Conservative or operative therapy for acromioclavicular dislocation - is there evidence?

There is controversy about the therapy for third-degree acromioclavicular d islocation according to Tossy and Rockwood's classification. Both operative and non-operative treatment is reported to have satisfactory results in th e literature. The purpose of this study was to analyze the literature in a systematic manner based on the criteria of evidence-based medicine. It was our hypothesis that there is no scientific evidence for the superiority of one treatment over the other. A total of 370 papers were retrieved and clas sified into three groups: (1) randomized controlled trials; (2) comparative retrospective studies; and (3) retrospective studies. in three studies tha t were graded with high evidence, the major outcome for both operative and non-operative treatment was similar. The advantages of non-operative treatm ent include a shorter period of rehabilitation and a significantly lower co mplication rate while the advantages of operative treatment include a low r ate of persisting subluxation of the AC joint. Similar results were found f or retrospective comparative and longterm studies. For retrospective studie s without controls, both operative and conservative therapy are described w ith good and excellent results, ranging between 80 and 97 %. In conclusion, there is good evidence on the therapy of third-degree acromioclaviculary d islocation studies. The functional result according to the literature is si milar, and complications associated with therapy occur more often with oper ative treatment. Conservative treatment appears to be the method of choice for third-degree acromioclavicular dislocations unless the patient's prefer ence is operative therapy.