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Acromioclavicular dislocation. Conservative or surgical therapy

A M Phillips1, C Smart, A F Groom

  • 1Department of Orthopaedics, Lewisham Hospital, London, United Kingdom.

Clinical Orthopaedics and Related Research
|September 5, 1998
PubMed
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For severely displaced acromioclavicular dislocations, surgery does not offer significant benefits over non-surgical treatment. Outcomes, including return to activity and strength, were similar, with fewer complications reported for non-operative management.

Area of Science:

  • Orthopedic Surgery
  • Sports Medicine
  • Evidence-Based Medicine

Background:

  • Severely displaced acromioclavicular (AC) dislocations are common injuries in young adults.
  • Treatment decisions often involve weighing surgical intervention against conservative management.
  • Limited high-quality evidence exists to guide these decisions.

Purpose of the Study:

  • To review available literature on surgical versus non-surgical treatment for severely displaced AC dislocations.
  • To clarify outcomes and complications associated with each treatment approach.
  • To inform clinical decision-making for young adult patients.

Main Methods:

  • A literature review of 24 papers, encompassing 1172 patients.
  • Analysis focused on studies reporting both surgical and conservative outcomes.

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  • Included prospective randomized and non-randomized comparative studies.

    • Main Results:

    • Overall satisfactory outcomes were high for both surgical (88%) and non-surgical (87%) groups.
    • Non-surgical treatment resulted in fewer complications, notably less need for further surgery and reduced deformity.
    • Return to activity was not faster with surgery; range of motion and strength were often better with non-operative care.
    • Meta-analysis showed no significant benefit from surgical intervention.

    Conclusions:

    • Current evidence does not support recommending surgery for Rockwood et al Type III AC dislocations.
    • Non-surgical management appears to yield comparable or superior outcomes with fewer complications.
    • Larger, multicenter studies are needed to definitively establish surgical benefits, if any.