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Open reduction and tunneled suspension device fixation not superior to conservative care for acromioclavicular joint dislocation
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Although open reduction and tunneled suspension device fixation achieved anatomical reduction and functional outcome among patients with acromioclavicular joint dislocations, results published in The Journal of Bone and Joint Surgery showed the fixation was not superior to nonoperative management at 1 year postoperatively.
Researchers randomly assigned 60 patients with an acute type 3 or 4 disruption of the acromioclavicular joint to undergo open reduction and tunneled suspension device (ORTSD) fixation or nonoperative treatment. At 6 weeks, 3 months, 6 months and 1 year after treatment, researchers assessed functional outcomes using the DASH as the primary outcome measure and the Oxford Shoulder Score and SF-12 as secondary outcome measures. Researchers evaluated reduction with use of radiographs and noted any complications at each assessment. Researchers also evaluated the economic implication of each treatment.
Compared with patients who underwent nonoperative treatment, results showed a significantly lower mean degree of radiographic displacement in patients who underwent ORTSD fixation. Researchers noted a mean DASH score of 4.67 and 5.63 and a mean Oxford Shoulder Score of 45.72 and 45.63 in the nonoperative group and ORTSD fixation group, respectively, at 1 year postoperatively. At 6 weeks postoperatively, researchers found inferior DASH scores in patients who underwent ORTSD fixation. According to results, five patients underwent a surgical procedure after failed nonoperative treatment. Significantly higher costs were found with ORTSD fixation vs. nonoperative treatment, researchers noted.
“Future challenges include identifying patients who are likely to experience failed nonoperative management,” the authors wrote. “We believe treatment should be individualized on the basis of age, activity level and expectations.” – by Casey Tingle
Disclosures: Murray reports he receives support from Arthrex. Please see the full study for a list of all other authors’ relevant financial disclosures.
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