Surgical Management of Acute Acromioclavicular Type 3 Separation: A Systematic Review and Meta-analysis of RCTs

Objectives: A common 12% of shoulder injuries are acromioclavicular (AC) joint injuries, particularly in young athletes and manual laborers. It's still debatable how to handle grade III injuries. Surgical procedures restore anatomy but increase the risk of complications, while non-surgical techniques offer less complications but run the risk of persistent insatiability. With an emphasis on patient safety and functional outcomes, this systemic review evaluates the clinical outcomes of surgical versus non-surgical treatments. Research hypothesis: Surgical treatment leads to superior long-term functional outcomes compared to non-surgical management in Grade III AC joint dislocations. Tightrope fixation provides better joint stability and fewer complications compared to other surgical techniques. Methods: Following PRISMA guidelines, a systematic search for randomized controlled trials (RCTs) was carried out in the Cochrane, Web of Science, and PubMed databases. The inclusion criteria were satisfied by six RCTs with 345 patients that compared surgical and non-surgical management, as well as Tightrope fixation versus other surgical techniques. We extracted and examined data based on demographics, joint stability, functional outcomes, interventions, and complication rates. Results: A meta-analysis showed no discernible difference between non-surgical and surgical methods in terms of functional outcomes [MD=-0.24 [-4.49, 4.00] 95% CI, P= 0.11]. However, when compared to different types of surgical procedures, tightrope fixation showed better functional outcomes with fewer problems [MD=8.34 [5.67, 11.02] 95% CI, P= 0.48]. The rates of postoperative complications [RD= 0 [-0.11, 0.11] 95% CI, P= 0.22] and joint displacement [MD=-2.15 [-5.89, 1.59] 95% CI, P= 0.35] did not significantly differ between surgical techniques. Conclusion: For grade III AC joint dislocations, the functional results of surgical and non-surgical approaches are similar. Among surgical options, tightrope fixation yields the best outcomes. Patients’ activity levels and cosmetic preferences should be taken into account while making a personalized treatment decision. Given the study limitations of the small sample size, which restricts the generalizability of findings, future large-scale RCTs with longer follow-up periods are necessary to establish more definitive treatment guidelines and further evaluate the clinical significance of Tightrope fixation over other surgical techniques.