 patients underwent clinical and radiological follow-up (87.5%). Only 35% of the patients were satisfied or very satisfied, whereas 100% of them would recommend the operation. Full-time work was resumed in 91% of the cases and all sports could be resumed in 86%. The pre- and postoperative values at 1 year changed as follows: the mean Constant score improved from 61 to 87 (p=0.00002); the subjective QuickDASH score decreased from 41 to 9 (p=0.00002); and radiologically significant reduction of the initial displacement was observed in the vertical plane (p<10(-3)) and the horizontal plane (p=0.022).
  
  
  CONCLUSIONS
  In this study, the favorable prognostic factors found were: time to surgery less than 3 months (p=0.02), associated acromioclavicular stabilization, and postoperative immobilization with a sling extended to 6 weeks. However, resection of the distal clavicle did not influence the final result.
  
  
  METHODS
  Level II prospective non-randomized comparative study.
authors.affiliation: Centre ostéo-articulaire des Cèdres, parc Sud Galaxie, 5, rue des Tropiques, 38130 Échirolles, France. Electronic address: jrhbarth@yahoo.fr.
authors.forename: J
authors.initials: J
authors.lastname: Barth
authors.affiliation: CHU de Rouen, 76000 Rouen, France.
authors.forename: F
authors.initials: F
authors.lastname: Duparc
authors.affiliation: Centre ostéo-articulaire des Cèdres, parc Sud Galaxie, 5, rue des Tropiques, 38130 Échirolles, France.
authors.forename: L
authors.initials: L
authors.lastname: Baverel
authors.affiliation: Clinique générale, 74000 Annecy, France.
authors.forename: J
authors.initials: J
authors.lastname: Bahurel
authors.affiliation: Clinique générale, 74000 Annecy, France.
authors.forename: B
authors.initials: B
authors.lastname: Toussaint
authors.affiliation: CHU de Rouen, 76000 Rouen, France.
authors.forename: S
authors.initials: S
authors.lastname: Bertiaux
authors.affiliation: Service de chirurgie de l'épaule et du coude, CCOM, CHRU de Strasbourg, 67000 Strasbourg, France.
authors.forename: P
authors.initials: P
authors.lastname: Clavert
authors.affiliation: Hôpital Pasteur 2, institut universitaire de l'appareil locomoteur et du sport, CHU de Nice, 30, voie Romaine, CS51069, 06001 Nice cedex 1, France.
authors.forename: O
authors.initials: O
authors.lastname: Gastaud
authors.affiliation: Clinique de Cagne-sur-Mer, 06800 Cagne-sur-Mer, France.
authors.forename: N
authors.initials: N
authors.lastname: Brassart
authors.affiliation: Centre hospitalier régional de Chambéry, 73000 Chambéry, France.
authors.forename: E
authors.initials: E
authors.lastname: Beaudouin
authors.affiliation: Médipôle de Savoie, 73000 Chambéry, France.
authors.forename: P
authors.initials: P
authors.lastname: De Mourgues
authors.affiliation: Clinique Kennedy, 26200 Montélimar, France.
authors.forename: D
authors.initials: D
authors.lastname: Berne
authors.affiliation: Médipôle Garonne, 31000 Toulouse, France.
authors.forename: M
authors.initials: M
authors.lastname: Duport
authors.affiliation: CHU de Rennes, 35000 Rennes, France.
authors.forename: N
authors.initials: N
authors.lastname: Najihi
authors.affiliation: Hôpital universitaire Xavier-Bichat, 75018 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Boyer
authors.affiliation: Hôpital universitaire Ambroise-Paré, 92100 Boulogne-Billancourt, France.
authors.forename: B
authors.initials: B
authors.lastname: Faivre
authors.affiliation: CMC Paris V, 75005 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Meyer
authors.affiliation: Chirurgie de l'épaule Groupe Maussins, 67, rue de Romainville, 75019 Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Nourissat
authors.affiliation: Polyclinique du Plateau, 21, rue de Sartrouville, 95870 Bezons, France.
authors.forename: S
authors.initials: S
authors.lastname: Poulain
authors.affiliation: Hôpital privé de l'Ouest Parisien, 78190 Trappes, France.
authors.forename: F
authors.initials: F
authors.lastname: Bruchou
authors.affiliation: Unité biostatistique du CHU de Rouen, Rouen, France.
authors.forename: J F
authors.initials: JF
authors.lastname: Ménard
mesh_terms: D000173:Acromioclavicular Joint / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D000328:Adult; D002908:Chronic Disease; D002968:Clavicle / Q000601:surgery; D005260:Female; D006801:Humans; D016268:Internal Fixators; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D011859:Radiography; D000068958:Return to Sport; D062707:Return to Work; D020069:Shoulder Pain / Q000209:etiology; D061665:Time-to-Treatment; D055815:Young Adult
keywords: Chronic acromioclavicular dislocation; Prognostic factors; Surgical treatment