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Outcomes After Operative Versus Nonoperative Management of Type III to V Acromioclavicular Joint Dislocations: A
Darius Luke Lameire1, Matthew Cecere2, Ashlee Chan2
1Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Background:
Acromioclavicular joint (ACJ) injuries are common; however, there is disagreement about the optimal treatment of Rockwood type ≥III ACJ dislocations.
Purpose:
To systematically review and meta-analyze the outcomes of all randomized controlled trials that compared the operative and nonoperative treatment of Rockwood type III to V ACJ dislocations.
Study Design:
Systematic review; Level of evidence, 2.
Methods:
A systematic search of 4 databases was performed through September 15, 2024. Inclusion criteria included (1) adult patients, (2) acute Rockwood type III to V ACJ dislocations, (3) direct comparisons of operative to nonoperative management, (4) randomized controlled trial methodology, and (5) reporting of clinical outcomes. The primary outcome was the Constant score, and secondary outcomes consisted of other patient-reported outcome measure (PROM) scores, cosmesis, radiographic findings, range of motion, return to work/sport, complications, and unplanned surgery.
Results:
There were 5 comparative studies included in this review with a total of 367 patients: 193 patients underwent operative treatment (102 type III, 11 type IV, 40 type V, and 40 type III-V), and 174 underwent nonoperative treatment (84 type III, 13 type IV, 34 type V, and 43 type III-V). The mean age was 39.1 years for operative patients and 37.4 years for nonoperative patients. The follow-up ranged from 12 to 229.2 months. The mean Constant score at ≥2 years was 92.4 for operative patients and 90.1 for nonoperative patients, with meta-analysis demonstrating no significant differences at ≥2 years (95% CI, -0.03 to 0.43; P = .2). However, at shorter follow-up durations, individual studies found statistically significant differences favoring nonoperative management. One study found improved return to work rates with nonoperative management at 3 months, with no differences found at other time points. Meta-analysis found no significant differences in major complications between operative and nonoperative management (P = .84), although there were statistically significantly more minor complications with operative management (P < .0001). There were few reported outcomes for isolated type III, IV, or V injuries, but where reported, these outcomes followed the overall trend, with early PROM scores favoring nonoperative treatment and comparable outcomes between treatment groups at longer follow-up.
Conclusion:
There were comparable PROM scores at ≥1 year when comparing operative to nonoperative treatment in patients who sustained a Rockwood type III to V ACJ dislocation. However, early PROM scores favored nonoperative management. There were comparable satisfaction rates and comparable return to work/sport rates between groups. Therefore, the nonoperative management of type III to V ACJ dislocations resulted in comparable clinical outcomes compared to operative treatment.