title: Results of Operative and Nonoperative Treatment of Rockwood Types III and V Acromioclavicular Joint Dislocation: A Prospective, Randomized Trial With an 18- to 20-Year Follow-up.
abstract: BACKGROUND
  The optimal treatment of acute, complete dislocation of the acromioclavicular joint (ACJ) is still unresolved.
  
  
  OBJECTIVE
  To determine the difference between operative and nonoperative treatment in acute Rockwood types III and V ACJ dislocation.
  
  
  METHODS
  Randomized controlled trial; Level of evidence, 2.
  
  
  METHODS
  In the operative treatment group, the ACJ was reduced and fixed with 2 transarticular Kirschner wires and ACJ ligament suturing. The Kirschner wires were extracted after 6 weeks. Nonoperatively treated patients received a reduction splint for 4 weeks. At the 18- to 20-year follow-up, the Constant, University of California at Los Angeles Shoulder Rating Scale (UCLA), Larsen, and Simple Shoulder Test (SST) scores were obtained, and clinical and radiographic examinations of both shoulders were performed.
  
  
  RESULTS
  Twenty-five of 35 potential patients were examined at the 18- to 20-year follow-up. There were 11 patients with Rockwood type III and 14 with type V dislocations. Delayed surgical treatment for ACJ was used in 2 patients during follow-up: 1 in the operatively treated group and 1 in the nonoperatively treated group. Clinically, ACJs were statistically significantly less prominent or unstable in the operative group than in the nonoperative group (normal/prominent/unstable: 9/4/3 and 0/6/3, respectively; P = .02) and in the operative type III (P = .03) but not type V dislocation groups. In operatively and nonoperatively treated patients, the mean Constant scores were 83 and 85, UCLA scores 25 and 27, Larsen scores 11 and 11, and SST scores 11 and 12 at follow-up, respectively. There were no statistically significant differences in type III and type V dislocations. In the radiographic analysis, the ACJ was wider in the nonoperative than the operative group (8.3 vs 3.4 mm; P = .004), and in the type V dislocations (nonoperative vs operative: 8.5 vs 2.4 mm; P = .007). There was no statistically significant difference between study groups in the elevation of the lateral end of the clavicle. Both groups showed equal levels of radiologic signs of ACJ osteoarthritis and calcification of the coracoclavicular ligaments.
  
  
  CONCLUSIONS
  Nonoperative treatment was shown to produce more prominent or unstable and radiographically wider ACJs than was operative treatment, but clinical results were equally good in the study groups at 18- to 20-year follow-up. Both treatment methods showed statistically significant radiographic elevations of the lateral clavicle when compared with a noninjured ACJ.
authors.affiliation: Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Joukainen
authors.affiliation: Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland. ; BCRU, Institute of Clinical Medicine, University of Eastern Finland, Finland.
authors.forename: Heikki
authors.initials: H
authors.lastname: Kröger
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Lea
authors.initials: L
authors.lastname: Niemitukia
authors.affiliation: Terveystalo Private Hospital, Kuopio, Finland.
authors.forename: E Antero
authors.initials: EA
authors.lastname: Mäkelä
authors.affiliation: Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland. ; Ite-Lasaretti Private Hospital, Kuopio, Finland.
authors.forename: Urho
authors.initials: U
authors.lastname: Väätäinen
keywords: acromioclavicular joint dislocation; nonoperative; operative; prospective randomized study; treatment