Age-stratified comparative outcomes of operative versus conservative treatment in type III acromioclavicular joint dislocation: a systematic review and meta-analysis

Abstract

Type III acromioclavicular (AC) joint dislocation is a common shoulder-girdle injury with no consensus on optimal management. This systematic review and meta-analysis aimed to evaluate age-stratified clinical and functional outcomes between operative and conservative treatment strategies. A PRISMA-compliant search was conducted across PubMed, Embase, Cochrane Library, and Google Scholar through February 2026 (PROSPERO: CRD420261366430). RCTs and comparative cohort studies comparing surgical and conservative management were included. Outcomes included functional scores (Constant-Murley, DASH, VAS pain), radiological measures, complications, and patient satisfaction. Quality was appraised with RoB 2 and MINORS. Thirteen studies (7 RCTs, 6 cohort studies; n≤845) were included. Pooled analyses showed no significant difference in Constant-Murley Score (SMD≤0.24; 95% CI: âˆ'0.11 to 0.59; p≤0.174) or VAS pain (SMD≤âˆ'0.10; 95% CI: âˆ'0.40 to 0.19; p≤0.484). The DASH score significantly favoured surgery (SMD≤âˆ'0.45; 95% CI: âˆ'0.71 to âˆ'0.18; p≤0.001), though below the minimal clinically important difference. Conservative management allowed faster early recovery; surgery improved cosmesis but carried more complications. Operative treatment confered no consistent long-term functional advantage over conservative management. Shared decision-making should weigh function, cosmesis, and recovery trajectory.