ACROMIOCLAVICULAR DISLOCATION - CONSERVATIVE OR SURGICAL THERAPY

A literature review was performed to clarify available information whi ch influences decisions whether to advise a young adult patient to und ergo surgery for a severely displaced acromioclavicular dislocation. T wenty-four papers were retrieved yielding 1172 patients of whom the me an follow-up for the 833 surgically treated patients was 43.7 months a nd not surgically treated was 60.4 months. Of the 24 papers, only five reported surgical and conservative outcomes; two of these papers used prospective randomized methodology and three used nonrandomized metho dology. Fourteen papers reported surgical outcome only and five papers reported conservative outcome only. Overall, 88% of surgically treate d patients and 87% of nonsurgically treated patients had a satisfactor y outcome. Complications most commonly listed were (surgically treated versus nonsurgically treated): need for further surgery (59% versus 6 %), infection (6% versus 1%), and deformity (3% versus 37%). Return to activity was no quicker with surgery. Pain was not any more common wi thout surgery. Range of movement was more frequently normal or near no rmal without surgery (95% versus 86% if surgically treated) and so was strength (92% versus 87%). Metaanalysis of the four studies including data from surgical and conservative therapy showed no significant ben efit from surgery. Power studies suggest that to show a statistically significant benefit from surgery large studies would be required, whic h, given the relative incidence of these injuries, would probably be m ulticenter and therefore vulnerable to methodologic difficulties, Ther e does not seem to be any reason to recommend an operative procedure t o a patient with a Rockwood et al Type III injury based on the evidenc e currently available.