Work

Clinical Outcomes and Functional Evaluation of Autologous Tendon Grafting for Acromioclavicular Joint Reconstruction

Year: 2025

Type: article

Abstract: AIM: To evaluate the clinical efficacy and functional outcomes of autologous tendon grafting in reconstructing Rockwood type III-V acromioclavicular (AC) joint dislocations, and to compare its performance with conventional titanium fixation. METHODS: A total of 276 patients who underwent AC joint reconstruction between January 2019 and March 2024 were retrospectively analyzed. Following propensity score matching (PSM), 87 patients were included in the autologous tendon and titanium fixation groups. Primary outcome measures comprised radiographic parameters (acromioclavicular distance [ACD], coracoclavicular distance [CCD], magnetic resonance imaging [MRI] signal intensity), functional scores (Constant-Murley, University of California at Los Angeles [UCLA] shoulder score, visual analog scale [VAS]), biomechanical indices (horizontal motion displacement [HMD], range of motion [ROM] loss ratio, CCD maintenance rate), and complication rates. Prognostic factors were identified using Cox proportional hazards and logistic regression models. An extreme gradient boosting (XGBoost)-based machine learning model was constructed to predict postoperative functional recovery. RESULTS: After matching, no significant differences in baseline characteristics were observed between groups (n = 87 each). Compared with the titanium group, autologous tendon grafting achieved significantly superior joint stability (ACD, CCD, HMD, ROM loss) and radiological outcomes (tendon signal intensity, bone remodeling score) (all p < 0.01). It was also associated with a lower incidence of redislocation and implant-related failures (p < 0.05). Cox regression identified four independent prognostic factors, including surgical technique, Rockwood classification, preoperative CCD, and ROM limitation. A multivariable risk scoring system demonstrated high predictive accuracy for recurrence at 12 months (area under the curve [AUC] = 0.91). Logistic regression revealed that titanium fixation, Rockwood type V, older age, and impaired bone healing capacity were significant risk factors for complications. The XGBoost model highlighted surgical technique and tissue quality as key predictors of functional recovery, though its external generalizability warrants further validation. CONCLUSIONS: Compared to conventional titanium-based fixation, autologous tendon graft reconstruction yields superior joint stability, improved radiographic outcomes, and better functional scores within 12 months postoperatively, suggesting more favorable early clinical efficacy and biomechanical restoration.

Source: Annali Italiani di Chirurgia

DOI: 10.62713/aic.4244