Is conservative treatment still defensible in grade III acromioclavicular dislocation? Are there predictive factors of poor outcome?

Quentin Rasmont, Christian Delloye, Elisa Bigare, Tom Van Isacker


The optimal treatment of grade III acromioclavicular (AC) dislocation is still controversial. Recent studies recommend surgery at that stage whereas meta-analysis favours conservative management. The objective of the present investigation was to analyse a clinical series of non-operated grade III AC dislocations and to determine their functional status.

Thirty-five patients treated conservatively with a grade III acromioclavicular dislocation were retrospectively reviewed. Simple shoulder test, Oxford shoulder and bilateral Constant shoulder score were used for assessment. Various predictive criteria of poor outcome, particularly scapular dyskinesis were taken into account for analysis.

Overall mean and median Constant Score of the injured side were 92.9 and 94, whilst the contralateral shoulder values were respectively 94.9 and 95 (mean and median scores). Ten patients had scapular dyskinesis. Laterality, shoulder activity and scapular dyskinesis were not statistically related to worse outcome. Twenty-eight (80%) patients resumed normal activity within six months. All but two patients were subjectively very satisfied or satisfied.

Conservative treatment provided satisfactory results whatever the shoulder activity. No risk factors were predictive of a poorer outcome. Conservative management should remain the first option to manage these injuries.


acromioclavicular dislocation ; grade III lichtman ; conservative treatment ;


Bannister GC, Wallace WA, Stableforth PG, Hutson MA. The management of acute acromioclavicular dislocation. A randomised prospective controlled trial. J Bone Joint Surg Br. 1989 ; 71 : 848–50.

Beitzel K, Cote MP, Apostolakos J, Solovyova O, Judson CH, Ziegler CG, et al. Current concepts in the treatment of acromioclavicular joint dislocations. Arthroscopy. 2013 ; 29 : 387–97.

Bosworth BM. Acromioclavicular Dislocation: End-Results of Screw Suspension Treatment. Ann. Surg. 1948 ; 127 : 98–111.

Bradley JP, Elkousy H. Decision making: operative versus nonoperative treatment of acromioclavicular joint injuries. Clin Sports Med. 2003 ; 22 : 277–90.

Burkhart SS, Morgan CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology. Part II: evaluation and treatment of SLAP lesions in throwers. Arthroscopy. 2003 ; 19 : 531–9.

Calvo E, López-Franco M, Arribas IM. Clinical and radiologic outcomes of surgical and conservative treatment of type III acromioclavicular joint injury. J Shoulder Elbow Surg. 2006 ; 15 : 300–5.

Chen M, Ye X, Ni Y, Mou Z, Huang L. [Application of endobutton in the treatment of acute acromioclavicular joint dislocation]. Zhongguo Gu Shang. 2011 ; 24 : 189–91.

Cohen G, Boyer P, Pujol N, Hamida Ferjani B, Massin P, Hardy P. Endoscopically assisted reconstruction of acute acromioclavicular joint dislocation using a synthetic ligament. Outcomes at 12 months. Orthop Traumatol Surg Res. 2011 ; 97 : 145–51.

Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin. Orthop. Relat. Res. 1987 ; 160–4.

Dearden PMC, Ferran NA, Maqsood M. A modified Weaver-Dunn procedure without need for internal fixation. Acta Orthop Belg. 2010 ; 76 : 120–3.

Di Francesco A, Zoccali C, Colafarina O, Pizzoferrato R, Flamini S. The use of hook plate in type III and V acromio-clavicular Rockwood dislocations: clinical and radiological midterm results and MRI evaluation in 42 patients. Injury. 2012 ; 43 : 147–52.

Galpin RD, Hawkins RJ, Grainger RW. A comparative analysis of operative versus nonoperative treatment of grade III acromioclavicular separations. Clin. Orthop. Relat. Res. 1985 ; 150–5.

Glanzmann MC, Buchmann S, Audigé L, Kolling C, Flury M. Clinical and radiographical results after double flip button stabilization of acute grade III and IV acromioclavicular joint separations. Arch Orthop Trauma Surg. 2013 ; 133 : 1699–707.

