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Clinical, Radiographic, and Return-to-Sport Outcomes After MINAR Reconstruction for Acute High-Grade Acromioclavicular Joint Separation in Recreational Football Players

Year: 2026

Type: article

Abstract: Background: High-grade acromioclavicular (AC) joint separations are clinically relevant injuries in contact sports, yet data specific to recreational football players remain limited. This study evaluated clinical recovery, maintenance of vertical coracoclavicular reduction, and return-to-sport outcomes after minimally invasive acromioclavicular reconstruction (MINAR) in recreational players with acute Rockwood type IV-V AC joint separation. Methods: This single-center retrospective analysis included 49 male recreational football players who sustained acute, isolated, unilateral Rockwood type IV or V acromioclavicular (AC) joint separation during football participation between January 2015 and December 2023. All patients underwent surgery within 7 days of injury using the same MINAR construct and implant platform, and all procedures were performed by the same experienced surgical team. Postoperative rehabilitation was supervised by the institutional physiotherapy department, generally three times weekly, with progression individualized according to clinical recovery. The primary outcome was the change in Constant score from preoperative assessment to 24 months. Secondary outcomes included Taft, American Shoulder and Elbow Surgeons (ASES), and visual analog scale (VAS) pain scores; minimal clinically important difference (MCID) achievement; coracoclavicular (CC) distance; return to unrestricted match play; return to preinjury football level; and exploratory comparisons according to vertical reduction status. Coracoclavicular distance was measured independently by three blinded observers, and the mean of the three measurements was used for the radiographic analyses. Radiographic loss of vertical reduction was defined a priori as a 24-month injured-to-contralateral CCD ratio greater than 1.50. Because only five patients met this criterion, comparisons according to vertical reduction status were considered exploratory and descriptive. Results: The mean age was 35.1 ± 6.2 years, the mean body mass index was 27.9 ± 5.2 kg/m2, and the mean follow-up was 48.6 ± 14.5 months. Forty-one patients had Rockwood type V injuries and eight had type IV injuries. All clinical scales improved over time (Friedman p < 0.001). The Constant score increased from 29.9 ± 6.0 preoperatively to 94.5 ± 3.8 at 24 months. Mean preoperative-to-24-month improvements were 64.6 points in Constant score, 6.11 points in Taft score, and 43.3 points in ASES score, while VAS pain decreased by 6.50 points. All 49 patients exceeded the prespecified Constant-score MCID threshold, and 47 of 49 patients (95.9%) exceeded the Taft-score MCID threshold. Return to unrestricted match play occurred in all patients at a mean of 239.9 ± 43.5 days, and 44 patients (89.8%) returned to their preinjury match level. Five patients met the radiographic criterion for loss of vertical reduction (10.2%; 95% CI, 4.4–21.8). In exploratory unadjusted comparisons, these five patients returned to unrestricted match play later than patients who maintained vertical reduction (332.4 ± 35.6 vs. 229.4 ± 29.8 days; unadjusted mean difference, 103.0 days; 95% CI, 59.5–146.5), and none returned to the preinjury football level (0/5 vs. 44/44). These sparse subgroup comparisons were interpreted descriptively. Conclusions: In this cohort of male recreational football players with acute Rockwood type IV-V acromioclavicular joint separation, MINAR reconstruction was followed by substantial improvement in shoulder function, minimal residual pain, and a high rate of return to football. Maintenance of vertical reduction and return-to-sport outcomes showed a clinically notable pattern in exploratory unadjusted analyses; however, the reduction-loss subgroup comprised only five patients, and patient-level chronology did not uniformly support a temporal pathway from reduction loss to delayed return. These findings should therefore be regarded as hypothesis-generating rather than predictive or causal.

Source: Journal of Clinical Medicine

DOI: 10.3390/jcm15207907