No Differences in Outcomes Between Operative and Non-Operative Approaches for High-Grade Acromioclavicular Joint Injuries: A Systematic Review and Meta-analysis.

Background: This study aimed to compare the clinical outcomes and complications of operative versus non-operative approaches in treating patients with high-grade acromioclavicular (AC) joint injuries. Methods: A search was conducted in PubMed, Scopus, and Cochrane databases for studies published between 2007 and 2024. The search focused on studies directly comparing postoperative patient-reported outcomes, radiographic findings, and complications associated with surgical and non-surgical techniques for high-grade AC joint injuries. For dichotomous outcomes, odds ratios (ORs) were calculated, while mean differences (MDs) were computed for continuous outcomes. Results: A total of eight studies, encompassing 473 AC joints, were analyzed. The results indicated no statistically significant differences in postoperative clinical outcomes at final follow-up between the operative and non-operative approaches. Specifically, among the seven studies reporting the Constant Score, MD was - 1.38 (95% confidence interval [CI] - 3.14 to 0.38, p = 0.12). For the Disabilities of the Arm, Shoulder, and Hand score, the MD was 1.92 (95% CI - 0.34 to 4.17, p = 0.10), indicating no statistically significant differences. Additional radiographic findings also suggested similar outcomes between the two treatment modalities. Conclusion: The analysis revealed comparable clinical outcomes between the two approaches, demonstrating that both strategies can be considered viable options for patient management.