Hook plate fixation of acute grade III acromioclavicular (AC) joint dislocations resulted in similar clinical outcomes at 12 months compared with conservative therapy with a sling. Stéphane Pelet, MD, PhD, FRCSC, Hôpital Enfant-Jésus, Quebec, Quebec, Canada, presented data from a study comparing conservative treatment with surgical hook plate treatment [NCT01110304].

AC joint dislocation is a common injury and mainly results from an impact to the point of the shoulder. Conservative therapy with a sling is the predominant treatment, and the role for surgical therapy is still controversial. The purpose of this trial was to compare the efficacy of surgical treatment of acute grade III AC joint dislocation with a hook plate to the conservative management.

In this single-center, prospective trial, 56 patients with acute grade III AC dislocation were randomly assigned to undergo surgical treatment with hook plate fixation or conservative therapy with a sling. Patients were assessed at 1-year follow-up and then by telephone at 2 and 3 years. In patients who had undergone surgery, hardware removal was allowed at 6 months. Patient characteristics such as sex, smoking status, type of work (physical vs intellectual), and sporting level were similar among both arms.

The primary end point was Constant–Murley score at 1 year. Secondary end points included Disabilities of the Arm, Shoulder, and Hand (DASH) score; shoulder range of motion; return to main activities; radiographic assessment; American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form; Rowe assessment score; and complications.

Although patients in the surgical arm experienced significantly lower Constant–Murley scores from 6 weeks to 6 months (P < .01), by 12 months there was no significant difference compared with conservative therapy (P = .61; Figure 1). Similarly, the surgical group demonstrated higher DASH scores from 6 weeks to 6 months (P < .01), but there was no significant difference at 12 months compared with conservative therapy (P = .86).

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Figure 1.

Effect of Hook Plate Fixation on Outcomes in Acute Acromioclavicular Joint Dislocation

Reproduced with permission from S Pelet, MD, PhD, FRCSC.

At 1 year, there was a significant difference in radiographic evaluation between the 2 arms (P = .001). In the surgical arm, no joints remained dislocated, 3 were subluxated, and 23 were reduced. In the conservative-therapy arm, 30 joints were subluxated or dislocated. The coracoclavicular distance was significantly improved immediately after surgery for up to 12 months compared with the distance observed in patients who received conservative therapy (P < .01).

There were no complications in the conservative-therapy group. In patients who underwent surgery, 9 complications occurred, including 8 acromial erosions and 1 plate failure. In addition, 92% of patients underwent reoperation for plate removal, whereas no patients in the conservative-therapy group underwent surgery (P < .01). At 2- and 3-year follow-up, none of the patients had undergone further surgery for chronic AC joint pain or instability, and only 1 patient, who was treated with conservative therapy, reported slight pain but had full range of motion.

Prof Pelet concluded that the results from this study suggest that conservative management and surgical treatment of acute grade III AC dislocations result in similar outcomes by 12 months. Although safe, Prof Pelet pointed out that hook plate fixation was associated with high complication and reoperation rates. In addition, patients treated with conservative therapy appear satisfied with their care.