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Journal of Orthopaedics and Traumatology

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Open Access 01-03-2011 | Review

Operative versus non-operative management following Rockwood grade III acromioclavicular separation: a meta-analysis of the current evidence base

Authors: Toby O. Smith, Rachel Chester, Eyiyemi O. Pearse, Caroline B. Hing

Published in: Journal of Orthopaedics and Traumatology | Issue 1/2011

Abstract

Background

Whilst there is little debate over the treatment of Rockwood grade V and VI acromioclavicular dislocation, the management of grade III acromioclavicular dislocation remains less clear. The purpose of this study was to compare the clinical outcomes of patients managed operatively and non-operatively following grade III acromioclavicular dislocation.

Materials and methods

A systematic review of published and unpublished material was conducted. All included studies were reviewed against the PEDro appraisal tool. Where appropriate, a meta-analysis of pooled results was conducted.

Results

Among 724 citations, six studies met the eligibility criteria. All six studies were retrospective case series (level 4 evidence). The findings of this study indicated that operative management of grade III acromioclavicular dislocation results in a better cosmetic outcome (P < 0.0001) but greater duration of sick leave compared to non-operative management (P < 0.001). There was no difference in strength, pain, throwing ability and incidence of acromioclavicular joint osteoarthritis compared to non-operative management. Only one study recorded and showed a higher Constant score for operative management compared to non-operative management (P = 0.003).

Conclusions

There is a lack of well-designed studies in the literature to justify the optimum mode of treatment of grade III acromioclavicular dislocations.

Rockwood CA, Williams GR, Young DC (1996) Acromioclavicular injuries. In: Rockwood CA, Green DP, Bucholz RW, Heckman JD (eds) Fractures in adults, vol 1, 4th edn. Lippincott-Raven, Philadelphia, pp 1341–1413

Rolf O, Hann von Weyhern A, Ewers A, Boehm TD, Gohlke F (2008) Acromioclavicular dislocation Rockwood III–V: results of early versus delayed surgical treatment. Arch Orthop Trauma Surg 128:1153–1157PubMedCrossRef

Hootman JM (2004) Acromioclavicular dislocation: conservative or surgical therapy. J Athl Train 39:10–11PubMedCentralPubMed

Bradley JP, Elkousy H (2003) Decision making: operative versus nonoperative treatment of acromioclavicular joint injuries. Clinics Sports Med 22:277–290CrossRef

Bäthis H, Tingart M, Bouillon B, Tiling T (2000) Conservative or surgical therapy of acromioclavicular joint injury—what is reliable? A systematic analysis of the literature using “evidence-based medicine” criteria. Chirurg 71:1082–1089PubMedCrossRef

Phillips AM, Smart C, Groom AF (1998) Acromioclavicular dislocation. Conservative or surgical therapy. Clin Orthop Relat Res 353:10–17PubMedCrossRef

Ceccarelli E, Bondì R, Alviti F, Garofalo R, Miulli F, Padua R (2008) Treatment of acute grade III acromioclavicular dislocation: a lack of evidence. J Orthop Traumatol 9:105–108PubMedCentralPubMedCrossRef

Calvo E, Lopez-Franco M, Arribas IM (2006) Clinical and radiological outcomes of surgical and conservative treatment of type III acromioclavicular joint injury. J Shoulder Elbow Surg 15:300–305PubMedCrossRef

Taft TN, Wilson FC, Oglesby JW (1987) Dislocation of the acromioclavicular joint. J Bone Joint Surg Am 69:1045–1051PubMed

10.

Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:2535CrossRef

11.

Foley NC, Bhogal SK, Teasell RW, Bureau Y, Speechley MR (2006) Estimates of quality and reliability with the physiotherapy evidence-based database scale to assess the methodology of randomized controlled trials of pharmacological and nonpharmacological interventions. Phys Ther 86:817–824PubMed

12.

Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M (2003) Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther 83:713–721PubMed

13.

Constant CR, Murley AHG (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164PubMed

14.

Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 22:719–748PubMed

15.

Fremerey R, Freitag N, Bosch U, Lobenhoffer P (2005) Complete dislocation of the acromioclavicular joint: operative versus conservative treatment. J Orthop Traumatol 6:174–178CrossRef

16.

Fremerey RW, Lobenhoffer P, Ramacker K, Gerich T, Skutek M, Bosch U (2001) Acute acromioclavicular joint dislocation—operative or conservative therapy? Unfallchirurg 104:294–299PubMedCrossRef

17.

Bakalim G, Wilppula E (1975) Surgical or conservative treatment of total dislocation of the acromioclavicular joint. Acta Chir Scand 141:43–47PubMed

18.

Bannister GC, Wallace WA, Stableforth PG, Hutson MA (1989) The management of acute acromioclavicular dislocation. A randomised prospective controlled trial. J Bone Joint Surg Br 71:848–850PubMed

19.

