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SURGERY NOT ALWAYS BEST FOR AC JOINT DISLOCATION, STUDY SHOWS

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If you dislocate the acromio-clavicular (AC) joint in your shoulder during sports, the treatment options will depend on the severity of the injury.

Most dislocations just need a sling to rest the joint for a few days, followed by exercises to help you regain all the movement in your shoulder. It usually takes about six weeks for the discomfort to disappear and, although a bump may remain, the injury should heal well.

For more severe dislocations, surgery is sometimes recommended to put the joint back together and repair the torn ligaments. But is surgery the best option?

A new study compared operative versus non-operative treatment of AC joint dislocations using modern surgical fixation. In a randomised clinical trial, 83 patients with acute (<28 days from the time of injury) complete (grade III, IV and V) dislocations of the AC joint were assigned to receive either operative repair with hook plate fixation followed by rehabilitation or non-operative treatment with sling and rehabilitation.

Researchers followed the patients for two years, tracking complications, level of disability and patient satisfaction with how their shoulders looked after injury.

Patients in the non-surgical group showed greater mobility than the surgical patients at follow-up sessions six weeks and three months after injury.

“Three months after the initial injury, more than 75% of the patients who did not have AC joint surgical repair were able to return to work, whereas only 43% of those who underwent surgery were back at work,” said Dr. Michael McKee, an orthopaedic surgeon with St. Michael´s Hospital in Toronto, Canada.

There were no significant mobility differences between the groups at six months, one year or two years, but the researchers noted that seven of the 40 patients who received surgery experienced major complications such as a loose plate or a deep wound infection, and another seven experienced minor complications.

There were only two major complications among the 43 patients who did not receive surgery, both of which resulted from repeat falls that further injured the AC joint.

“The main advantages of surgery are that the joint is put back in place and the shoulder appears more symmetrical and pleasing to the eye,” explained Dr. McKee. “The long-term implications of surgery for AC joint dislocation remain unclear when compared to non-operative treatment.”

Although satisfaction with appearance of the shoulder is undoubtedly a consideration, surgeons should think twice before recommending surgery for an AC joint dislocation, Dr. McKee believes. “Patients who forgo surgery return to work sooner, experience less disability during the first months after injury and have fewer complications,” he said.

The findings have been published in the Journal of Orthopaedic Trauma.

http://www.wimbledonclinics.co.uk/ac-joint-disorders-dislocation-subluxation/treatments/

http://www.stmichaelshospital.com/media/detail.php?source=hospital_news/2015/20151022_hn

http://journals.lww.com/jorthotrauma/Abstract/2015/11000/Multicenter_Randomized_Clinical_Trial_of.1.aspx