Surgical versus conservative management of Type III acromioclavicular dislocation: a systematic review.
The management of Type III acromioclavicular (AC) dislocations is still controversial. We wished to compare the rate of recurrence and outcome scores of operative versus non-operative treatment of patients with Type III AC dislocations.



A systematic review of the literature was performed by applying the PRISMA guidelines according to the PRISMA checklist and algorithm. A search in Medline, PubMed, Cochrane and CINAHL was performed using combinations of the following keywords: 'dislocation', 'Rockwood', 'type three', 'treatment', 'acromioclavicular' and 'joint'.



Fourteen studies were included, evaluating 646 shoulders. The rate of recurrence in the surgical group was 14%. No statistical significant differences were found between conservative and surgical approaches in terms of postoperative osteoarthritis and persistence of pain, although persistence of pain seemed to occur less frequently in patients undergoing a surgical treatment.



Persistence of pain seemed to occur less frequently in patients undergoing surgery.



Persistence of pain seems to occur less frequently in patients treated surgically for a Type III AC dislocation.



There is insufficient evidence to establish the effects of surgical versus conservative treatment on functional outcome of patients with AC dislocation. High-quality randomized controlled clinical trials are needed to establish whether there is a difference in functional outcome.
Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.
Umile Giuseppe
UG
Longo
Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.
Mauro
M
Ciuffreda
Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.
Giacomo
G
Rizzello
Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.|University of Melbourne, Melbourne Medical School, Melbourne, VIC 3010, Australia.
Nicholas
N
Mannering
Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.|Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, UK.
Nicola
N
Maffulli
Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy.
Vincenzo
V
Denaro
D000173:Acromioclavicular Joint / Q000293:injuries*; D000465:Algorithms; D057189:Checklist; D000072700:Conservative Treatment; D006801:Humans; D004204:Joint Dislocations / Q000145:classification / Q000601:surgery / Q000628:therapy*; D010149:Postoperative Pain / Q000453:epidemiology; D012008:Recurrence; D016896:Treatment Outcome
Level IV; acromioclavicular; arthroscopy; dislocation; primary; shoulder; systematic review; treatment