Evolving concepts and consensus in challenging shoulder problems: a European perspective

Abstract

Acromioclavicular (AC) joint injuries are among the most common sports-related disorders of the shoulder, especially in young men [8], and in recent years scientific interest in them has grown rapidly. Increasing clarification of AC joint anatomy and function has led to the publication of a growing number of surgical techniques designed to address AC joint instability. At a certain point, however, the abundance of options seemed to be creating confusion and undermining efforts to unveil new science-based strategies. Despite the availability of multiple surgical options, there appeared to be doubts and uncertainties on how to correctly manage these injuries. We, therefore, felt that the time was ripe for a structured analysis of the field. This special issue of KSSTA contains a systematic review of all the available techniques for surgical treatment of acute and chronic AC joint dislocation [6, 7]. After reviewing more than 150 papers, the authors concluded that biological and synthetic reconstructions are the most suitable options in both acute and chronic settings. An open approach is probably still the most common, even though there is certainly a growing interest in arthroscopic AC joint reconstruction techniques among surgeons. Of the various surgical options, anatomical reconstructions showed the best functional performance in both settings. To avoid overlooking any step in the natural history of treated or untreated conditions of the AC joint, this special publication carefully considers issues related not only to AC joint instability, but also to osteoarthritis [9]. Nevertheless, systematic literature reviews only represented a solid foundation for a more ambitious plan. In October 2018, in Athens, the European Shoulder Associates (ESA), a special section of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA), held its first Closed Meeting. The focus of this successful event was the diagnosis and treatment of AC joint disorders. All the members of the international panel of experienced shoulder surgeons attending the meeting took part in the first round of a Consensus Project, which took four more rounds, held in the course of a year, to complete. The last round took place at the ESSKA Specialty Days Meeting in Madrid in November 2019. After carefully considering the experts’ opinions and literature findings, and considering in depth all the stages in the diagnostic-treatment algorithm, a final consensus was reached on the main and most controversial issues surrounding AC joint dislocation. A detailed description of the ESA-ESSKA Consensus Project on the AC joint and its outcomes can be found in this special issue [4]. In particular, the consensus document clearly states that a true anteroposterior view or a bilateral Zanca radiograph without loading of the arm is sufficient for correct diagnosis and classification of AC joint dislocation. Moreover, the Rockwood classification, as modified by the International Society of Arthroscopy, Knee Surgery and Orthopedic Sports Medicine (ISAKOS) statement, is still considered the most valid. Most important, a clear demarcation line between acute and chronic cases was consensually set at 3 weeks. From a surgical standpoint, anatomical reconstructions were confirmed to be the best option. * Giuseppe Milano [email protected]