Purpose

To synthesise the evidence on the prevalence of associated intraarticular lesions in subjects with acute acromioclavicular joint (ACJ) dislocations.

Methods

A search in two electronic databases (PUMBMED and EMBASE) was performed from 1985 to 2019. Two independent reviewers selected studies that complied with the following inclusion criteria: (1) the study included data on surgically treated ACJ dislocation grade III–V in the Rockwood classification, (2) the ACJ injuries were acute (the surgery was performed less than 6 weeks after injury), (3) an arthroscopic evaluation of the glenohumeral joint was performed during surgery. The quality of the studies included was assessed using the tool of the Joanna Briggs Institute.

Results

A total of 47 studies with acute ACJ injuries met the initial inclusion criteria. Of these, 21 studies (9 retrospective case series, 9 prospective case series and 3 retrospective cohort studies) presented data on associated intraarticular lesions amenable for use in the meta-analysis. The meta-analysed studies included a total of 860 subjects with acute ACJ dislocations with a male/female ratio of 6.5 and a mean age of 32 years. The meta-analysis showed a prevalence of associated intraarticular lesions in subjects with acute ACJ of 19.9% (95% confidence interval [CI] 14.0–26.4%; 21 studies, 860 analysed participants; P = 0.000; I²: 74.5% random-effects model; low risk of bias).

Conclusion

One in five subjects with surgically treated acute ACJ dislocations will have an associated intraarticular lesion that requires further intervention. The case for a customary arthroscopic evaluation of the joint, even when an open procedure is performed to deal with the ACJ dislocation, is strong.

Level of evidence IV

Trial registry Systematic review registration number: PROSPERO CRD42018090609.

目的

综合有关急性肩锁关节 (ACJ) 脱位受试者相关关节内病变患病率的证据。

方法

1985 年至 2019 年在两个电子数据库（PUMBMED 和 EMBASE）中进行了检索。两位独立评审员选择了符合以下纳入标准的研究：（1）该研究包含了 Rockwood 手术治疗的 III-V 级 ACJ 脱位的数据分类，(2) ACJ 损伤为急性（损伤后 6 周内进行手术），(3) 手术期间对盂肱关节进行关节镜评估。所纳入研究的质量是使用乔安娜·布里格斯研究所的工具进行评估的。

结果

共有 47 项急性 ACJ 损伤研究符合最初的纳入标准。其中，21 项研究（9 项回顾性病例系列、9 项前瞻性病例系列和 3 项回顾性队列研究）提供了适合用于荟萃分析的相关关节内病变的数据。荟萃分析研究共纳入 860 名急性 ACJ 脱位受试者，男女比例为 6.5，平均年龄 32 岁。荟萃分析显示，急性 ACJ 受试者中相关关节内病变的患病率为 19.9%（95% 置信区间 [CI] 14.0–26.4%；21 项研究，860 名分析参与者；P = 0.000；I 2 ：  74.5 %^随机-效应模型；低偏差风险）。

结论

五分之一的接受手术治疗的急性 ACJ 脱位患者会出现相关的关节内病变，需要进一步干预。即使进行开放手术来处理 ACJ 脱位，对关节进行常规关节镜评估的情况也是很充分的。

证据级别IV

试验登记系统审查登记号：PROSPERO CRD42018090609。