No difference in clinical outcome at 2-year follow-up in patients with type III and V acromioclavicular joint dislocation treated with hook plate or physiotherapy: a randomized controlled trial

Review written by Jared Powell info

Key Points

  1. Both surgical and non-surgical approaches to grade 3 and 5 ACJ injuries can produce positive clinical outcomes – with no significant between group differences.
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Acromioclavicular joint (ACJ) injuries are often neglected in clinical discourse, an afterthought to their more illustrious cousin, the glenohumeral joint dislocation. They are, however, common injuries which typically occur in young, active males. An ACJ injury is typically described according to the Rockwood classification [1] on a spectrum from I – VI. Historically, grade 1 and 2 ACJ injuries are thought to require non-surgical management, grade 3 is uncertain, and grades 4-6 are surgical. Nice and neat, right? Perhaps not.

This trial set out to compare a surgical (hook plate) and non-surgical approach (physiotherapy) for grades 3 and 5 ACJ injuries to determine if there was a superior approach. Their hypothesis was that there will be no difference between the two approaches.

Acromioclavicular joint injuries are common injuries which typically occur in young, active males.
There is now strong evidence that most acromioclavicular joint injuries can be successfully treated without surgery, irrespective of the grade.


This was a parallel-arm, randomized controlled trial (RCT).

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