The AC joint is located at the top of the shoulder, between the collarbone and the top of the shoulder blade. This joint is most commonly injured playing sports and during physical activities, car accidents or falls.
If the dislocation of the AC joint is minor, a doctor will recommend a sling and physiotherapy. Dr. Michael McKee, orthopedic surgeon at St. Michael’s Hospital, said, “For severe AC joint dislocations, surgery is the common practice but there’s not much evidence to suggest this is actually the best treatment.”
Eighty-three patients with moderate to severe AC joint dislocation were followed for the study; some underwent surgery and others were assigned a sling and rehabilitation. The patients were followed for two years and researchers documented complications, levels of disability and level of satisfaction with how the shoulder looked and functioned post-surgery.
During follow-up sessions, at six weeks and three months, those who received the rehabilitation and sling had greater mobility than those who received surgery. At the six-month follow-up until the end of the study there were no differences between either group.
Dr. McKee added, “Three months after the initial injury, more than 75 percent of the patients who did not have AC joint surgical repair were able to return to work, whereas only 43 percent of those who underwent surgery were back at work.”
Out of the 40 patients who received surgery, seven experienced major complications and an additional seven experienced minor complications. Among the 43 who did not receive surgery, there were only two cases of major complications. Those complications were due to repeated falls, which injured the shoulder even more.
“The main advantages of surgery are that the joint is put back in place and the shoulder appears more symmetrical and pleasing to the eye,” said Dr. McKee. “The long-term implications of surgery for AC joint dislocation remain unclear when compared to non-operative treatment.”
Compared to the surgery group, 16 percent of those who underwent rehabilitation had greater dissatisfaction with the appearance of the shoulder because it was not surgically put back into place. Only five percent of surgical patients were dissatisfied with the appearance of their shoulder. After two years dissatisfaction increased in the non-surgical group to 21 percent.
Dr. McKee concluded, “While satisfaction with appearance of the shoulder should be a consideration, I believe surgeons should think twice before recommending surgery for an AC joint dislocation – regardless of the severity. Patients who forgo surgery return to work sooner, experience less disability during the first months after injury and have fewer complications.”