Surgical Timing After Acromioclavicular Joint Separation: Association With Clinical Outcomes

Background: Treatment of acromioclavicular joint (ACJ) separations continually lacks consensus between providers, and while low-grade injuries generally respond well to conservative management, high-grade injury management is more complex. For patients requiring surgery, the effect of the timing of surgery with respect to the original injury on clinical outcomes remains unclear. Hypothesis: Clinical outcome measures would worsen as the time between ACJ dislocation injury and surgery increased. Study Design: Cohort study; Level of evidence, 3. Methods: A large nationwide insurance claims database was queried for patients who had an ACJ dislocation injury using International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and ICD-10) codes. Surgical management via ACJ repair or ACJ reconstruction was identified using Current Procedural Terminology codes 23550 and 23552, respectively. The time between the date of initial ACJ dislocation diagnosis and the date of surgery was used to separate patients into 4 temporal subgroups with the following parameters: 0 to 4 weeks, 4 weeks to 3 months, 3 months to 1 year, and after 1 year. Clinical outcomes—including complication rate, infection rate, and fracture rate—were compared between temporal and procedural subgroups. Outcomes were compared using chi-square tests. Results: A total of 13,194 patient met the inclusion criteria and were included in the study, of whom 8639 received surgical management of their ACJ dislocation within 4 weeks of initial injury diagnosis, 2210 between 4 weeks and 3 months, 1264 between 3 months and 1 year, and 1081 more than 1 year after injury diagnosis. The rate of all measured adverse clinical outcomes increased over time as surgical management was delayed in the ACJ repair subgroup, and the rates of revisions and complications increased over time as surgical management was delayed in the ACJ reconstruction subgroup. Conclusion: The rate of all measured adverse clinical outcomes increased over time as surgical management was delayed in the ACJ repair subgroup, and the rate of revisions and complications increased over time as surgical management was delayed in the ACJ reconstruction subgroup. Further research is needed to define the role of injury severity and classification in these outcomes and identify which patients would benefit from early surgical intervention.