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Published on: February 10, 2015
Functional, Radiological, and Scapular Motion Evaluation of Surgical Versus Nonsurgical Treatment of Type 3
Paulo Henrique Schmidt Lara1,2, Ewerton Borges de Sousa Lima1,2, Carlos Vicente Andreoli1,2,3
1Sports Medicine Discipline, Paulista School of Medicine-UNIFESP, São Paulo, Brazil.
Background:
Acromioclavicular (AC) joint dislocations are common in young athletes. The optimal management of Rockwood type 3 injuries, which involve a complete tear of both the AC and coracoclavicular (CC) ligaments, remains controversial.
Purpose/Hypothesis:
The purpose of this study was to compare the clinical outcomes of surgical and nonoperative treatment of type 3 AC joint dislocations. The hypothesis was that surgical treatment would result in superior functional outcomes.
Study Design:
Randomized controlled trial; Level of evidence, 1.
Methods:
A total of 70 patients (mean age, 31.2 ± 8.1 years) with acute type 3 AC joint dislocations were randomized to the surgical (modified Weaver-Dunn technique) (n = 35) and nonoperative treatment group (n = 35). The inclusion criteria were as follows: adults aged >18 years diagnosed with grade 3 AC dislocation within 21 days of the injury; no history of AC dislocation or previous surgery in the affected shoulder; and no associated fractures involving the acromion, coracoid, or clavicle. The exclusion criteria were as follows: failure to adhere to the follow-up schedule; improper performance of radiological examinations; or noncompliance with the prescribed rehabilitation protocol. Ten patients were lost to follow-up, resulting in a final sample size of 60 patients (30 per group). The primary outcome was the Disabilities of the Arm, Shoulder, and Hand (DASH) score at 12 months. Secondary outcomes included the University of California-Los Angeles (UCLA) score, scapular dyskinesis, range of motion, radiographic alignment, cosmetic satisfaction, return to sport, and complications. Follow-up was conducted over 24 months. All statistical tests were 2-tailed, and P < .05 was considered statistically significant. No adjustments were made for multiple comparisons because of the exploratory nature of secondary outcomes.
Results:
No significant differences were found in DASH scores (11.4 vs 10.63; P = .179) at final follow-up. The surgical group showed significantly higher UCLA scores (36.07 vs 33.74; P < .001) and lower rates of cosmetic dissatisfaction (14.8% vs 44%; P = .017), although the range of motion, return to sport, scapular dyskinesis, and complication rates did not differ between groups.
Conclusion:
Surgical management of type 3 AC joint dislocations resulted in similar DASH scores and range of motion compared with nonoperative management, although some secondary outcomes-including higher UCLA scores and cosmetic satisfaction scores-favored surgery.The trial was registered in the Brazilian Registry of Clinical Trials (RBR-4r6jhy6).
