General Health Status after Non-operative versus Operative Treatment for Acute, Complete Acromio-clavicular Joint Dislocation: Results of a Multicenter, Randomized Clinical Trial.

OBJECTIVE: To assess the general health status of patients following non-operative (Non-op) versus operative (OP) treatment for acromioclavicular (AC) joint dislocations.

DESIGN: Multicenter, randomized controlled clinical trial.

SETTING: Eleven Canadian trauma centers.

PARTICIPANTS: Eighty-three patients with acute (≤ 28 days old), complete (Rockwood grades III, IV, or V) dislocations of the AC joint.

INTERVENTION: Participants were randomized to non-operative treatment or operative treatment with hook plate fixation.

MAIN OUTCOME MEASUREMENTS: Physical and mental health were evaluated using the Short Form-36 version 2 survey at baseline, six weeks, three months, six months, one year and two years.

RESULTS: In the non-operative group, 33 patients had grade III injuries, three patients had grade IV injuries, five patients had grade V injuries, and the injury grade was unknown for two patients. In the operative group, 37 patients had grade III injuries and three patients had grade V injuries (no difference in Type IV and V Non-op vs. Op, p = 0.12). Fifty-eight percent of patients in the non-operative group and 63% of patients in the operative group completed the two year follow up. The non-operative group had better physical health scores than the operative group at three months post-treatment (52.13 vs. 45.75, p < 0.001). There were no significant differences between the physical health scores of the two groups at any other point (six weeks, 45.81 vs. 41.21, p = 0.03; six months, 54.50 vs. 51.61, p = 0.02; one year, 55.10 vs. 53.96, p = 0.37; two years, 55.24 vs. 57.13, p = 0.17). Mental health scores were similar between the non-operative and operative groups at each follow up interval (six weeks, 49.29 vs. 51.27, p = 0.49; three months, 52.24 vs. 55.84, p = 0.13; six months, 54.89 vs. 55.05, p = 0.93; one year, 55.35 vs. 56.72, p = 0.35; two years, 56.41 vs. 55.43, p = 0.56). In both treatment groups, the pre-injury physical and mental health scores were better than published population norms before declining to a level equal to or below the norm following dislocation. Physical health recovered to a level above the norm at six months in the non-operative group and two years in the operative group. Mental health recovered at three months in the operative group and six months in the non-operative group.

CONCLUSIONS: Hook plate fixation does not lead to improved general health status compared to non-operative treatment. Presently, there is no definitive evidence that hook plate fixation is superior to non-operative treatment for acute, complete AC joint dislocations.

LEVEL OF EVIDENCE: Therapeutic Level I.