Structural Failure After Acromioclavicular Joint Reconstruction: Factors Affecting Clinical Outcomes

Sep 30, 2026

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Structural Failure After Acromioclavicular Joint Reconstruction: Factors Affecting Clinical Outcomes investigates why some patients develop structural failure after AC joint reconstruction and how this relates to clinical results. The study examines loss of coronal AC reduction, subsidence of the reconstruction, and defines suboptimal outcomes as revision surgery or an ASES score below 80. Among 29 patients followed for 7.4 years, 21% required revision.

LanguageEnglish

CategoryHealthcare

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Pages9

Reading Time23 min

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RESEARCH ARTICLE Structural Failure After Acromioclavicular Joint Reconstruction: Factors Affecting Clinical Outcomes Benjamin Read Campbell, MD; Omar Sarhan, BS; Ryan Lopez, MD; Hamd Mahmood, MD; Cassandra Sanko, MD; Surena Namdari, MD Research performed at Rothman Orthopaedic Institute at Thomas Jefferson University, Department of Orthopaedic Surgery, Philadelphia, PA, USA Received: 8 July 2025 Accepted: 3 September 2025 Abstract Objectives: Management of acromioclavicular (AC) joint injuries remains controversial regarding ideal surgical indications and technique. While loss of reduction following AC reconstruction is common, its relationship to clinical outcomes is uncertain. The purpose of this study was to evaluate outcomes and potential predictors of suboptimal results in patients with structural failure following AC reconstruction. 50% loss of coronal AC joint reduction between immediate and final postoperative radiographs. Failures were subsidence of AC reduction. Suboptimal clinical outcomes were defined as undergoing reoperation or postoperative American Shoulder and Elbow Surgeons (ASES) score less than 80. Bivariate analyses were performed to identify management of structural failure. Results: Twenty-nine patients were evaluated with mean follow-up of 7.4 years (range 4.0-10.5 years) . 21% underwent revision surgery (n = 6) and 79% were treated nonoperatively (n = 23) . Mean postoperative ASES, Numerical Rating Scale (NRS), and Single Assessment Numeric Evaluation (SANE) scores at final follow-up were 82 +/ -20 (range 33-100), 1.6 +/ -2.2 (range 0-7), and 82 +/ -20 (range 22-100) respectively. 41% of the total cohort (n = 12) had a suboptimal clinical result. On bivariate analysis, structural failure following acute reinjury was associated with suboptimal clinical outcomes (50% vs 6%, p = 0.011) and a higher likelihood of reoperation (67% vs 13%, p = 0.018) . Conclusion: Structural failures of AC reconstruction following an acute injury are more likely to experience suboptimal clinical outcomes and undergo reoperation compared to spontaneous loss of reduction. Larger analyses are warranted to determine if there are additional factors which may affect outcomes and guide management in these clinical scenarios. Level of evidence: IV Keywords: AC joint , Acromioclavicular injury , Acromioclavicular reconstruction , Coracoclavicular reconstruction , Loss of reduction , Radiographic failure , Structural failure Methods: Patients with structural failure following AC reconstruction from 2013-2019 were identified, defined as categorized by degree of displacement and mechanism, which included traumatic reinjury versus spontaneous risk factors for suboptimal clinical results and compare outcomes between operative versus nonoperative Introduction A cromioclavicular (AC) joint to 12% of all shoulder injuries account for up injuries.1 Traumatic dislocation of the AC joint alters the biomechanics of the shoulder girdle and can lead to discomfort, functional limitations, and dissatisfaction with the associated deformity that leads many patients to consider surgical options. Surgical intervention of these injuries remains controversial, and there is currently no established consensus regarding the ideal technique or indications. Since its inception in the early 1900s, numerous techniques for stabilization of AC injuries have been described which vary widely in their utilization of implants and methods of fixation.2,3 Regarding indications for surgery, reconstruction is often considered in Rockwood Type III- VI injuries which involve compromise of both the AC and coracoclavicular (CC) ligaments.4 However, some prior randomized controlled trials and systematic reviews have reported minimal clinical difference between operative and nonoperative treatment of these injuries, even some studies including Type V injuries, which has made the optimal management strategy unclear.5-9 Des

FAQs

How does the study define structural failure and suboptimal clinical outcomes?

Structural failure is assessed through loss of coronal AC joint reduction between immediate and final postoperative radiographs, including subsidence of AC reduction. Suboptimal outcomes are defined as undergoing reoperation or having an ASES score below 80.

What were the main findings regarding revision surgery and clinical scores?

In 29 evaluated patients with a mean follow-up of 7.4 years, 21% underwent revision surgery and 41% had suboptimal clinical results. Final ASES, NRS, and SANE scores averaged about 82, 1.6, and 82 respectively.

Which factor was associated with worse outcomes after structural failure?

On bivariate analysis, structural failure following acute reinjury was associated with suboptimal clinical outcomes (50% vs 6%, p = 0.011) and a higher likelihood of reoperation (67% vs 13%, p = 0.018).

What conclusion does the study draw about acute reinjury versus spontaneous loss of reduction?

Structural failures after an acute injury were more likely to lead to suboptimal clinical outcomes and reoperation compared with spontaneous loss of reduction, supporting the need for larger analyses to identify additional predictors.

Sep 30, 2026

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