# Evolution and trends in the management of acromioclavicular joint dislocations: an epidemiological analysis from Germany between 2013 and 2023

## TL;DR

This study shows that in Germany, arthroscopic surgery for shoulder joint dislocations has become more common than traditional open methods, especially among younger patients, over the past decade.

## Contribution

The study provides a nationwide epidemiological analysis of surgical trends for acromioclavicular joint dislocations in Germany from 2013 to 2023.

## Key findings

- Arthroscopically assisted stabilization increased from 19.6% in 2013 to 37.5% in 2023.
- Open surgical techniques significantly declined over the study period.
- ACJD incidence was 8.2 times higher in men than women.

## Abstract

This study aims to analyze nationwide trends in the management of hospitalized patients with acromioclavicular joint dislocations (ACJDs) in Germany over the past decade, focusing on surgical procedures and demographic patient data. The investigation examines the shift from conventional open stabilization techniques to mini-open and arthroscopically assisted approaches.

Hospital billing data from the Federal Statistical Office of Germany (2013-2023) were analyzed, including patients diagnosed with ACJD (International Classification of Diseases-10: primary diagnosis International Classification of Diseases S43.1) who underwent surgical reconstruction of the ACJD (German Operation and Procedure Classification System codes: 5-814b, 5-807.4, 5-807.5, 5-807.6, 5-930.0, 5-852.f, and 5-852.f8). Data included year of diagnosis, patient sex, surgical codes, and age (grouped in 5-year intervals). Data processing used R software for transformation and Tableau Desktop for subgroup analyses, stratified by type of procedure type, sex, and age. Statistical analyses, including linear regression and chi-squared tests, were conducted using GraphPad Prism (GraphPad Software, Inc., San Diego, CA, USA). Statistical significance was set at P ≤ .05.

From 2013 to 2023, 82,254 patients were hospitalized and surgically treated for ACJD in Germany, indicating a decline in inpatient surgical management (P < .05). This reduction primarily reflects a decrease in the number of inpatient procedures rather than changes in hospitalization duration or a shift toward outpatient surgery. Arthroscopically assisted stabilization increased from 19.6% in 2013 to 37.5% in 2023, becoming the most common surgical technique, while open techniques, such as plate stabilization and screw or Kirschner wire fixation, significantly decreased (P < .05). Tendon augmentation procedures showed a notable rise despite their rarity (P < .005). Arthroscopic techniques were predominantly used in younger patients (mean age: 39.6 years), while open reduction with plates was the most commonly used method in the age group over 60 years (P < .05). ACJD incidence was 8.2 times higher in men than women, with significant male dominance across all surgical techniques (P < .05).

Over the past decade, the management of ACJD s in Germany has shifted toward arthroscopically assisted stabilization, particularly in younger patients, while traditional open techniques have declined. Numbers of hospitalized treated cases have decreased, with a strong male predominance and age-related preferences influencing surgical approaches.