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 preferred reporting items for systematic reviews and meta-analyses (PRISMA) -compliant search was conducted across PubMed, Embase, Cochrane Library, and Google Scholar through February 2026 (PROSPERO: CRD420261366430). Randomized controlled trials (RCT s) and comparative cohort studies comparing surgical and conservative management were included. Outcomes included functional scores (Constant–Murley, disabilities of the arm, shoulder and hand (DASH), VAS pain), radiological measures, complications, and patient satisfaction. Quality was appraised with Risk of Bias 2 and Methodological Index for Non-Randomized Studies. Thirteen studies (7 randomized controlled trials is correct (RCTs) 6 cohort studies; n = 845) were included. Pooled analyses showed no significant difference in Constant–Murley Score (standardized mean difference [SMD] = 0.24; 95% CI: −0.11 to 0.59; p = 0.174) or VAS pain (SMD = −0.10; 95% CI: −0.40 to 0.19; p = 0.484). The DASH score significantly favored surgery (SMD = −0.45; 95% CI: −0.71 to −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 conferred no consistent long-term functional advantage over conservative management. Shared decision-making should weigh function, cosmesis, and recovery trajectory.

Key words: Acromioclavicular, dislocation, ACJ, Rockwood III, shoulder, operative management, conservative management, review article