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Results of Operative and Nonoperative Treatment of Rockwood Types III and V Acromioclavicular Joint Dislocation: A Prospective, Randomized Trial With an 18- to 20-Year Follow-up.

Joukainen A, Kröger H, Niemitukia L, Mäkelä EA, Väätäinen U - Orthop J Sports Med (2014)

Bottom Line: Nonoperatively treated patients received a reduction splint for 4 weeks.Nonoperative treatment was shown to produce more prominent or unstable and radiographically wider ACJs than was operative treatment, but clinical results were equally good in the study groups at 18- to 20-year follow-up.Both treatment methods showed statistically significant radiographic elevations of the lateral clavicle when compared with a noninjured ACJ.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland.

ABSTRACT

Background: The optimal treatment of acute, complete dislocation of the acromioclavicular joint (ACJ) is still unresolved.

Purpose: To determine the difference between operative and nonoperative treatment in acute Rockwood types III and V ACJ dislocation.

Study design: Randomized controlled trial; Level of evidence, 2.

Methods: In the operative treatment group, the ACJ was reduced and fixed with 2 transarticular Kirschner wires and ACJ ligament suturing. The Kirschner wires were extracted after 6 weeks. Nonoperatively treated patients received a reduction splint for 4 weeks. At the 18- to 20-year follow-up, the Constant, University of California at Los Angeles Shoulder Rating Scale (UCLA), Larsen, and Simple Shoulder Test (SST) scores were obtained, and clinical and radiographic examinations of both shoulders were performed.

Results: Twenty-five of 35 potential patients were examined at the 18- to 20-year follow-up. There were 11 patients with Rockwood type III and 14 with type V dislocations. Delayed surgical treatment for ACJ was used in 2 patients during follow-up: 1 in the operatively treated group and 1 in the nonoperatively treated group. Clinically, ACJs were statistically significantly less prominent or unstable in the operative group than in the nonoperative group (normal/prominent/unstable: 9/4/3 and 0/6/3, respectively; P = .02) and in the operative type III (P = .03) but not type V dislocation groups. In operatively and nonoperatively treated patients, the mean Constant scores were 83 and 85, UCLA scores 25 and 27, Larsen scores 11 and 11, and SST scores 11 and 12 at follow-up, respectively. There were no statistically significant differences in type III and type V dislocations. In the radiographic analysis, the ACJ was wider in the nonoperative than the operative group (8.3 vs 3.4 mm; P = .004), and in the type V dislocations (nonoperative vs operative: 8.5 vs 2.4 mm; P = .007). There was no statistically significant difference between study groups in the elevation of the lateral end of the clavicle. Both groups showed equal levels of radiologic signs of ACJ osteoarthritis and calcification of the coracoclavicular ligaments.

Conclusion: Nonoperative treatment was shown to produce more prominent or unstable and radiographically wider ACJs than was operative treatment, but clinical results were equally good in the study groups at 18- to 20-year follow-up. Both treatment methods showed statistically significant radiographic elevations of the lateral clavicle when compared with a noninjured ACJ.

No MeSH data available.


Related in: MedlinePlus

Flowchart of patients with acromioclavicular joint dislocation included in the 18- to 20-year follow-up study.
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fig1-2325967114560130: Flowchart of patients with acromioclavicular joint dislocation included in the 18- to 20-year follow-up study.

Mentions: The Committee on Research Ethics of the Hospital District of North-Savo approved the study. The 40 patients in this study were recruited between May 1989 and July 1991 at the Kuopio University Hospital, Kuopio, Finland. The flowchart of the study patients is presented in Figure 1. Nineteen patients were randomized to the OT group and 21 to the NOT group.


Results of Operative and Nonoperative Treatment of Rockwood Types III and V Acromioclavicular Joint Dislocation: A Prospective, Randomized Trial With an 18- to 20-Year Follow-up.

Joukainen A, Kröger H, Niemitukia L, Mäkelä EA, Väätäinen U - Orthop J Sports Med (2014)

Flowchart of patients with acromioclavicular joint dislocation included in the 18- to 20-year follow-up study.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4555529&req=5

fig1-2325967114560130: Flowchart of patients with acromioclavicular joint dislocation included in the 18- to 20-year follow-up study.
Mentions: The Committee on Research Ethics of the Hospital District of North-Savo approved the study. The 40 patients in this study were recruited between May 1989 and July 1991 at the Kuopio University Hospital, Kuopio, Finland. The flowchart of the study patients is presented in Figure 1. Nineteen patients were randomized to the OT group and 21 to the NOT group.

Bottom Line: Nonoperatively treated patients received a reduction splint for 4 weeks.Nonoperative treatment was shown to produce more prominent or unstable and radiographically wider ACJs than was operative treatment, but clinical results were equally good in the study groups at 18- to 20-year follow-up.Both treatment methods showed statistically significant radiographic elevations of the lateral clavicle when compared with a noninjured ACJ.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland.

ABSTRACT

Background: The optimal treatment of acute, complete dislocation of the acromioclavicular joint (ACJ) is still unresolved.

Purpose: To determine the difference between operative and nonoperative treatment in acute Rockwood types III and V ACJ dislocation.

Study design: Randomized controlled trial; Level of evidence, 2.

Methods: In the operative treatment group, the ACJ was reduced and fixed with 2 transarticular Kirschner wires and ACJ ligament suturing. The Kirschner wires were extracted after 6 weeks. Nonoperatively treated patients received a reduction splint for 4 weeks. At the 18- to 20-year follow-up, the Constant, University of California at Los Angeles Shoulder Rating Scale (UCLA), Larsen, and Simple Shoulder Test (SST) scores were obtained, and clinical and radiographic examinations of both shoulders were performed.

Results: Twenty-five of 35 potential patients were examined at the 18- to 20-year follow-up. There were 11 patients with Rockwood type III and 14 with type V dislocations. Delayed surgical treatment for ACJ was used in 2 patients during follow-up: 1 in the operatively treated group and 1 in the nonoperatively treated group. Clinically, ACJs were statistically significantly less prominent or unstable in the operative group than in the nonoperative group (normal/prominent/unstable: 9/4/3 and 0/6/3, respectively; P = .02) and in the operative type III (P = .03) but not type V dislocation groups. In operatively and nonoperatively treated patients, the mean Constant scores were 83 and 85, UCLA scores 25 and 27, Larsen scores 11 and 11, and SST scores 11 and 12 at follow-up, respectively. There were no statistically significant differences in type III and type V dislocations. In the radiographic analysis, the ACJ was wider in the nonoperative than the operative group (8.3 vs 3.4 mm; P = .004), and in the type V dislocations (nonoperative vs operative: 8.5 vs 2.4 mm; P = .007). There was no statistically significant difference between study groups in the elevation of the lateral end of the clavicle. Both groups showed equal levels of radiologic signs of ACJ osteoarthritis and calcification of the coracoclavicular ligaments.

Conclusion: Nonoperative treatment was shown to produce more prominent or unstable and radiographically wider ACJs than was operative treatment, but clinical results were equally good in the study groups at 18- to 20-year follow-up. Both treatment methods showed statistically significant radiographic elevations of the lateral clavicle when compared with a noninjured ACJ.

No MeSH data available.


Related in: MedlinePlus