Clinical Results After Conservative Management for Grade III Acromioclavicular Joint Injuries: Does Eventual Surgery Affect Overall Outcomes?

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Injuries to the acromioclavicular (AC) joint represent up to half of all shoulder girdle injuries in contact athletes. These injuries most commonly occur after a direct, high-energy impact to the lateral shoulder with the humerus adducted. Dislocation and superior displacement of the distal clavicle occur in cases that involve complete disruption of both the AC joint capsule and the coracoclavicular (CC) ligaments. Controversy still exists regarding the optimal treatment strategy for patients with grade III injuries.

The classification of AC joint injuries was originally described by Rockwood according to injury severity. Grade I and II injuries represent ligamentous strain and partial tearing of supporting ligaments, respectively, with minimal displacement of the distal clavicle. These injuries are most often treated conservatively with excellent results. Grade III through VI injuries represent complete disruption of both the AC joint capsule and the CC ligaments. In these cases the distal clavicle may be displaced superiorly (grades III and V), posteriorly (grade IV), or inferiorly beneath the coracoid (grade VI).

Although surgical management is typically indicated for patients with grade IV through VI AC joint injuries, many surgeons recommend early operative management for grade III AC injuries in high-level athletes and manual laborers, in addition to patients who have become chronically symptomatic. However, surgical intervention carries inherent risks to the patient, including the possibility of loss of reduction, clavicle fracture, wound infection, osteomyelitis, nerve injury, heterotopic ossification, osteoarthritis, stiffness, and hardware failure. Furthermore, surgical reconstruction of grade III AC joint injuries is associated with increased medical costs and a longer duration of sick leave when compared with nonoperative management.

Therefore the purpose of this study was to compare the clinical outcomes in patients with grade III AC joint injuries in whom nonoperative therapy was successfully completed and those who had nonoperative therapy failure by proceeding to surgical reconstruction. We hypothesized that there would be no differences in the clinical outcomes scores between these treatment groups.

Full Article: Clinical Results After Conservative Management for Grade III Acromioclavicular Joint Injuries: Does Eventual Surgery Affect Overall Outcomes?