Treatment of grade III acromioclavicular joint injuries: a systematic review

Although nonoperative treatment is considered the standard of care for the treatment of Grade I and II acromioclavicular (AC) joint injuries, the treatment of Grade III injuries is controversial. There are as many methods of nonoperative treatment as there are for operative stabilization. Most of the literature represents Level IV evidence with very few Level II and III studies upon which to base decisions. A systematic review of the English-language literature was performed to determine if Grade III AC joint separations are best treated operatively or nonoperatively. Based on limited low-evidence, nonoperative treatment was deemed more appropriate than traditional nonoperative treatments because the results of the latter were not clearly better and were associated with higher complication rates, longer convalescence, and longer time away from work and sport.