Objective: There is no consensus for the optimal treatment method for Rockwood type III acromioclavicular (AC) injuries. The aim of the study is to compare treatment methods in terms of functional scores and patient discomfort.
Materials and
Methods: In this retrospective cohort study, patients with Rockwood type III AC joint injuries treated either conservatively or surgically between 2022 and 2024 were evaluated. Patients were categorized based on treatment modality (conservative vs. surgical) with an exploratory subgroup analysis comparing hook plate and suture-button fixation within the surgically treated cohort. The QuickDASH scores and results of a questionnaire evaluating overall discomfort rates, activities provoking discomfort, and presence of persistent pain were compared between the groups after a 12-month follow-up period.

Results: A total of 53 patients (age 39.2±12.7, 79.2% male) were evaluated. A total of 21 patients (39.6%) were treated conservatively and 32 (60.4%) surgically, including 15 with hook plate and 17 with suture-button fixation. Conservative and surgery groups showed no statistically significant differences in median QuickDASH scores (p=0.235) or questionnaire results (p>0.05) at 12 months postoperatively. In the exploratory subgroup analysis, no significant differences could be detected between median QuickDASH scores of hook plate and suture-button groups (p=0.165); however, patient-reported overall discomfort was higher in the hook plate group (60% vs. 23.5%, p=0.036).

Conclusion: In Rockwood type III AC joint injuries, no statistically significant differences in functional outcomes were observed between conservative and surgical treatments. Exploratory subgroup analysis suggested an association between hook plate fixation and higher rates of patient-reported discomfort compared with suture-button fixation.