Hook-Plate Fixation in Patients with Acute Acromioclavicular Joint Dislocation Improved Radiographic But Not Clinical Outcomes Compared with Nonoperative Treatment

Canadian Orthopaedic Trauma Society. Multicenter randomized clinical trial of nonoperative versus operative treatment of acute acromio-clavicular joint dislocation. J Orthop Trauma. 2015 Nov;29(11):479-87. ### Question: In patients with high-grade, acute acromioclavicular (AC) joint dislocation, does operative repair with hook-plate fixation improve patient outcomes more than nonoperative treatment? ### Design: Randomized (allocation concealed), unblinded, controlled trial with 2 years of follow-up and intention-to-treat analysis. ### Setting: 11 hospitals in Canada. ### Patients: 83 patients 16 to 60 years of age (mean age, 38 years; 94% men) who had a closed, complete (Rockwood grade-III to V) AC joint dislocation and were recruited ≤28 days after the injury. Exclusion criteria included previous surgery on the injured shoulder, scapulothoracic dissociation, vascular or ipsilateral shoulder injury, coracoid process fracture of the injured shoulder, or limited life expectancy. >80% of patients were assessed for secondary outcomes at 1 year; 1 year. ### Intervention: Operative repair (n = 40) or nonoperative treatment (n = 43). Operative repair was done ≤28 days after the injury and included anatomic …