Editorial Commentary: Return to Sport After Surgical Treatments of the Acromioclavicular Joint Dislocation Seems to Be Almost Perfect in the Literature

Abstract

Systematic reviews identify completed studies that address a research question and evaluate the results of these studies to arrive at conclusions about a body of research. They should be encouraged because the findings, with power enhanced by the larger sample size available from the combined studies, often represent an important scientific contribution. The systematic review findings also can be a useful background for developing practice guidelines in the future. One of limitations of this approach is a risk of publication bias. Studies with negative results are more likely to remain unpublished or excluded from the review owing to a lack of reporting outcome of the specific interest. Although publication bias is difficult to eliminate, it should be addressed by the authors with appropriate statistical procedures that may be helpful in detecting its presence. Negative results should not be masked by overall good outcomes. This rather long caveat relates to a recent review showing that return to sport after surgical treatments of acromioclavicular joint dislocation seems to be almost perfect in the literature. Perfection is rare, so publication bias could be a limitation of the review.

Return to Play After Surgical Treatment of High-Grade Acromioclavicular Joint Injuries in the Australian Football League

“…A systematic review 16 investigating the effect of surgical management for ACJ dislocations has found that many papers present excellent return-to-sport rate but at longer times that may affect career goals. This resulted in an editorial 18 that suggested publication bias may be affecting the outcomes and that the outcome of interest often goes unreported. For this reason, we not only investigated the time taken to return to sport and on-field performance but also used an outcome measure that was sensitive and specific to measuring changes in the ACJ-injured population.…”

“…27 Grading of ACJ injuries should be made in comparison with the uninjured side. 18 An addition to the Rockwood classification was introduced to distinguish between horizontally stable (type IIIA) and unstable (type IIIB) injuries in the anteroposterior plane. 5 Basamania 39 has initiated discussion of so-called medial ACJ instability where the acromion is pushed in under the lateral clavicle in cross-body and resisted external rotation activities that are seen in sport with "fending away" movements, which are critical to AFL football.…”

“…23 The treatment of acute Rockwood type III injuries remains controversial. 27 This is in part owing to discrepancies in the diagnosis and, hence, classification of Rockwood type III versus type IV injuries, 18,27 variations in upper limb demands within patient populations when surgery versus conservative management is compared, and the use of outcome measures that are not ACJ specific. 4 A recent survey of National Football League (NFL) physicians reported that most preferred to treat Rockwood type III ACJ injuries conservatively, 33 given recent studies that have reported a mean loss to play between 26.4 20 and 31.9 days 11 in NFL and National Collegiate Athletic Association (NCAA) football players with type III ACJ injuries when the majority were treated conservatively.…”

“…27 Grading of ACJ injuries should be made in comparison with the uninjured side. 18 An addition to the Rockwood classification was introduced to distinguish between horizontally stable (type IIIA) and unstable (type IIIB) injuries in the anteroposterior plane. 5…”