Type III acromioclavicular dislocation and persistence of pain in the surgical versus conservative approach: a systematic review.

Abstract

Type III acromioclavicular dislocation is characterized by the complete rupture of the acromioclavicular and coracoclavicular ligaments. The approach to acute type III acromioclavicular dislocation is still dichotomous in the literature, since both the non-surgical and surgical approaches have similar clinical results. This study is a systematic review applying the PRISMA guidelines. The data sources used were PubMed/MEDLINE, Embase, Cochrane and Scopus. The search was carried out using the descriptors "acromioclavicular dislocation", "type III", "treatment" and "conservative". The methodological evaluation was carried out using the Newcastle-Ottawa scale. The scales used to assess pain were the Constant Score and the Visual Analog Scale (VAS). After analysis, 7 studies were reviewed, from which 299 patients were included, 148 undergoing conservative treatment and 151 undergoing surgical treatment. The average age of the patients was 41, with a predominance of males. The average follow-up time was 5.3 years for conservative treatment and 3.7 years for surgical treatment. With regard to the functional scales, the Constant Score (CS) was higher in the surgical approach and the visual analog scale was lower. The scores for the surgical modality were CS 90.2 and VAS 0.83, while the conservative modality was CS 87.9 and VAS 1.66. There seems to be no significant difference in the persistence of pain between conservative and surgical treatment. The choice of treatment still depends on the surgeon, and risk factors and complications should help in the decision.