Acromioclavicular joint separation: Controversies and treatment algorithm.

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Abstract

Conflict of interest statement: No conflict of interest between authors: 15. Knee Surg Sports Traumatol Arthrosc. 2024 Jul;32(7):1810-1820. doi: 10.1002/ksa.12070. Epub 2024 Feb 19. Acromioclavicular joint dislocation Rockwood type III and V show no difference in functional outcome and 91% recovered well without the need for surgery. Haugaard KB(1), Bak K(2), Ryberg D(3), Muharemovic O(4), Hölmich P(1), Barfod KW(1). Author information: (1)Department of Orthopedic Surgery, Sports Orthopedic Research Center-Copenhagen (SORC-C), Copenhagen University Hospital Hvidovre, Copenhagen, Denmark. (2)Adeas Private Hospital, Copenhagen, Denmark. (3)Department of Physical and Occupational Therapy, Physical Medicine and Rehabilitation Research-Copenhagen (PMR-C), Copenhagen University Hospital Hvidovre, Copenhagen, Denmark. (4)Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark. PURPOSE: Acromioclavicular (AC) joint dislocations are common injuries, but the indication for and timing of surgery is debated. The objective of the study was to evaluate the results after acute AC joint dislocations Rockwood type III and V treated nonsurgically with the option of delayed surgical intervention. METHODS: This is a prospective cohort study with clinical, radiological and patient-reported outcome assessment at baseline, 6 weeks, 3 months, 6 months and 1 year after acute AC joint dislocation. Patients aged 18-60 with acute AC joint dislocation and a baseline panorama (Zanca) radiograph with an increase in the coracoclavicular distance of >25% compared to the uninjured side were eligible for inclusion. All patients were treated nonsurgically with 3 months of home-based training and with the option of delayed surgical intervention. The primary outcome was the Western Ontario Shoulder Instability Index (WOSI). Secondary outcomes were surgery yes/no and the Shoulder Pain and Disability Index (SPADI). RESULTS: Ninety-five patients were included. Fifty-seven patients were Rockwood type III and 38 patients were type V. There were no statistically significant differences in WOSI and SPADI between patients with type III and V injuries at any time point. Nine patients (9.5%) were referred for surgery; seven type III and two type V (ns). CONCLUSION: Ninety-one percent of patients with acute AC joint dislocation Rockwood type III and V recovered without surgery and there were no differences in outcome scores between type III and V at any time point. LEVEL OF EVIDENCE: Level IV. © 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy. DOI: 10.1002/ksa.12070