Summary

High-grade acromioclavicular dislocation is a frequent injury in rugby players. Even though surgical treatment of Type IV and V, is the treatment of choice, we think that conservative treatment could be a reasonable option in this kind of collision athletes.

Abstract

Introduction

There is a consensus that surgical treatment is the treatment of choice of Type IV and V acromioclavicular dislocations (ACD). When it comes to the treatment of high-grade ACD in rugby players, however, we believe that this pathology could be handled from a different perspective, as return-to-play is these patients' main concern and aesthetic deformities do not usually present a problem for them. On the other hand, collision athletes are exposed to a high risk of recurrence.
The objective of this study is to report the long-term results of conservative treatment of grade IV and V acromioclavicular dislocation in a group of rugby players.

Methods

We retrospectively evaluated nonoperatively treated male rugby players with grade IV and V ACD at a minimum of a five-year follow-up. All patients were evaluated by the UCLA and Constant scores, and the visual analogue scale of pain (VAS) from 0 to 10, as well as the satisfaction degree from 0 to 10, were obtained. Return-to-sport time and whether the patient received local corticosteroids injections were also documented. Possible comorbidities such as pain for daily activities, cosmetic discomfort, mobility deficit, and any limitations concerning recreational sports activities were additionally recorded. A comparative Zanca view X-ray was performed for all patients.

Results

There were 87 patients, 72 ( 82,75%) with type V AC joint dislocation and 15 (17,25%) with type IV. The average age at the time of injury was 24.2 years (14 - 37) and the average follow-up time was 13.8 years (5 - 23). The return to sports time was 3,8 weeks (1 - 12), the average return-to-play time for the patients that received a cortisone injection was 2,1 weeks (1-9), whereas for the no injection group it was 4,9 weeks (2-12).
Of the 87 patients, 49 (56.32%) reported no pain for daily activities, 33 patients (37.5%) had some minor pain or discomfort, 5 patients (5.74%) continued to experience moderate pain, and no patients presented with severe pain. The visual analogue scale average was 2.2 points (0 - 5). Regarding aesthetic discomfort, only 4 patients (4.59%) experienced significant discomfort, 29 (33.33%) manifested less discomfort, and the remaining 54 patients (62%) did not present any aesthetic discomfort.
The result of the UCLA score was 31,3 points (28 - 35), Constant score average was 88,2 points (68-100) and the VAS was 2,2 (0 - 5),
The average separation in the Zanca View X-ray was 198% (106-309%). Only 3 patients (3,45%) underwent surgery in the chronic face due to bad results.
The degree of satisfaction was 7.8 points (5-10) and no patient regretted not undergoing surgery.

Conclusions

Rugby players with type IV and V ACD, have good long-term functional results with conservative treatment. We believe that it is an acceptable therapeutic option in this type of patients as it allows for an almost immediate return to play and, in case of failure, these patients can still undergo an anatomical reconstruction in a delayed form