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Surgical versus conservative interventions for treating acromioclavicular dislocation of the shoulder in adults.

Abstract

BACKGROUND

Dislocation of the acromioclavicular joint is one of the most common shoulder problems in general orthopaedic practice. The question of whether surgery should be used remains controversial.

OBJECTIVES

To assess the relative effects of surgical versus conservative (non-surgical) interventions for treating acromioclavicular dislocations in adults.

SEARCH STRATEGY

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (to February 2009), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 1), MEDLINE (1966 to February 2009), EMBASE (1988 to February 2009), and LILACS (1982 to February 2009), trial registries and reference lists of articles. There were no restrictions based on language or publication status.

SELECTION CRITERIA

All randomised and quasi-randomised trials that compared surgical with conservative treatment of acromioclavicular dislocation in adults were included.

DATA COLLECTION AND ANALYSIS

All review authors independently performed study selection. Two authors independently assessed the included trials and performed data extraction.

MAIN RESULTS

Three trials were included in this review. These involved a total of 174 mainly male participants. Two trials were randomised and one was quasi-randomised. None used validated measures for assessing functional outcome.Fixation of the acromioclavicular joint using coracoclavicular screws, acromioclavicular pins or, usually threaded, wires was compared with supporting the arm in a sling or similar device. There were no significant differences between the two groups in unsatisfactory longer-term (one year) shoulder function based on a composite measure including pain, movement and strength or function (risk ratio 1.49, 95% confidence interval 0.75 to 2.95), nor in treatment failure that generally required an operation (risk ratio 1.72, 95% confidence interval 0.72 to 4.12). However, there were fixation failures in all three trials. Particularly, the trial using wires reported a high incidence of wire breakage (16/39 (41%)). Two trials reported that surgery significantly delayed the return to work. The methods used in the three trials also meant a routine second operation for implant removal was necessary.

AUTHORS' CONCLUSIONS

There is insufficient evidence from randomised controlled trials to determine when surgical treatment is indicated for acromioclavicular dislocation in adults in current practice. Sufficiently powered, good quality, well-reported randomised trials of currently-used surgical interventions versus conservative treatment for well-defined injuries are required.

Authors+Show Affiliations

Department of Orthopaedics and Traumatology, Universidade Federal de São Paulo, Rua Borges Lagoa, 783 - 5th Floor, São Paulo, São Paulo, Brazil, 04038-032.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

20687087

Citation

Tamaoki, Marcel Jun S., et al. "Surgical Versus Conservative Interventions for Treating Acromioclavicular Dislocation of the Shoulder in Adults." The Cochrane Database of Systematic Reviews, 2010, p. CD007429.
Tamaoki MJ, Belloti JC, Lenza M, et al. Surgical versus conservative interventions for treating acromioclavicular dislocation of the shoulder in adults. Cochrane Database Syst Rev. 2010.
Tamaoki, M. J., Belloti, J. C., Lenza, M., Matsumoto, M. H., Gomes Dos Santos, J. B., & Faloppa, F. (2010). Surgical versus conservative interventions for treating acromioclavicular dislocation of the shoulder in adults. The Cochrane Database of Systematic Reviews, (8), CD007429. https://doi.org/10.1002/14651858.CD007429.pub2
Tamaoki MJ, et al. Surgical Versus Conservative Interventions for Treating Acromioclavicular Dislocation of the Shoulder in Adults. Cochrane Database Syst Rev. 2010 Aug 4;(8)CD007429. PubMed PMID: 20687087.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical versus conservative interventions for treating acromioclavicular dislocation of the shoulder in adults. AU - Tamaoki,Marcel Jun S, AU - Belloti,João Carlos, AU - Lenza,Mário, AU - Matsumoto,Marcelo Hide, AU - Gomes Dos Santos,Joao Baptista, AU - Faloppa,Flávio, Y1 - 2010/08/04/ PY - 2010/8/6/entrez PY - 2010/8/6/pubmed PY - 2010/8/26/medline SP - CD007429 EP - CD007429 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 8 N2 - BACKGROUND: Dislocation of the acromioclavicular joint is one of the most common shoulder problems in general orthopaedic practice. The question of whether surgery should be used remains controversial. OBJECTIVES: To assess the relative effects of surgical versus conservative (non-surgical) interventions for treating acromioclavicular dislocations in adults. SEARCH STRATEGY: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (to February 2009), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 1), MEDLINE (1966 to February 2009), EMBASE (1988 to February 2009), and LILACS (1982 to February 2009), trial registries and reference lists of articles. There were no restrictions based on language or publication status. SELECTION CRITERIA: All randomised and quasi-randomised trials that compared surgical with conservative treatment of acromioclavicular dislocation in adults were included. DATA COLLECTION AND ANALYSIS: All review authors independently performed study selection. Two authors independently assessed the included trials and performed data extraction. MAIN RESULTS: Three trials were included in this review. These involved a total of 174 mainly male participants. Two trials were randomised and one was quasi-randomised. None used validated measures for assessing functional outcome.Fixation of the acromioclavicular joint using coracoclavicular screws, acromioclavicular pins or, usually threaded, wires was compared with supporting the arm in a sling or similar device. There were no significant differences between the two groups in unsatisfactory longer-term (one year) shoulder function based on a composite measure including pain, movement and strength or function (risk ratio 1.49, 95% confidence interval 0.75 to 2.95), nor in treatment failure that generally required an operation (risk ratio 1.72, 95% confidence interval 0.72 to 4.12). However, there were fixation failures in all three trials. Particularly, the trial using wires reported a high incidence of wire breakage (16/39 (41%)). Two trials reported that surgery significantly delayed the return to work. The methods used in the three trials also meant a routine second operation for implant removal was necessary. AUTHORS' CONCLUSIONS: There is insufficient evidence from randomised controlled trials to determine when surgical treatment is indicated for acromioclavicular dislocation in adults in current practice. Sufficiently powered, good quality, well-reported randomised trials of currently-used surgical interventions versus conservative treatment for well-defined injuries are required. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/20687087/Surgical_versus_conservative_interventions_for_treating_acromioclavicular_dislocation_of_the_shoulder_in_adults_ L2 - https://doi.org/10.1002/14651858.CD007429.pub2 DB - PRIME DP - Unbound Medicine ER -