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

Abstract

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.

Acromioclavicular joint injuries

“…The evolution and resultant heterogeneity of surgical procedures makes direct comparison between them difficult. In general, constant scores seem to favor operative treatment, while the simple shoulder test and Oxford shoulder score show no differences (Gstettner et al, 2008;Smith et al, 2011;Tamaoki et al, 2010). However, those improvements may be offset by a delayed return to work (Smith et al, 2011;Gstettner et al, 2008).…”

Acromioclavicular joint injuries

“…The evolution and resultant heterogeneity of surgical procedures makes direct comparison between them difficult. In general, constant scores seem to favor operative treatment, while the simple shoulder test and Oxford shoulder score show no differences (Gstettner et al, 2008;Smith et al, 2011;Tamaoki et al, 2010). However, those improvements may be offset by a delayed return to work (Smith et al, 2011;Gstettner et al, 2008).…”

Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence

“…Evidence base: Evidence for the effectiveness of surgery for the musculoskeletal pain presentations (excluding multi-site pain) was synthesised from one guideline and a care pathway document [ 38 , 47 ], nine Cochrane reviews [ 176 – 184 ] and eight systematic reviews [ 66 , 185 – 191 ]. Reviews were mostly high in methodological quality.…”

“…In specific cases, such as arthroscopic debridement and joint lavage of the knee, available evidence indicates no clinically important benefit (SMD -0.11, 95% CI, to 0.42 to 0.21) for pain or function compared to control (SMD -0.10, 95% CI, -0.30 to 0.11) at three months [ 182 ]. Available evidence suggests there are no long-term benefits of surgical procedures for clinical outcomes compared with conservative treatment [ 177 , 184 – 188 , 190 ]. Neither was there strong evidence for a significant difference in favour of any particular surgical technique for any of the pain sites [ 182 , 183 , 189 , 191 ].…”

Review article: Best practice management of common shoulder injuries and conditions in the emergency department (part 4 of the musculoskeletal injuries rapid review series)

“…). At full text, 12 primary articles, 49 systematic review (SR) articles and 12 guidelines were included.…”

Acromioclavicular joint injuries

“…The evolution and resultant heterogeneity of surgical procedures makes direct comparison between them difficult. In general, constant scores seem to favor operative treatment, while the simple shoulder test and Oxford shoulder score show no differences (Gstettner et al, 2008;Smith et al, 2011;Tamaoki et al, 2010). However, those improvements may be offset by a delayed return to work (Smith et al, 2011;Gstettner et al, 2008).…”

Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence

“…Evidence base: Evidence for the effectiveness of surgery for the musculoskeletal pain presentations (excluding multi-site pain) was synthesised from one guideline and a care pathway document [ 38 , 47 ], nine Cochrane reviews [ 176 – 184 ] and eight systematic reviews [ 66 , 185 – 191 ]. Reviews were mostly high in methodological quality.…”

“…In specific cases, such as arthroscopic debridement and joint lavage of the knee, available evidence indicates no clinically important benefit (SMD -0.11, 95% CI, to 0.42 to 0.21) for pain or function compared to control (SMD -0.10, 95% CI, -0.30 to 0.11) at three months [ 182 ]. Available evidence suggests there are no long-term benefits of surgical procedures for clinical outcomes compared with conservative treatment [ 177 , 184 – 188 , 190 ]. Neither was there strong evidence for a significant difference in favour of any particular surgical technique for any of the pain sites [ 182 , 183 , 189 , 191 ].…”

Review article: Best practice management of common shoulder injuries and conditions in the emergency department (part 4 of the musculoskeletal injuries rapid review series)

“…). At full text, 12 primary articles, 49 systematic review (SR) articles and 12 guidelines were included.…”

Acromioclavicular joint injuries

“…The evolution and resultant heterogeneity of surgical procedures makes direct comparison between them difficult. In general, constant scores seem to favor operative treatment, while the simple shoulder test and Oxford shoulder score show no differences (Gstettner et al, 2008;Smith et al, 2011;Tamaoki et al, 2010). However, those improvements may be offset by a delayed return to work (Smith et al, 2011;Gstettner et al, 2008).…”

Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence

“…Evidence base: Evidence for the effectiveness of surgery for the musculoskeletal pain presentations (excluding multi-site pain) was synthesised from one guideline and a care pathway document [ 38 , 47 ], nine Cochrane reviews [ 176 – 184 ] and eight systematic reviews [ 66 , 185 – 191 ]. Reviews were mostly high in methodological quality.…”

“…In specific cases, such as arthroscopic debridement and joint lavage of the knee, available evidence indicates no clinically important benefit (SMD -0.11, 95% CI, to 0.42 to 0.21) for pain or function compared to control (SMD -0.10, 95% CI, -0.30 to 0.11) at three months [ 182 ]. Available evidence suggests there are no long-term benefits of surgical procedures for clinical outcomes compared with conservative treatment [ 177 , 184 – 188 , 190 ]. Neither was there strong evidence for a significant difference in favour of any particular surgical technique for any of the pain sites [ 182 , 183 , 189 , 191 ].…”

Review article: Best practice management of common shoulder injuries and conditions in the emergency department (part 4 of the musculoskeletal injuries rapid review series)

“…). At full text, 12 primary articles, 49 systematic review (SR) articles and 12 guidelines were included.…”