Search Filters

  • Presentation Format
  • Media Type
  • Diagnosis / Condition
  • Diagnosis Method
  • Patient Populations
  • Treatment / Technique

Is Surgical Treatment An Advantage When Treating Acute AC Joint Dislocation Type III And V? A Prospective Randomized Clinical Trial

Is Surgical Treatment An Advantage When Treating Acute AC Joint Dislocation Type III And V? A Prospective Randomized Clinical Trial

Helena Boström Windhamre, MD, SWEDEN Johan von Heideken, MD, PhD, SWEDEN Viveka Une-Larsson, PT, SWEDEN Wilhelmina Ekström, MD, Associate Professor, SWEDEN Anders Ekelund, SWEDEN

Orthopedic Dep Capio St Görans Hospital, Stockholm, SWEDEN

2021 Congress   Abstract Presentation   5 minutes   Not yet rated


Anatomic Location

Diagnosis / Condition

Treatment / Technique

Anatomic Structure

Diagnosis Method

Sports Medicine

This media is available to current ISAKOS Members, Global Link All-Access Subscribers and Webinar/Course Registrants only.

Summary: No longterm difference in clinical outcome in patients with acute AC joint dislocation Rockwood type III and V treated with physiotherapy or surgery


To evaluate outcome after surgery and conservative treatment of acute acromioclavicular joint dislocation Rockwood type III and V


Acromioclavicular joint (AC joint) dislocation is a common injury among sport-active young to middle-aged people. AC joint dislocations Rockwood type I and II are treated conservatively. Treatment of grade III is controversial, while surgery is often recommended for grade V.


A prospective randomized clinical trial comparing the results after surgery or conservative treatment of acute Rockwood type III and V dislocation was performed.
Patients aged 18-65 years were included after classification of the AC-joint dislocation on plain radiographs of both shoulders, information and written consent. Patients were randomized to surgical treatment with hook plate within 3 weeks after injury, or physiotherapy. The hook plate was routinely removed after 3 months. Clinical follow-up was performed at 3, 6, 12 and 24 months by an orthopedic surgeon and a blinded physiotherapist. Primary outcome was Constant score (CS). Secondary outcomes were Subjective Shoulder Value (SSV), QuickDASH, shoulder pain at rest and during activity on a Visual Analogue Scale 0-10, EQ5D and adverse events. Radiographic follow up with plain radiographs was performed at 24 months. Statistical data analysis was performed by an unbiased evaluator and data was analyzed by intention-to-treat (ITT).


124 patients were enrolled and randomized in the study; 114 men and 10 women with a mean age of 40 years (range 18-64). At 1 month patients treated without surgery had significantely better EQ-5D index. At 3 months patients treated conservatively had significant better CS compared to patients treated with surgery (Rockwood III 81 vs 57, Rockwood V 84 vs 64, p<0.001) as well as significantly less pain during movement on a VAS scale compared to patients treated with surgery (Rockwood type III 1.5 vs 2.8, Rockwood V 1.5 vs 2, p=0.002). SSV at 3 months was significantly better for the conservatively treated patients (Rockwood III 73 vs 50, Rockwood V 73 vs 57, p<0.001) as well as Quick-DASH (Rockwood III 18 vs 34, Rockwood V 13 vs 32, p<0.001).
Follow-up at 6, 12 and 24 months showed no significant difference between the groups.

At 24 months CS for patients with Rockwood III and non-surgical treatment was 88 vs 91 after surgical treatment and for Rockwood V CS was 90 for non-surgical treatment vs 91 after surgical treatment, p=0.477.

Of the patients assigned to physiotherapy, 11 patients (18%, 6 type III and 5 type V), chose to have secondary surgery within 19 months (range 6-19).


Both treatments groups had very good restoration of shoulder function at 24 months, and operative treatment did not lead to better outcome compared to conservative treatment. In conclusion, our study did not support surgery with hook plate for patients with acute AC joint dislocation Rockwood type III or V.

More ISAKOS 2021: Global Content