Larsen E, Bjerg-Nielsen A, Christensen P (1986) Conservative or surgical treatment of acromioclavicular dislocation. A prospective, controlled, randomized study. J Bone Joint Surg Am 68:552–555PubMed

20.

Rosenorn M, Pedersen EB (1974) A comparison between conservative and operative treatment of acute acromioclavicular dislocation. Acta Orthop Scand 45:50–59PubMedCrossRef

21.

Press J, Zuckerman JD, Gallagher M, Cuomo F (1997) Treatment of grade III acromioclavicular separations. Operative versus nonoperative management. Bull Hosp Jt Dis 56:77–83PubMed

22.

Gstettner C, Tauber M, Hitzl W, Resch H (2008) Rockwood type III acromioclavicular dislocation: surgical versus conservative treatment. J Shoulder Elbow Surg 17:220–225PubMedCrossRef

23.

Friedman LM, Furberg CD, DeMets DL (2009) Fundamentals of clinical trials, 3rd edn. Springer, New York

24.

Petrie A, Sabin S (2000) Medical statistics at a glance. Blackwell Science, Oxford

25.

Bland M (2006) An introduction to medical statistics, 3rd edn. Oxford University Press, Oxford

26.

Galpin RD, Hawkins RJ, Grainger RW (1985) A comparative analysis of operation versus nonoperative treatment of grade III acromio-clavicular separations. Clin Orthop Relat Res 193:150–155PubMed

27.

Wojtys EM, Nelson G (1991) Conservative treatment of grade III acromioclavicular dislocations. Clin Orthop 268:112–119PubMed

28.

Väätäinen U, Pirinen A, Mäkelä A (1991) Radiological evaluation of the acromioclavicular joint. Skeletal Radiol 20:115–116PubMedCrossRef

29.

Cook DA, Heiner JP (1990) Acromioclavicular joint injured. Orthop Rev 16:510–516

30.

Urist MR (1946) Complete disruption of the acromioclavicular joint: the nature of the traumatic lesion and effective methods of treatment with an analysis of 41 cases. J Bone Joint Surg 28:813–837PubMed

31.

Darrow JC, Smith JA, Lockwood RC (1980) A new conservative methods for treatment of type III acromiclavicular separations. Orthop Clin North Am 11:727–733PubMed

32.

Giannestras NJ (1944) A method of immobilization of acute acromioclavicular separation. J Bone Joint Surg 26:597–599

33.

Spigelman L (1969) A harness for acromioclavicular separation. J Bone Joint Surg Am 51:585–586PubMed

34.

Thorndike A, Quigley TB (1942) Injuries to the acomioclavicular joint; a plea for conservative treatment. Am J Surg 55:250–261CrossRef

35.

Bosworth BM (1941) Acromioclavicular separation: new method of repair. Surg Gynec Obstet 73:866

36.

Weaver JK, Dunn HK (1972) Treatment of acromioclavicular injuries, especially complete acromioclavicular separation. J Bone Joint Surg Am 54:1187–1194PubMed

37.

Phemister DB (1942) The treatment of dislocation of acromioclavicular joint by open reduction and threaded-wire fixation. J Bone Joint Surg 24:166

38.

Ejam S, Lind T, Falkenberg B (2008) Surgical treatment of acute and chronic acromioclavicular dislocation Tossy type III and V using the Hook plate. Acta Orthop Belg 74:441–445PubMed

39.

Scheibel M, Ifesanya A, Pauly S, Haas NP (2008) Arthroscopically assisted coracoclavicular ligament reconstruction for chronic acromioclavicular joint instability. Arch Orthop Trauma Surg 128:1327–1333PubMedCrossRef

40.

Hosseini H, Friedmann S, Tröger M, Lobenhoffer P, Agneskirchner JD (2009) Arthroscopic reconstruction of chronic AC joint dislocations by transposition of the coracoacromial ligament augmented by the TightRope device: a technical note. Knee Surg Sports Traumatol Arthrosc 17:92–97PubMedCrossRef

Title: Operative versus non-operative management following Rockwood grade III acromioclavicular separation: a meta-analysis of the current evidence base
Authors: Toby O. Smith
Rachel Chester
Eyiyemi O. Pearse
Caroline B. Hing
Publication date: 01-03-2011
Publisher: Springer International Publishing
Published in: Journal of Orthopaedics and Traumatology / Issue 1/2011
Print ISSN: 1590-9921
Electronic ISSN: 1590-9999
DOI: https://doi.org/10.1007/s10195-011-0127-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Operative versus non-operative management following Rockwood grade III acromioclavicular separation: a meta-analysis of the current evidence base

Abstract

Background

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusions

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