Noninvasive bracing of acromioclavicular joint dislocations is not superior to early functional rehabilitation and not inferior to surgical stabilization in Rockwood type III and V injuries.

BACKGROUND

Treatment of acromioclavicular joint (ACJ) separations remains controversial. Yet, conservative treatment has become more common even for high-grade injuries. Available conservative treatment does currently however not address the loss of anatomical joint integrity in Rockwood (RW) III and V injuries. In a recent case report, we outlined the concept of restoring ACJ integrity by noninvasively bracing a RW V injury.

AIM

The purpose of this study was to prospectively evaluate the clinical and radiological efficacy of a modern Kenny-Howard splint like brace and compare it to early functional rehabilitation or surgery in RW III and V injuries after a minimum of 12 months.

METHODS

Patients with acute RW III injuries (n = 18) and patients with RW V injuries who refused surgery (n = 7) were prospectively enrolled and treated with an ACJ brace and followed up clinically and radiologicalally for 12 months. Endpoint results were compared to injury grade-, sex-, age-, and follow-up-period-matched patients treated with early functional rehabilitation (n = 23) or surgical TightRope stabilization (n = 23). Clinical outcomes included Constant Score (CS), Subjective Shoulder Value (SSV), Taft Score (TS), and modified Acromioclavicular Joint Instability Score (mAJIS) and radiological outcome included coracoclavicular index.

RESULTS

CS, SSV, TS, and mAJIS improved in RW III and CS and SSV in RW V patients over time, when treated with the ACJ brace. Significance was only reached in RW III patients (P < .001). Radiological indices did not improve over time in RW III and V patients. No differences were found when comparing functional and cosmetic outcomes (CS, SSV, TS, mAJIS) after a minimum of 12 months between bracing, surgery, and early functional rehabilitation in RW III and V patients. The coracoclavicular index was most improved in patients treated with surgery compared to bracing after a minimum of 12 months (P = .0011 for RW III).

CONCLUSION

Brace treatment led to comparable clinical and cosmetic outcomes as early functional rehabilitation or surgery in patients with high grade ACJ injuries after a minimum of 12 months. However, no sustainably improved reduction of the ACJ resulted from bracing, when compared to early functional rehabilitation, thus questioning its utility. While surgery ensured radiological improvement compared to bracing, no benefit was seen over early functional rehabilitation.