No difference in clinical outcome at 2-year follow-up in patients with type III and V acromioclavicular joint dislocation treated with hook plate or physiotherapy: a randomized controlled trial.

BACKGROUND: The need for operative treatment of acute acromioclavicular (AC) joint dislocation is unclear. The purpose of this randomized controlled trial was to compare the outcomes after operative treatment with a hook plate with the outcomes after nonoperative treatment of acute Rockwood type III and type V AC joint dislocations separately. METHODS: The inclusion criteria were patients aged 18-65 years with an acute type III or type V AC joint dislocation with the availability to start treatment within 3 weeks after trauma. All patients received the same standardized outpatient rehabilitation protocol and were followed up for 24 months. Assessments were based on radiographs, clinical examination findings, and questionnaires. The primary outcome was the Constant score (CS). The secondary outcomes were as follows: Subjective Shoulder Value (SSV), QuickDASH score (abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire), shoulder pain at rest and during movement rated using a visual analog scale, EQ-5D (European Quality of Life 5 Dimensions) score, patient satisfaction, cosmesis, complications, and adverse events. The 4 groups were compared using 1-way analysis of variance and intention to treat. RESULTS: The included patients (N = 124) (mean age, 40 years [range, 18-64 years]; 91% male patients) were randomized, stratified by type, to nonoperative treatment (type III, n = 33; type V, n = 30) or operative treatment with a hook plate (type III, n = 30; type V, n = 31) at a single center. Three patients randomized to physiotherapy dropped out before any follow-up measures, leaving 121 patients in the study. Complete clinical follow-up data were obtained from 118 patients at 24 months. At 3 months, patients in both nonoperatively treated groups had a significantly better mean CS, SSV, and QuickDASH score and had less pain at rest and during movement compared with patients treated operatively. At 6, 12, and 24 months, there were no significant differences in the CS, SSV, QuickDASH score, pain, or EQ-5D score between the groups regardless of intervention. At 24 months, the mean CS was 88 for nonoperatively treated type III patients vs. 91 for operatively treated type III patients and was 90 vs. 91 for type V patients (P = .477). At final follow-up, patients had regained 97% of the mean CS comparing the uninjured and injured shoulders and 86% of the patients rated the result as excellent or good. Eleven patients assigned to nonoperative treatment (18%, 6 type III and 5 type V) underwent surgery within 19 months. CONCLUSIONS: Both the nonoperative and operative treatment groups had very good restoration of shoulder function and patient satisfaction at 24 months, and operative treatment did not lead to better outcomes compared with nonoperative treatment. In conclusion, our study does not support surgery with a hook plate in patients with acute Rockwood type III or type V AC joint dislocations.

Acute surgical treatment of acromioclavicular dislocation type V with a hook plate: superiority to late reconstruction.

BACKGROUND: Outcomes for patients with acromioclavicular joint dislocation, Rockwood type V, treated with acute or delayed hook plate surgery were investigated. MATERIALS AND METHODS: Patients treated with a hook plate for acromioclavicular joint dislocation, Rockwood type V, were retrospectively evaluated 1 to 8 years after the injury. Of 41 patients, 37 were re-evaluated, 32 in person and 5 by telephone or letter. The acute surgery group comprised 22 patients operated on with a hook plate within 4 weeks after the injury. The delayed surgery group comprised 15 patients, with unacceptable pain or functional disability after a minimum of 4 months of conservative treatment, who were operated on with modified Weaver-Dunn procedure augmented with a hook plate. The evaluation was based on radiographs, registration of activity level, and shoulder function. RESULTS: The median Constant Score was 91 for the acute surgery group and 85 for the delayed surgery group (P = .097). The acutely treated patients had better outcomes according to the median Shoulder Pain and Disability Index (SPADI; P = .006), shortened version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH; P = .002), and Subjective Shoulder Value (P = .032). The acutely treated patients had less pain in their injured shoulder during rest (P = .014) and during movement (P = .005). There was a significant difference in subluxation between the groups in favor of the acute group, shown by weighted radiographs (P = .011), but no significant relation between subluxation on the weighted radiographs and the shoulder function according to Constant Score at follow-up (r(s) = .122, P = .619). CONCLUSIONS: Patients treated with acute surgery had a more satisfactory outcome than those with late surgery after failed conservative treatment.

Surgical treatment of chronic acromioclavicular dislocations: a comparative study of Weaver-Dunn augmented with PDS-braid or hook plate.

BACKGROUND: The objective was to evaluate the Weaver-Dunn procedure (W-D) for chronic acromioclavicular joint dislocation augmented with a temporary hook plate or braided polydioxanone (PDS) loop suture. METHODS: Retrospective comparative study of all patients treated for chronic acromioclavicular joint dislocation 1995-2006; 47 out of 52 included patients were re-examined. Twenty-three patients were operated with W-D augmented with PDS-braid and 24 patients with W-D and a temporary hook plate. Thirty-six were re-examined and new radiographs were taken, while 11 patients were evaluated over the phone. RESULTS: The mean Constant score was 85 for the PDS group and 75 for the hook plate group (P = .21). There was no difference in outcome between the groups, according to the mean SPADI (P = .19), QuickDASH (P = .06), or Subjective Shoulder Value (P = .13). The patients in the hook plate group had more pain during movement (P = .003) at Visual Analogue Scale. Furthermore, there was no difference in the degree of subluxation after surgery between the PDS group and the hook plate group (P = .80). CONCLUSION: Reconstruction of chronic acromioclavicular joint dislocations restores good shoulder function and results in satisfied patients. Patients treated with the hook plate had more pain during movement and rest at the follow-up. The more rigid hook plate had no advantage and did not improve functional outcome. Furthermore, the extraction of the hook plate results in an additional surgical procedure.