Is surgery always warranted for high-grade acromioclavicular dislocations?

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.
• 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.