Prospective Multicenter Randomized Controlled Trial of Surgical Versus Nonsurgical Treatment for Acute Rockwood Type 3 Acromioclavicular Injury

Mark Tauber; Thomas Hoffelner; Lars Lehmann; Natascha Kraus; Markus Scheibel; Philipp Moroder

doi:10.1177/23259671231190411

Prospective Multicenter Randomized Controlled Trial of Surgical Versus Nonsurgical Treatment for Acute Rockwood Type 3 Acromioclavicular Injury

Orthop J Sports Med. 2023 Aug 25;11(8):23259671231190411. doi: 10.1177/23259671231190411. eCollection 2023 Aug.

Authors

Mark Tauber^{1

2}, Thomas Hoffelner², Lars Lehmann³, Natascha Kraus^{4

5}, Markus Scheibel^{4

6}, Philipp Moroder^{4

6}

Affiliations

¹ German Shoulder Center, ATOS Clinic, Munich, Germany.
² Department of Orthopaedic and Trauma Surgery, Paracelsus Medical University, Salzburg, Austria.
³ Department of Orthopaedics and Traumatology, St Vinzenz Kliniken, Karlsruhe, Germany.
⁴ Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charitè University Hospital, Berlin, Germany.
⁵ Department of Orthopaedics, University Clinic, Greifswald, Germany.
⁶ Department of Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland.

Abstract

Background: Evidence for the superiority of surgical versus nonsurgical treatment of Rockwood type 3 acromioclavicular joint (ACJ) dislocation is still lacking.

Hypothesis: It was hypothesized that surgical treatment will outperform nonsurgical treatment.

Study design: Randomized controlled trial; Level of evidence, 1.

Methods: A prospective randomized trial involving 4 study centers was performed from January 1, 2011, to March 31, 2016. A total of 85 patients with acute Rockwood type 3 ACJ dislocations were allocated randomly to receive either nonsurgical or surgical treatment. A total of 70 patients were treated as allocated, and 8 patients made an early crossover from nonsurgical to surgical treatment, leaving 47 patients treated surgically and 31 patients nonsurgically. All patients were followed up longitudinally, including clinical evaluation using the Constant score and standardized radiographic evaluation, with final follow-up after 2 years.

Results: At no follow-up time point was there a significant difference in Constant score between the surgically and nonsurgically treated patients. Radiographic analysis showed not only an inferior coracoclavicular distance at all follow-up points for surgical treatment but also a higher incidence of posttraumatic osteoarthritis and heterotopic ossifications, without any negative clinical correlation. With regard to complications, 1 patient (3%) in the nonsurgical group underwent secondary surgical ACJ stabilization. The revision rate after surgical treatment was 17% (P < .001). Neither primary horizontal instability nor younger age were associated with inferior clinical outcomes after nonsurgical treatment.

Conclusion: Surgical treatment of ACJ Rockwood type 3 injuries did not lead to superior functional outcomes. Neither younger age nor horizontal instability were associated with inferior outcomes after nonsurgical treatment. Surgical treatment led to a slower recovery and to higher complication and revision rates.

Registration: ISRCTN registry (study ID: ISRCTN92265154).

Keywords: Rockwood type 3; acromioclavicular dislocation; functional outcome; skillful neglect; surgery.