Quantification of dynamic posterior translation in modified bilateral Alexander views and correlation with clinical and radiological parameters in patients with acute acromioclavicular joint instability

Introduction: Classification of AC-joint instability is based on radiologic evaluation of anteroposterior (a.p.) stress views of both shoulders, neglecting the horizontal component of instability. Recent studies have proposed an association of dynamic posterior translation (DPT) and inferior clinical results. The purpose of this study was to quantify DPT in modified Alexander views and correlate it with other radiological and clinical data.

Materials and methods: Thirty-two patients (4 f, 28 m, mean age 34.1) with acute AC-joint dislocation (16 = RW III, 16 = RW V) underwent radiological examination including bilateral a.p. stress views with measurement of the coracoclavicular distance (CCD) and bilateral modified Alexander views with different approaches to quantify DPT (overlapping area OA_AC, overlapping length OL_AC). In addition, the Constant Score, Subjective Shoulder Value, Taft Score (TF), and the Acromioclavicular Joint Instability Score (ACJI) were obtained.

Results: In Rockwood (RW) type III injuries, a mean CCD of 15.8 (9.8-22.8) mm, OA_AC of 50.9 (0-216.6) mm², and OL_AC of 6.5 (-4.7-17.9) mm were found. RW V patients showed a CCD of 23.1 (13.7-32.0) mm; OA_AC 7.0 (0-92.3) mm²; and OL_AC -4.8 (-19.6-9.8) mm. Particularly in RW III the CCD, OA_AC and OL_AC revealed significant correlation with the ACJI (r = -0.64/r = 0.72/r = 0.68, p < 0.05) and TF (r = -0.56/r = 0.68/r = 0.51, p < 0.05). The proposed quantification tools for DPT were found to have a moderate-to-strong correlation with the score results, especially with AC-joint specific scores. RW type V injuries had a moderate correlation with clinical parameters (OA_AC with ACJI: r = 0.44, p > 0.05 and OL_AC with TF: r = -0.45, p > 0.05).

Conclusions: Measuring the OL_AC is a convenient way for quantifying DPT in modified Alexander views. It showed significant correlation with clinical scores, indicating the relevance of DPT in patients with AC-joint injury.