Gstettner C, Tauber M, Hitzl W, Resch H. Rockwood type III acromioclavicular dislocation: surgical versus conservative treatment. J Shoulder Elbow Surg. 2008 ; 17 : 220–5.

Gumina S, Carbone S, Postacchini F. Scapular dyskinesis and SICK scapula syndrome in patients with chronic type III acromioclavicular dislocation. Arthroscopy. 2009 ; 25 : 40–5.

Hootman JM. Acromioclavicular Dislocation: Conservative or Surgical Therapy. J Athl Train. 2004 ; 39 : 10–1.

Imatani RJ, Hanlon JJ, Cady GW. Acute, complete acromioclavicular separation. J Bone Joint Surg Am. 1975 ; 57 : 328–32.

Kienast B, Thietje R, Queitsch C, Gille J, Schulz AP, Meiners J. Mid-term results after operative treatment of rockwood grade III-V acromioclavicular joint dislocations with an AC-hook-plate. Eur. J. Med. Res. 2011 ; 16 : 52–6.

Korsten K, Gunning AC, Leenen LPH. Operative or conservative treatment in patients with Rockwood type III acromioclavicular dislocation: a systematic review and update of current literature. Int Orthop. 2013 ;

Kraeutler MJ, Williams GR Jr, Cohen SB, Ciccotti MG, Tucker BS, Dines JS, et al. Inter- and intraobserver reliability of the radiographic diagnosis and treatment of acromioclavicular joint separations. Orthopedics. 2012 ; 35 : e1483–1487.

L’Insalata JC, Warren RF, Cohen SB, Altchek DW, Peterson MG. A self-administered questionnaire for assessment of symptoms and function of the shoulder. J Bone Joint Surg Am. 1997 ; 79 : 738–48.

Lädermann A, Grosclaude M, Lübbeke A, Christofilopoulos P, Stern R, Rod T, et al. Acromioclavicular and coracoclavicular cerclage reconstruction for acute acromioclavicular joint dislocations. J Shoulder Elbow Surg. 2011 ; 20 : 401–8.

Larsen E, Bjerg-Nielsen A, Christensen P. Conservative or surgical treatment of acromioclavicular dislocation. A prospective, controlled, randomized study. J Bone Joint Surg Am. 1986 ; 68 : 552–5.

Law KY, Yung SH, Ho PY, Chang HT, Chan KM. Coracoclavicular ligament reconstruction using a gracilis tendon graft for acute type-III acromioclavicular dislocation. J Orthop Surg (Hong Kong). 2007 ; 15 : 315–8.

Leidel BA, Braunstein V, Kirchhoff C, Pilotto S, Mutschler W, Biberthaler P. Consistency of long-term outcome of acute Rockwood grade III acromioclavicular joint separations after K-wire transfixation. J Trauma. 2009 ; 66 : 1666–71.

Liu H-H, Chou Y-J, Chen C-H, Chia W-T, Wong C-Y. Surgical treatment of acute acromioclavicular joint injuries using a modified Weaver-Dunn procedure and clavicular hook plate. Orthopedics. 2010 ; 33 : 2010 Aug 11;33(8)

Liu X, Huangfu X, Zhao J. Arthroscopic treatment of acute acromioclavicular joint dislocation by coracoclavicular ligament augmentation. Knee Surg Sports Traumatol Arthrosc. 2013 ;

Lu N, Zhu L, Ye T, Chen A, Jiang X, Zhang Z, et al. Evaluation of the coracoclavicular reconstruction using LARS artificial ligament in acute acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc. 2013 ;

Martetschläger F, Horan MP, Warth RJ, Millett PJ. Complications after anatomic fixation and reconstruction of the coracoclavicular ligaments. Am J Sports Med. 2013 ; 41 : 2896–903.

Murena L, Canton G, Vulcano E, Cherubino P. Scapular dyskinesis and SICK scapula syndrome following surgical treatment of type III acute acromioclavicular dislocations. Knee Surg Sports Traumatol Arthrosc. 2013 ; 21 : 1146–50.

Murena L, Vulcano E, Ratti C, Cecconello L, Rolla PR, Surace MF. Arthroscopic treatment of acute acromioclavicular joint dislocation with double flip button. Knee Surg Sports Traumatol Arthrosc. 2009 ; 17 : 1511–5.

