Clinical Results Following Non-operative Management for Grade III Acromioclavicular Joint Injuries: Does Eventual Surgery Affect Overall Outcomes?

Abstract

Following grade III acromioclavicular (AC) joint injury, some patients who are treated non-operatively will eventually seek surgical management. The purpose of this study was to compare the clinical outcomes in patients who completed non-operative (non-op) therapy to those who failed non-operative therapy and proceeded to AC reconstruction. This is a level 3, IRB approved study. 38 patients were initially treated non-op for acute grade III AC injuries with physical therapy. Outcomes measures included SF-12 PCS, ASES, QuickDASH, and SANE with a minimum follow-up of two years. Non-op failure occurred when a patient underwent AC reconstruction before final follow-up. 38 patients with a mean age of 38 years (range, 22-79) were included. 28/38 (74%) successfully completed non-op treatment whereas 10/38 (26%) failed after a median of 44 days (range, 6-511) from the initiation of physical therapy. Of the 10 patients who failed, 9 (90%) sought treatment >30 days after the injury. Two of these patients had a subsequent surgery before final follow-up and were therefore not included in outcomes analysis. Follow-up was available for the remaining 7/8 patients (87.5%) who failed non-op treatment and for 22/28 patients (78%) who were successfully treated non-op. Mean follow up was 3.3 years (range, 2.0-5.9). Although there were no significant differences in outcomes scores between groups (Table1; p >0.05), those who sought treatment >30 days after injury demonstrated decreased postoperative SANE scores (p = 0.002) and had 13.8x greater relative risk for failure of non-op treatment. Surgical decision making after acute grade 3 injuries is evolving. Based on our data, we conclude that (1) a trial of non-op treatment as warranted as successful outcomes can be expected even in those that eventually opt for surgery, and (2) oatients who present >30 days after their injury are much less likely to complete nonoperative treatment successfully.