New insights in the treatment of acromioclavicular separation

Table 1 Characteristics of comparative studies with a minimum 4-yr follow-up

Ref.	Type of study	LE	Rockwood classification (No. of patients)	Operative technique (No. of patients)	Category1	FU (yr)	Outcome
Boström Windhamre et al[55] 2010	Retrospective case control	III	Delayed type III-V (47)	Weaver-Dunn and PDS suture (23) Weaver-Dunn and hookplate (24)	3 2	6.1	Constant score: P > 0.05 SPADI: P ≥ 0.05 QuickDASH: P > 0.05 VASa: P = 0.03 (in favor of PDS) Subluxation: P > 0.05
Kovilazhikathu Sugathan et al[56] 2012	Retrospective cohort	IV	Early type III (7) Delayed type III (11) Early	Open reduction and internal fixation + tension band wiring (7) Modified Weaver-Dunn procedure with PDS suture (11)	1 3	6.3	OSS: P = 0.05 Complications: 71% (early), 9% (delayed)
Motta et al[52] 2012	Retrospective case control	III	type III-V (34) Delayed type III-V (17)	CC reconstruction with LARS (34) CC reconstruction with LARS (17)	3 3	5.4	Reductiona: P < 0.05 (in favor of early reconstruction) Constant score: P > 0.05 SST: P > 0.05
Fauci et al[59] 2013	RCT	I	Delayed type III-V (40)	Allograft (semitendinosus) (20) Synthetic ligament (LARS) (20)	4 3	4	Constant scorea: P = 0.01 Reduction: P > 0.05
Jensen et al[39] 2014	Retrospective comparative study	III	Early type III-V (56)	Hookplate (30) Double TR technique (26)	2 3	4	VAS: P > 0.05 SST: P > 0.05

^aStatistically significant difference (P < 0.05);

¹Four categories: (1) fixation of the AC and/or CC with hardware including screws and K-wires; (2) hook plates; (3) fixation of the CC with sutures or suture buttons; and (4) reconstruction of the CC ligaments with autograft or allograft tendon. LE: Level of evidence; FU: Follow-up; SPADI: Shoulder pain and disability index; QuickDASH: Disabilities of the arm, shoulder and hand score; VAS: Visual analogue scale; OSS: Oxford shoulder score; LARS: Ligament augmentation and reconstruction system; RCT: Randomised controlled trial; SST: Simple Shoulder Test; TR: Tight rope.