Konservative oder operative Therapie der Schultereckgelenkverletzung – was ist gesichert ? Eine systematische Literaturanalyse nach Kriterien der „evidence based medicine“

Abstract

There is controversy about the therapy for third-degree acromioclavicular dislocation according to Tossy and Rockwood's classification. Both operative and non-operative treatment is reported to have satisfactory results in the literature. The purpose of this study was to analyze the literature in a systematic manner based on the criteria of evidence-based medicine. It was our hypothesis that there is no scientific evidence for the superiority of one treatment over the other. A total of 370 papers were retrieved and classified into three groups: (1) randomized controlled trials; (2) comparative retrospective studies; and (3) retrospective studies. In three studies that were graded with high evidence, the major outcome for both operative and non-operative treatment was similar. The advantages of non-operative treatment include a shorter period of rehabilitation and a significantly lower complication rate while the advantages of operative treatment include a low rate of persisting subluxation of the AC joint. Similar results were found for retrospective comparative and long-term studies. For retrospective studies without controls, both operative and conservative therapy are described with good and excellent results, ranging between 80 and 97%. In conclusion, there is good evidence on the therapy of third-degree acromioclaviculary dislocation studies. The functional result according to the literature is similar, and complications associated with therapy occur more often with operative treatment. Conservative treatment appears to be the method of choice for third-degree acromioclavicular dislocations unless the patient's preference is operative therapy.

Resultados funcionais e radiológicos do tratamento cirúrgico da luxação acromioclavicular aguda com âncoras e fixação clavículo-escapular

“…The goal of acute ACD treatment is to achieve a reduction that enables soft tissue healing and recovery of previous joint function; however, the numerous procedures described in the literature show the lack of consensus regarding the ideal method. 18 The mean values of the functional scores were: UCLA = 32 (±6.33); DASH = 11.21 (±20.18); and Constant-Murley = 86.93 (±20.34), with overall satisfaction of 96.87% (all but 1 patient in the sample). Algarín et al 19 evaluated 42 patients treated with a minimally-invasive technique, and obtained 86% of satisfactory results according to the UCLA score.…”

“…The best treatment method for grade-III injuries is uncertain. 25 Some authors describe similar results regarding the surgical and non-surgical treatments in cases of grade III, 18 while others found unsatisfactory results with the non-surgical treatment, such as residual pain and decreased shoulder muscular strength in up to 50% of cases, favoring the surgical management as a choice in these cases. 26 According to Rasmont et al, 27 conservative treatment is the first choice for these lesions.…”

“…Although the literature shows good functional results with the use of metallic anchors in the coracoid as a method of treatment of acute ACD, 15 18 19 different results were found according to the age of the patients. In the sample of the present study, there was a statistically significant difference, with worse functional results in the UCLA ( p = 0.005), DASH ( p = 0.006) and Constant-Murley ( p = 0.002) scores in patients with mean ages of 56.7 (±3.2), 54.0 (±6.7), 53.8 (±6.0) years respectively, suggesting that the treatment of acute ACD by this method in patients of this age group should be reviewed.…”

AC-Verletzungen: konservativ-funktionelle Therapie und Ergebnisse

“…In einer Metaanalyse von über 600 Publikationen konnten Phillips et al [10] zeigen, dass, bezogen auf die verwertbaren Studien, keine Unterschiede im Behandlungsergebnis zwischen konservativ und operativ behandelten Patienten bestanden (⊡ Tabelle 2).Auch Bäthis et al [2] kamen bei einer Auswertung von 370 Publikationen nach den Kriterien der "evidence based medicine" zu einem ähnlichen Ergebnis. Insgesamt kann in nahezu 80% der Tossy-III-Verletzungen unabhängig von der Verfahrenswahl mit einem guten Ergebnis gerechnet werden.…”

The relationship between chronic type III acromioclavicular joint dislocation and cervical spine pain

“…Literature reviews show that the rate of patients that obtained satisfactory results after conservative treatment is not much different from patients that underwent surgical procedures [1-4]. This conclusion becomes apparent when the shoulder function is globally considered.…”