Clinical and Patient-Reported Outcomes for Acute Acromioclavicular Joint Fixation are Similar With or Without Allograft Augmentation

PURPOSE: To compare functional outcomes, complications, and revision rates between allograft reconstruction and graftless fixation techniques for the treatment of Rockwood grades III-V acute acromioclavicular (AC) joint separation. METHODS: Patients who underwent graftless or allograft surgery acutely (≤6 weeks from injury) for Rockwood type III-V AC joint separations from 2012 to 2018 were retrospectively reviewed. Clinic notes and operative reports were identified to confirm the surgical technique and presence of complications including revision, infection, and fracture. In addition, postoperative radiographs were assessed to determine any instances of loss of adequate reduction, and several patient-reported outcomes were collected. RESULTS: In total, 115 patients (52 allograft, 63 graftless) were included in this study with a mean follow-up of 3.8 ± 2.5 years. There were no differences between allograft and graftless patients regarding rates of loss of reduction >5 mm (11.1% graftless vs 21.2% allograft), revision (3.2% vs 1.9%), infection (1.6% vs 3.9%), fracture (3.2% vs 7.7%), or total complication (7.9% vs 9.6%) rates (all P > .05). Patient-reported outcome measures also did not significantly differ between groups. Multivariate analysis found that increased time from injury to repair and increased Rockwood injury grade (grades IV and V) were associated with increased CC distance at postoperative follow-up (P = .008, .050, and .047, respectively). CONCLUSION: Multivariate analysis found that patients who underwent acute AC joint fixation without allograft augmentation had similar functional outcomes, complications, and revision rates compared with patients who underwent AC joint reconstruction with allograft. LEVEL OF EVIDENCE: Level III, retrospective comparative study.