ACJ Injury Project

Project title – A prospective-multi centre observational cohort evaluation to evaluate frequency, management and outcomes of severe Acromioclavicular Joint Injuries (Grade III and above) in the UK.

Project lead and main contributors –  Helen Ingoe, Paul Cowling, Phil Holland, Lucksy Kottam, Prof Rangan

Aim –  What are the frequency, severity, management and outcomes following acute severe acromioclavicular injuries (Grade III and above).

Method – Study design
Prospective cohort evaluation

We propose that all new presentations of ACJ injuries (grade 3 and above) to new patient fracture clinics will be entered into the study.   Basic patient demographics including occupation, handedness and age will be taken at the initial clinic visit.   The treatment given will also be documented.
Patients will then be followed up at 6 months and 1 year following presentation, and outcome measures performed: Oxford Shoulder Score, a Euroqol EQ-5D5L & Nottingham clavicle score will be assessed. Patients will also be asked when they returned to work and other recreational activities e.g. contact sports. Data will be collected on any change in treatment management from the initial visit, and reasons collected. (e.g. initially conservative management was instigated, but subsequently the patient underwent surgery). The timing of surgery, as well as the type of surgery, and any complications will also be collected using the follow up form.

All above outcomes will be recorded in the fracture clinic at initial presentation and 6 months & 1 year from the injury (postal/telephone). Demographic data will also be recorded using the data collection sheets at all above time points (Baseline Form on initial presentation, 6 month follow up form and 1 year follow up form). Follow up forms will collect information about any delayed surgical interventions or any change in treatment plan from baseline that may have occurred, and record the details including any complications. Data will be collected by RedCAP software

This is an observational study. The treatment decision is made by the treating clinician as deemed appropriate. Study forms will record the patient as receiving “non-operative” or “operative treatment” and collect further details including reason for treatment decision.

All new ACJ injuries – Grade III and above presented with localised pain and tenderness over the ACJ with clinically and radiologically confirmed ACJ disruption will be considered for inclusion.
ACJ injury grade will be defined as per Rockwood’s classification

Inclusion criteria
Over 18 years of age
ACJ injury Grade III or above as defined
Previous normal function of both shoulders
Able to comply with 1 year follow-up

Exclusion criteria
Concurrent limb injury
Associated shoulder girdle fracture
Dislocation of the glenohumeral joint
Concurrent nerve injury
Lack of mental capacity
Unable to answer questionnaires in English

We plan to collect data from up to 50 new referrals to the fracture clinic with the above injury.

A descriptive analysis of the types of injuries, patient demographics and treatments offered will be undertaken and predictors of outcome will be drawn from this information. Differences between groups, surgical and non-surgical treatment at 6 months and 1 years will be analysed with adjustments made for baseline data such as grade of injury, age and gender. A multi-variable analysis

Participating centres –  All hospitals with trainees expected to participate

Project progress/outcomes –  Secured £5000 pump priming grant.

All forms are ready for submission. Awaiting Prof Rangan sign off.
Currently awaiting the okay from RedCap to use their software. Will be registering as service evaluation in South Tees in January and hoping to enlist recruiters to start at other sites from February changeover.

Ongoing project/requirements –  Volunteers to be site leads in each hospital to register as service evaluation in each hospital and be responsible for patients being enrolled into study.

If you want to help, contact Helen –