Review Question - QID 219173

Both nonoperative and operative management of acute acromioclavicular (AC) joint separations have significant improvement from the level of initial disability at 2 years.

An acromioclavicular joint injury, otherwise known as a shoulder separation, is a traumatic injury to the acromioclavicular (AC) joint with disruption of the acromioclavicular ligaments and/or coracoclavicular (CC) ligaments. Diagnosis is made with bilateral focused shoulder radiographs to assess for AC and CC interval widening. Treatment is immobilization or surgical reconstruction depending on patient activity levels, degree of separation, and degree of ligamentous injury.

The Canadian Orthopaedic Trauma Society performed a randomized clinical trial of operative versus nonoperative treatment of acute AC joint dislocations using modern surgical fixation and both patient-based and surgeon-based outcome measures to determine which treatment method was superior. They reported that although hook plate fixation resulted in superior radiographic alignment, it was not clinically superior to the nonoperative treatment of acute, complete dislocations of the AC joint. They noted that the nonoperative group had better early scores, although both groups improved from a significant level of initial disability to a good or excellent result at 2 years. They reported that there is no clear evidence that operative treatment with the hook plate improves short-term outcomes for complete AC joint dislocations.

Chang et al. performed a meta-analysis comparing the outcomes between operative and nonoperative management of high-grade (Rockwood types III–V, Allman types 2–3, and Tossy IIIs) AC joint dislocations. They reported that no clinical difference in functional outcome scores was detected between operative and nonoperative management of high-grade AC joint dislocations. They concluded that patients in the nonoperative cohort had a more rapid return to work but were associated with a poorer cosmetic outcome.

Figure A is an AP radiograph of the shoulder demonstrating an AC joint separation. Illustration A depicts the Rockwood classification.

Incorrect Answers:
Answer 1: Studies have shown that patients in the nonoperative cohort have a more rapid return to work but were associated with a poorer cosmetic outcome.
Answer 2: Operative interventions have led to improved cosmetic outcomes.
Answer 3: Studies have shown that nonoperative groups have led to better early outcome scores.
Answer 5: Operative intervention results in superior radiographic alignment, however, it is not clinically superior to nonoperative treatment.