Cochrane for Clinicians

Putting Evidence into Practice

Acromioclavicular Joint Dislocation: Surgical vs. Conservative Interventions

 

Am Fam Physician. 2021 Jul ;104(1):28-29.

Author disclosure: No relevant financial affiliations.

Clinical Question

Is surgical intervention for acromioclavicular (AC) joint dislocation superior to conservative interventions in adults?

Evidence-Based Answer

Surgical treatment for AC joint dislocation of the shoulder does not appear to be superior to conservative management in adults. Both strategies resulted in similar quality of life, function, and return to previous activities after one year. Surgical therapy increases the risk of hardware complications, infection, and continued discomfort.1 (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

Dislocation of the AC joint accounts for about 9% of shoulder injuries in the general population and increases to 40% among elite athletes participating in highly competitive impact sports.2 Dislocation of the AC joint involves injury to the AC ligament with or without coracoclavicular ligament disruption. It most commonly occurs in sports such as football, boxing, martial arts, and cycling and results from a direct impact or fall onto the superior aspect of the shoulder. The most widely accepted classification of AC joint injuries is the Rockwood classification, which grades the injury from I to VI. Types I and II are generally considered nonsurgical, and grades IV through VI are surgical. Treatment of type III injuries is controversial and is outside the scope of this review. The authors of this Cochrane review sought to determine if surgical management of AC joint dislocation was superior to conservative management.

The review included six randomized or quasi-randomized controlled trials and 357 participants.1 Most participants were male with a mean age of 32 years. All studies were determined to be at high risk of bias; blinding was impossible, and sham surgeries are unethical. Although not all studies specified the severity of injury, by description they all seemed to include type III, and some also included types IV through VI. Primary outcomes were shoulder

Author disclosure: No relevant financial affiliations.

References

1. Tamaoki MJS, Lenza M, Matsunaga FT, et al. Surgical versus conservative interventions for treating acromioclavicular dislocation of the shoulder in adults. Cochrane Database Syst Rev. 2019;(10):CD007429.

2. Mazzocca AD, Arciero RA, Bicos J. Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med. 2007;35(2):316–329.

3. Longo UG, Ciuffreda M, Rizzello G, et al. Surgical versus conservative management of type III acromioclavicular dislocation: a systematic review. Br Med Bull. 2017;122(1):31–49.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at https://www.aafp.org/afp/cochrane.

 

 

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