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Level 1 study shows no evidence that surgery is better for AC dislocation
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MINNEAPOLIS – The results of a multicenter randomized, prospective clinical trial showed that surgical treatment of acute dislocations of the acromioclavicular joint was not superior to conservative care at early follow-up.
“Surgical repair with hook fixation did not improve shoulder outcome in acute [acromioclavicular] AC dislocations. Shoulder function and clinical outcomes were consistently good in both groups with a mean Constant score over 90 and a mean DASH score of approximately eight in both groups at 1 year,” Michael D. McKee, MD, said at the Orthopaedic Trauma Association Annual Meeting 2012, here.
Michael D. McKee
McKee and colleagues studied 83 patients with complete AC joint dislocations who underwent either nonoperative treatment or surgical repair with hook plate fixation within 3 weeks of sustaining injury. In the hook plate group, McKee noted that surgeons “did not, in general, use any other augmentation devices. Although, this was allowed, it was not routinely done in this trial.”
Thirty-two of the 40 patients in the hook plate group had the plate removed 8 months after the injury as a planned second stage of the operation, and eight patients tolerated the plate and did not have it removed.
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The investigators found no significant differences between the treatment groups for mechanism of injury and initial degree of displacement. Although the conservatively treated group showed better Constant and DASH scores soon after care, McKee said there were no significant differences between the groups for these scores at 1 year.
In the hook plate group, four patients had complete redislocation, 14 subluxated, and 22 remained reduced. All patients in the nonoperative group remained subluxated or completely dislocated.
“This was statistically significant,” McKee said.
The hook plate group had four major complications including two acromial erosions and two plate failures or pull offs.
“All four of these, when we look back in retrospect, were due to over reduction of the joint,” he said.
The surgeons have since refined their technique, he said.
“Hook plate fixation, especially with some refinement of the technique, is a safe operation that consistently restored radiographic alignment,” McKee said. “We have not been able unfortunately to reliably identify the small subgroup of patients who seem to be unhappy following the nonoperative care of this injury.”
Reference:
McKee MD, Pelet S, Vincente MR. Operative versus nonoperative treatment of acute dislocation of the acromioclavicular joint: Results of a multicenter randomized, prospective clinical trial. Paper #91. Presented at the Orthopaedic Trauma Association Annual Meeting 2012. Oct. 3-6. Minneapolis.
Disclosure: McKee is on the speakers’ bureau and is a paid consultant for Synthes, and receives royalties from Stryker.
