Operative versus non-operative management following Rockwood grade III acromioclavicular separation: a meta-analysis of the current evidence base

Toby O Smith, Rachel Chester, Eyiyemi O Pearse, Caroline B Hing, Toby O Smith, Rachel Chester, Eyiyemi O Pearse, Caroline B Hing

Abstract

Background: Whilst there is little debate over the treatment of Rockwood grade V and VI acromioclavicular dislocation, the management of grade III acromioclavicular dislocation remains less clear. The purpose of this study was to compare the clinical outcomes of patients managed operatively and non-operatively following grade III acromioclavicular dislocation.

Materials and methods: A systematic review of published and unpublished material was conducted. All included studies were reviewed against the PEDro appraisal tool. Where appropriate, a meta-analysis of pooled results was conducted.

Results: Among 724 citations, six studies met the eligibility criteria. All six studies were retrospective case series (level 4 evidence). The findings of this study indicated that operative management of grade III acromioclavicular dislocation results in a better cosmetic outcome (P < 0.0001) but greater duration of sick leave compared to non-operative management (P < 0.001). There was no difference in strength, pain, throwing ability and incidence of acromioclavicular joint osteoarthritis compared to non-operative management. Only one study recorded and showed a higher Constant score for operative management compared to non-operative management (P = 0.003).

Conclusions: There is a lack of well-designed studies in the literature to justify the optimum mode of treatment of grade III acromioclavicular dislocations.

Figures

Fig. 1
Fig. 1
PRISMA chart illustrating the results of the search strategy
Fig. 2
Fig. 2
Funnel plot illustrating publication bias using the cosmetic results outcome measure
Fig. 3
Fig. 3
Forest plot illustrating constant score
Fig. 4
Fig. 4
Forest plot illustrating cosmetic outcome
Fig. 5
Fig. 5
Forest plot illustrating duration of sick leave
Fig. 6
Fig. 6
Forest plot illustrating infection rate

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