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Operative Versus Nonoperative Management of High-Grade Acromioclavicular Injuries: A Systematic Review and
Maamoun Adra1, Aslam Mohamed Haroon2, Hugh Milchem3
1General Medicine, Peterborough City Hospital, Peterborough, GBR.
Cureus
|February 3, 2025
Summary
Operative management for severe acromioclavicular (AC) joint injuries (Rockwood III-V) shows better functional and radiological outcomes. While nonoperative treatment yielded higher subjective satisfaction, surgery reduced AC joint width and dislocations.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Traumatology
Background:
- Acromioclavicular (AC) joint injuries, specifically Rockwood grades III-V, present significant clinical challenges.
- Optimal management strategies comparing operative versus nonoperative approaches for these severe injuries remain debated.
- Understanding functional and radiological outcomes is crucial for guiding treatment decisions in AC joint injuries.
Purpose of the Study:
- To conduct a meta-analysis comparing operative and nonoperative management for functional and radiological outcomes in Rockwood III-V AC injuries.
- To synthesize evidence from existing studies to inform clinical practice regarding severe AC joint injury treatment.
Main Methods:
- A comprehensive literature search was performed across multiple databases (Elsevier, CINAHL, PubMed, Cochrane, Scopus, Web of Science) up to May 28, 2024.
- Included studies focused on patients over 16 years with Rockwood grade III or higher AC joint injuries.
- Data from 13 eligible studies (n=729) comparing operative and nonoperative treatments were analyzed.
Main Results:
- At 24-48 months, operative management showed superior functional outcomes (Constant score: MD=2.38, favoring operative).
- Radiological outcomes favored surgery, with narrower AC joint width (MD=-5.60) and significantly less AC joint dislocation/subluxation (OR=0.01).
- Nonoperative treatment resulted in higher subjective "good" outcomes (OR=0.55), despite higher complication rates in the operative group (18.3% vs. 15.9%).
Conclusions:
- Operative management of Rockwood III-V AC injuries appears to offer better functional and radiological results compared to nonoperative treatment.
- While subjective satisfaction favored nonoperative care, objective measures suggest surgical intervention yields superior outcomes.
- Further long-term research is warranted to evaluate sustained outcomes and specific benefits across individual Rockwood grades.
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