Purpose To conduct a systematic review of the literature in relation to 3 considerations in determining treatment options for patients with acromioclavicular (AC) joint dislocations: (1) operative versus nonoperative management, (2) early versus delayed surgical intervention, and (3) anatomic versus nonanatomic techniques Methods The PubMed database was searched in October 2011 using the single term acromioclavicular and the following search limits: any date, humans, English , and all adult (19+) Studies were included if they compared operative with nonoperative treatment, early with delayed surgical intervention, or anatomic with nonanatomic surgical techniques Exclusion criteria consisted of the following: Level V evidence, laboratory studies, radiographic studies, biomechanical studies, fractures or revisions, meta-analyses, and studies reporting preliminary results Results This query resulted in 821 citations Of these, 617 were excluded based on the title of the study The abstracts and articles were reviewed, which resulted in the final group of 20 studies that consisted of 14 comparing operative with nonoperative treatment, 4 comparing early with delayed surgical intervention, and 2 comparing anatomic with nonanatomic surgical techniques The lack of higher level evidence prompted review of previously excluded studies in an effort to explore patterns of publication related to operative treatment of the AC joint This review identified 120 studies describing 162 techniques for operative reconstruction of the AC joint Conclusions There is a lack of evidence to support treatment options for patients with AC joint dislocations Although there is a general consensus for nonoperative treatment of Rockwood type I and II lesions, initial nonsurgical treatment of type III lesions, and operative intervention for Rockwood type IV to VI lesions, further research is needed to determine if differences exist regarding early versus delayed surgical intervention and anatomic versus nonanatomic surgical techniques in the treatment of patients with AC joint dislocations Level of Evidence Level III, systematic review of Level II and Level III studies and one case series

Current Concepts in the Treatment of Acromioclavicular Joint Dislocations

Forty-four patients, ranging in age from 17 to 57 years (average, 32), were evaluated an average of 4 years (range, 2 to 9) after surgical reconstruction for Allman- Tossy Grade III acromioclavicular dislocations. Twenty- seven patients underwent repair for acute injuries ( 3 weeks). Coracocla vicular fixation with heavy nonabsorbable sutures was used to correct superior displacement in all cases. In addition, transfer of the coracoacromial ligament to the distal clavicle was performed in 15 of the 27 early re pairs and 17 of the 17 late reconstructions. Overall, 26 of 27 (96%) early repairs and 13 of 17 (77%) late re constructions achieved satisfactory results. There was a trend for better results and return to sports or heavy labor with early repairs; however, this was not statisti cally significant (P = 0.065). When the results of early repairs were compared with those of late reconstruc tions performed more than 3 ...

Surgical Treatment of Complete Acromioclavicular Dislocations

Disorders of the acromioclavicular joint

A literature review was performed to clarify available information which influences decisions whether to advise a young adult patient to undergo surgery for a severely displaced acromioclavicular dislocation. Twenty-four papers were retrieved yielding 1172 patients of whom the mean followup for the 833 surgically treated patients was 43.7 months and 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 methodology. Fourteen papers reported surgical outcome only and five papers reported conservative outcome only. Overall, 88% of surgically treated patients and 87% of nonsurgically treated patients had a satisfactory 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 without surgery. Range of movement was more frequently normal or near normal without surgery (95% versus 86% if surgically treated) and so was strength (92% versus 87%). Meta-analysis of the four studies including data from surgical and conservative therapy showed on significant benefit from surgery. Power studies suggest that to show a statistically significant benefit from surgery, large studies would be required, which, given the relative incidence of these injuries, would probably be multicenter and therefore vulnerable to methodologic difficulties. There does not seem to be any reason to recommend an operative procedure to a patient with a Rockwood et al Type III injury based on the evidence currently available.

Acromioclavicular dislocation. Conservative or surgical therapy.

Rockwood type III acromioclavicular dislocation: surgical versus conservative treatment.

In a prospective study, 60 patients with acute acromioclavicular dislocation were randomly allocated to treatment with a broad arm sling or to reduction and fixation with a coracoclavicular screw. Of these 54 were followed for four years. Conservatively-treated patients regained movement significantly more quickly and fully, returned to work and sport earlier and had fewer unsatisfactory results than those having early operation. For severe dislocations, with acromioclavicular displacement of 2 cm or more, early surgery produced better results. Conservative management is best for most acute dislocations, but younger patients with severe displacement may benefit from early reduction and stabilisation.

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The management of acute acromioclavicular dislocation. A randomised prospective controlled trial

In a prospective study, 60 patients with acute acromioclavicular dislocation were randomly allocated to treatment with a broad arm sling or to reduction and fixation with a coracoclavicular screw. Of these 54 were followed for four years

The management of acute acromioclavicular dislocation: a randomised prospective controlled trial

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The management of acute acromioclavicular dislocation. A randomised prospective controlled trial

The management of acute acromioclavicular dislocation: a randomised prospective controlled trial