Surgical versus conservative interventions for treating acromioclavicular dislocation of the shoulder in adults.
BACKGROUND
Dislocation of the acromioclavicular joint is one of the most common shoulder problems in general orthopaedic practice. The question of whether surgery should be used remains controversial.


OBJECTIVE
To assess the relative effects of surgical versus conservative (non-surgical) interventions for treating acromioclavicular dislocations in adults.


METHODS
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (to February 2009), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 1), MEDLINE (1966 to February 2009), EMBASE (1988 to February 2009), and LILACS (1982 to February 2009), trial registries and reference lists of articles. There were no restrictions based on language or publication status.


METHODS
All randomised and quasi-randomised trials that compared surgical with conservative treatment of acromioclavicular dislocation in adults were included.


METHODS
All review authors independently performed study selection. Two authors independently assessed the included trials and performed data extraction.


RESULTS
Three trials were included in this review. These involved a total of 174 mainly male participants. Two trials were randomised and one was quasi-randomised. None used validated measures for assessing functional outcome.Fixation of the acromioclavicular joint using coracoclavicular screws, acromioclavicular pins or, usually threaded, wires was compared with supporting the arm in a sling or similar device. There were no significant differences between the two groups in unsatisfactory longer-term (one year) shoulder function based on a composite measure including pain, movement and strength or function (risk ratio 1.49, 95% confidence interval 0.75 to 2.95), nor in treatment failure that generally required an operation (risk ratio 1.72, 95% confidence interval 0.72 to 4.12). However, there were fixation failures in all three trials. Particularly, the trial using wires reported a high incidence of wire breakage (16/39 (41%)). Two trials reported that surgery significantly delayed the return to work. The methods used in the three trials also meant a routine second operation for implant removal was necessary.


CONCLUSIONS
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.
Tamaoki
Marcel Jun S
MJ
Department of Orthopaedics and Traumatology, Universidade Federal de São Paulo, Rua Borges Lagoa, 783 - 5th Floor, São Paulo, São Paulo, Brazil, 04038-032.
Belloti
João Carlos
JC
Lenza
Mário
M
Matsumoto
Marcelo Hide
MH
Gomes Dos Santos
Joao Baptista
JB
Faloppa
Flávio
F
D000173:Acromioclavicular Joint / Q000293:injuries*; D000328:Adult; D005260:Female; D006801:Humans; D007103:Immobilization / Q000379:methods*; D004204:Joint Dislocations / Q000601:surgery / Q000628:therapy*; D008297:Male; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation