Operative Versus Nonoperative Management of Acute High-Grade Acromioclavicular Dislocations: A Systematic Review and Meta-Analysis

Objectives: Management of high-grade acromioclavicular (AC) joint dislocations has been controversial. Recent studies suggest no difference in outcomes between operative and nonoperative management of Rockwood types III-V injuries. The objective of this meta-analysis is to compare outcomes between operative and nonoperative management of high-grade AC joint dislocations. Data Sources: Search was conducted using PubMed, Embase, and Cochrane databases through October 2016. A broad search strategy was used to identify English, comparative studies of AC joint dislocations. Study Selection: Inclusion criteria included comparative studies of AC joint dislocations in adult patients with acute, high-grade AC dislocations. Data Extraction: Two authors independently reviewed and assessed for bias according to the U.S. Preventative Task Force Quality Rating Criteria. Data were extracted for validated functional scores, clinical and radiographic outcomes, and complications. Data Synthesis: Nineteen studies (n = 954) were included in the meta-analysis. Operative group had better cosmetic outcome (odds ratio [OR] = 0.05; P < 0.00001) and radiographic reduction (OR = 24.94; P < 0.0001). Constant scores favored the operative group, although the difference may not be clinically significant (MD = 3.14; P = 0.03). Nonoperative treatment was associated with faster return to work (MD = 4.17, P < 0.0001), lower implant complications (OR = 7.19, P < 0.0001), and reduced infection rate (OR = 3.65, P = 0.007). No difference was found for DASH Score, return to sport, radiologic evidence of osteoarthritis, and need for surgery after failed management. Conclusions: No clinical difference in functional outcome scores was detected between operative and nonoperative management of high-grade AC joint dislocations. Patients in the nonoperative cohort had a more rapid return to work, but were associated with a poorer cosmetic outcome.