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Is surgery always warranted for high-grade acromioclavicular dislocations?

Omid Jamei-Martel^1,2,3, Riccardo Garibaldi¹, Carmen Castroviejo Fernández¹

¹Department of Traumatology and Orthopaedic Surgery, Wallis Hospital Center, Martigny, Wallis, Switzerland.

JSES International

|June 19, 2026

Summary

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For high-grade acromioclavicular (AC) joint dislocations, surgery improves alignment but not function. Clinically guided conservative treatment offers satisfactory results for AC joint injuries, supporting individualized care.

Area of Science:

Orthopedic surgery
Sports medicine
Musculoskeletal research

Background:

Management of high-grade acromioclavicular (AC) joint dislocations is controversial.
Surgical treatment enhances radiographic alignment but functional outcomes remain debated.
This study evaluates outcomes in Rockwood type III-V injuries with clinically guided treatment allocation.

Purpose of the Study:

To prospectively evaluate clinical and radiographic outcomes of high-grade AC joint dislocations.
To compare functional and radiographic results between conservative and surgical management.
To assess the impact of clinical criteria on treatment allocation and outcomes.

Main Methods:

Prospective observational cohort study of 49 patients with Rockwood type III-V AC dislocations.

Keywords:

ACJI score Acromioclavicular joint dislocation Conservative treatment Constant Score Patient-reported outcomes Radiographic alignment Scapulothoracic abnormal motion Shoulder subjective value (SSV)

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Treatment allocation based on predefined clinical criteria and shared decision-making.

Functional outcomes assessed using Shoulder Subjective Value (SSV), Constant Score, and AC Joint Instability score; radiographic analysis performed.

Main Results:

No significant difference in SSV between nonoperative (n=29) and operative (n=20) groups at 28 months median follow-up.
Constant Score slightly higher in nonoperative group; AC Joint Instability scores higher in surgical group (improved alignment).
Surgical complication rate was 17%; minimal correlation between radiographic parameters and functional outcomes.

Conclusions:

Surgical treatment for high-grade AC dislocations improves radiographic alignment but not functional outcomes compared to conservative management.
Clinically guided conservative treatment yields satisfactory results with a low crossover rate.
Individualized, clinically driven decision-making is supported for managing high-grade AC dislocations.