Phemister D. The treatment of dislocation of the acromioclavicular joint by open reduction and threaded-wire fixation. 1942 ; 4 : 166–8.

Phillips AM, Smart C, Groom AF. Acromioclavicular dislocation. Conservative or surgical therapy. Clin. Orthop. Relat. Res. 1998 ; 10–7.

Rangger C, Hrubesch R, Paul C, Reichkendler M. [Capacity to participate in sports after injuries of the acromioclavicular joint]. Orthopade. 2002 ; 31 : 587–90.

Sehmisch S, Stürmer EK, Zabka K, Losch A, Brunner U, Stürmer KM, et al. [Results of a prospective multicenter trial for treatment of acromioclavicular dislocation]. Sportverletz Sportschaden. 2008 ; 22 : 139–45.

Shao R, Zhang Y, Lou C, Shi G, Yu J, Luo C, et al. [Coracoclavicular ligament reconstruction using autologous double-strand palmaris longus tendon and artificial ligament for the treatment of acromioclavicular joint dislocation]. Zhongguo Gu Shang. 2011 ; 24 : 202–4.

Shetty NS, Yoo YS, Kim DY, Lee SS, Jeong US. Open anatomical coracoclavicular ligament reconstruction using a tendon graft with an Endobutton loop. Acta Orthop Belg. 2009 ; 75 : 828–31.

Smith TO, Chester R, Pearse EO, Hing CB. Operative versus non-operative management following Rockwood grade III acromioclavicular separation: a meta-analysis of the current evidence base. J Orthop Traumatol. 2011 ; 12 : 19–27.

Spencer EE Jr. Treatment of grade III acromioclavicular joint injuries: a systematic review. Clin. Orthop. Relat. Res. 2007 ; 455 : 38–44.

Tamaoki MJS, Belloti JC, Lenza M, Matsumoto MH, Gomes Dos Santos JB, Faloppa F. Surgical versus conservative interventions for treating acromioclavicular dislocation of the shoulder in adults. Cochrane Database Syst Rev. 2010 ; CD007429.

Tauber M, Gordon K, Koller H, Fox M, Resch H. Semitendinosus tendon graft versus a modified Weaver-Dunn procedure for acromioclavicular joint reconstruction in chronic cases: a prospective comparative study. Am J Sports Med. 2009 ; 37 : 181–90.

Trainer G, Arciero RA, Mazzocca AD. Practical management of grade III acromioclavicular separations. Clin J Sport Med. 2008 ; 18 : 162–6.

Trikha SP, Acton D, Wilson AJ, Curtis MJ. A new method of arthroscopic reconstruction of the dislocated acromio-clavicular joint. Ann R Coll Surg Engl. 2004 ; 86 : 161–4.

Tsou PM. Percutaneous cannulated screw coracoclavicular fixation for acute acromioclavicular dislocations. Clin. Orthop. Relat. Res. 1989 ; 112–21.

Weaver JK, Dunn HK. Treatment of acromioclavicular injuries, especially complete acromioclavicular separation. J Bone Joint Surg Am. 1972 ; 54 : 1187–94.

Ye T, Ouyang Y, Chen A. Evaluation of coracoclavicular stabilization of acute acromioclavicular joint dislocation with multistrand titanium cables. Eur J Orthop Surg Traumatol. 2013 ;

Yoo Y-S, Seo Y-J, Noh K-C, Patro BP, Kim D-Y. Arthroscopically assisted anatomical coracoclavicular ligament reconstruction using tendon graft. Int Orthop. 2011 ; 35 : 1025–30.

Zarzycki W, Lorczyński A, Ziółkowski W. [Nonoperative treatment of acute, grade III acromioclavicular dislocation in judo competing athletes]. Chir Narzadow Ruchu Ortop Pol. 1998 ; 63 : 321–7.

Zhu R-T, Ying Y-R, Gao F-M, Wang B, Chen M, Ying G-H, et al. [Clinical study on the treatment of acromioclavicular joint dislocation of tossy grade III with double endobutton]. Zhongguo Gu Shang. 2009 ; 22 : 653–4.


  • There are currently no refbacks.

© 1950-2014 Acta Orthopaedica Belgica | Non-Profit Organization, All rights reserved
Sponsored by BVOT & SORBCOT