Acute, complete acromioclavicular separation. The management of acute acromioclavicular dislocation. A randomised prospective controlled trial.
Twenty-three patients with acute, complete acromioclavicular separation were studied prospectively. Twelve patients were treated non-operatively and eleven were treated operatively. A twelve-month minimum follow-up, using a point system to evaluate clinical results, demonstrated comparable results with and without surgery. Roentgenographic findings did not correlate with the clinical results. Minimum immobilization and early rehabilitation of the shoulder was the recommended treatment of choice. 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.
There is insufficient evidence from randomised controlled trials to determine when surgical treatment is indicated for acromioclavicular dislocation in adults in current practice. Sufficiently powered, good quality, well-reported randomised trials of currently-used surgical interventions versus conservative treatment for well-defined injuries are required.