Reconstruction Alone Versus Hardware-Augmented Reconstruction in Chronic High-Grade AC Joint Dislocation: A Systematic Review of Treatment Outcomes.

Background: Acromioclavicular joint dislocation is a common shoulder injury, with chronic high-grade cases often requiring surgical intervention to restore stability. While reconstruction techniques are the standard approach for managing chronic dislocations, the role of hardware augmentation remains controversial. This systematic review compares the clinical outcomes of reconstruction alone versus hardware-augmented reconstruction in patients with chronic high-grade acromioclavicular joint dislocation. Methods: We searched Cochrane Library, EMBASE, and Pubmed databases using the keywords "acromioclavicular joint," "dislocation," and "surgery" according to the MeSH index for English-language studies. We performed a systematic review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: Two authors independently reviewed 915 articles. 36 met the inclusion criteria, comprising 1013 patients who underwent reconstruction surgery and 57 patients who underwent reconstruction with hardware-augmented reconstruction surgery. The reconstruction group demonstrated higher Constant-Murley (88.2 vs. 85.6) and Subjective Shoulder Value scores (84.1 vs. 70) compared to the combination group. However, the combination group had a superior American Shoulder and Elbow Surgeons score (93 vs. 82). The complication rate was higher in the reconstruction group (16% vs. 12%). In comparison, the combination technique had a lower revision rate (4.5% vs. 5.86%). Conclusion: This study compared treatment outcomes between reconstruction alone and hardware-augmented reconstruction, and it revealed that reconstruction alone is superior in functional outcomes. However, reconstruction augmented with a hardware-augmented reconstruction approach is superior in terms of lower complications and revision rates.