Treatment of acute grade III acromioclavicular dislocation: a lack of evidence

Ceccarelli, E.; Bondì, R.; Alviti, Federica; Garofalo, Raffaele; Miulli, F.; Padua, R.

doi:10.1007/s10195-008-0013-7

Cited by 103 publications

(66 citation statements)

References 9 publications

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“…Furthermore, each guideline explicitly linked the recommendations to the supporting evidence, guidelines all were reviewed externally, and a procedure for updating the guideline was consistently described. Common criticisms of clinical practice guidelines are that they fail to cite high levels of evidence [11]; however, although the volume of Levels I and II evidence has increased in orthopaedics during the last 10 years [8], areas remain in the specialty where high-quality evidence is lacking [6]. Recommendations, although often inconclusive, were based on the best available evidence.…”

Section: Discussionmentioning

confidence: 99%

High Methodologic Quality But Poor Applicability: Assessment of the AAOS Guidelines Using The AGREE II Instrument

Sabharwal

Patel

Gauher

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background The American Academy of Orthopaedic Surgeons (AAOS) is a globally recognized leader in musculoskeletal and orthopaedic education. Clinical guidelines are one important focus of the AAOS' educational efforts. Although their recommendations sometimes generate controversy, a critical appraisal of the overall quality of these guidelines has not, to our knowledge, been reported. Questions/purposes We wished to assess the overall quality of the AAOS guidelines using the AGREE II (Advancing Guideline Development, Reporting and Evaluation in Health Care) instrument. Methods All 14 guidelines available on the AAOS website as of August 2, 2013 were evaluated. Appraisal was performed by three reviewers, independently, using the AGREE II instrument. This is an internationally recognized and validated assessment tool for evaluating guideline quality. Interrater reliability was calculated and descriptive statistics were performed. Strong interrater reliability was shown using a Spearman's Rho test (correlation coefficient C 0.95). Results The overall results for AGREE II domains across all 14 guidelines were: scope and purpose (median score, 95%), stakeholder involvement (median score, 83%), rigor of development (median score, 94%), clarity of presentation (median score, 92%), applicability (median score, 48%), and editorial independence (median score, 79%). Conclusions This study showed that the overall quality of the AAOS guidelines is high, however their applicability was found to be poor. The value of guidelines that have a high quality but that are difficult for clinicians to implement is questionable. Numerous suggestions have been proposed to improve applicability including; health economist involvement in guideline production, implementation of pilot studies and audit to monitor uptake of the guidelines and clinician feedback sessions and barrier analysis studies. Future AAOS guidelines should consider and implement steps that can improve their applicability.

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Section: Discussionmentioning

confidence: 99%

High Methodologic Quality But Poor Applicability: Assessment of the AAOS Guidelines Using The AGREE II Instrument

Sabharwal

Patel

Gauher

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…5,6) Many operative techniques have been developed over the years. However, the optimal operative treatments among these options is still unclear.…”

Section: Introductionmentioning

confidence: 99%

Clinical and Radiological Outcomes of Acute Acromioclavicular Joint Dislocation: Comparison of Hook Plate Fixation with Single Tight Rope Technique

Lee¹,

Kim²,

Kook³

2017

Clinics in Shoulder and Elbow

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Background: This study was conducted to compare the clinical and radiological outcomes of the locking hook plate fixation (HP) technique and the single tight rope (TR) technique applied for acute high-grade acromioclavicular (AC) joint separations. Methods: Between 2009 and 2014, 135 consecutive patients with acute AC joint separation Rockwood types III, IV, and V were subjected to surgical reconstruction. One hundred fourteen patients (84.4%) were available for retrospective evaluation. Of them, 62 and 52 were treated using the single TR group and clavicular HP group techniques, respectively. The visual analogue scale, Constant, American Shoulder and Elbow Surgeons (ASES), and Taft scores were used for clinical assessment. Postoperative shoulder range of motion was also assessed. An anteroposterior radiograph of the coracoclavicular distance (CCD) was obtained to evaluate the radiographic signs of recurrence. Results: The TR group patients had better Constant, ASES, and Taft scores than the HP group patients. The loss of reduction in terms of the CCD did not differ between groups. Subacromial osteolysis was observed in 34.6% of the cases in the HP group. However, there were no significant differences in the clinical outcomes between the patients with and without osteolysis in the HP group. Subcoracoid osteolysis, drill tunnel widening, and metal displacement were observed in 3.2%, 22.6%, and 4.8% of the cases in the TR group, respectively. Conclusions: The single TR technique was relatively more effective at treating acute high-grade AC joint injuries than the HP fixation technique (level of evidence: therapeutic; retrospective comparative study, Level III). (Clin Shoulder Elbow 2017;20(3):153-161)

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“…Full activities resume as comfort allows. Consensus for non-operative treatment [ 4 , 13 , 14 ] Lack of evidence [ 6 ] Type III No consensus for type of treatment [ 5 ] No reason to recommend operative treatment [ 4 ] Lack of evidence [ 6 ] Non-operative treatment is more superior [ 13 ] Type IV Lack of evidence [ 5 ] Consensus for operative treatment [ 14 ] Lack of evidence [ 6 ] Type V-VI Consensus for operative treatment [ 5 ] Consensus for operative treatment [ 14 ] Lack of evidence [ 6 ] …”

Section: Treatment Strategymentioning

confidence: 99%