UTHealth Study Could Set New Standards for Treating Acromioclavicular Joint Injuries in Athletes

A new UTHealth Houston study focused on finding the best surgical technique for reconstruction of the acromioclavicular joint (ACJ), where the collarbone meets the shoulder blade, has the potential to enhance recovery and long-term shoulder health for young athletes.

Funded by a $3.5 million grant from the National Institutes of Health, researchers from the Department of Orthopedic Surgery at McGovern Medical School at UTHealth Houston, in collaboration with the Steadman Philippon Research Institute in Vail, Colorado, are working to establish a standardized approach for ACJ reconstruction. The joint is particularly vulnerable in young athletes engaged in contact sports such as football and hockey.

Currently, there is no standardized approach to treating ACJ injuries, which makes it challenging to determine the best method to repair an ACJ injury and position patients for successful, long-term outcomes. If left untreated, these injuries can lead to chronic pain, decreased mobility, and other complications, underscoring the need for an established treatment protocol."

Payam Zandiyeh, PhD, assistant professor in the Department of Orthopedic Surgery and lead investigator on the project

The study, titled "Multicenter, Longitudinal Study of Acromioclavicular Joint Reconstruction Techniques for Restoring Shoulder Complex Biomechanics and Soft Tissue Health," is the first of its kind to compare multiple surgical methods for ACJ reconstruction. Specifically, the study will evaluate three ACJ reconstruction techniques:

• Coracoclavicular (CC) ligament reconstruction alone, which stabilizes the joint vertically but does not address horizontal instability, potentially leaving the joint biomechanically vulnerable.

• Combined ACJ and CC reconstruction with bone tunnels, which enhances both vertical and horizontal stability by reconstructing the AC and CC ligaments using grafts or sutures passed through drilled bone tunnels in the clavicle and coracoid. While anatomically accurate, this method carries risks of fractures due to stress on the bone tunnels, requiring careful surgical technique and postoperative care.

• Combined ACJ and CC reconstruction without bone tunnels, which is a newer, tunnel-free technique designed to reduce fracture risks while maintaining joint stability. However, its long-term effectiveness in preserving joint function is not yet fully understood.

The study aims to identify the most effective technique for restoring stability, minimizing complications, and improving long-term outcomes, particularly for young athletes prone to ACJ injuries.

The study is built on the collaborative expertise of a multidisciplinary team. James Gregory, MD, associate professor in the Department of Orthopedic Surgery and a leading orthopedic surgeon on the project, played a pivotal role in shaping the study's surgical protocols and ensuring their practical application for patient care.

"Dr. Gregory's extensive surgical expertise is at the heart of this research," Zandiyeh said. "His insight into the complexities of ACJ injuries and reconstruction techniques ensures that our work is both clinically relevant and impactful for the patients we aim to serve."

The study also includes Manickam Nicks Kumaravel, MD, professor and Memorial Hermann Chair in the Department of Diagnostic and Interventional Imaging at McGovern Medical School, who will provide imaging diagnostics expertise for the study. Michael Jacobs, PhD, professor and Chair in Biomedical Engineering in the Department of Diagnostic and Interventional Imaging, contributed to the study's state-of-the-art magnetic resonance imaging (MRI) sequence design and analysis. Dejian Lai, PhD, professor of biostatistics and data science at UTHealth Houston School of Public Health, contributed to the study's advanced biostatistical and data science analyses.

The study uses state-of-the-art imaging technologies, including dynamic stereo X-ray, which provides real-time 3D imaging of joint movement, and MRI, offering detailed analysis of soft tissue health and shoulder function. Recovery progress will be monitored at six- and 12-months post-surgery.

In addition to imaging, researchers will incorporate patient-reported outcomes and surveys to evaluate the impact of surgical techniques on mobility, stability, and overall recovery from the patients' perspective.

"This multifaceted approach allows us to gain a comprehensive understanding of how different procedures influence recovery," Zandiyeh said. "By combining advanced imaging with patient feedback, we can identify the techniques that offer the best outcomes for long-term shoulder health."

The study's findings are expected to guide the development of evidence-based treatment protocols, helping physicians select the most effective surgical methods tailored to each patient's needs.

"This research has the potential to establish a gold-star standard of treatment for ACJ injuries," Zandiyeh said. "By providing physicians with evidence-based surgical options, we hope to help young athletes return to sports with a positive prognosis for long-term shoulder health."

The grant was awarded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases, part of the NIH (R01AR083471).