To the Editor,

In this systematic review, Korsten et al. [1] reviewed the current literature and presented an overview of the outcome of conservative versus operative treatment of Rockwood type III dislocations. They found that the objective and subjective shoulder function outcome was better in the operative group, especially in young adults, though the rate of complications and radiographic abnormalities were higher. The rehabilitation time was shorter in the conservative group, however the cosmetic outcome was worse. It is a very valuable study. Nevertheless, there are some questions we would like to ask related to this article.

To begin with, the investigators calculated the results of subjective shoulder function, complications, osteoarthritis, calcification and cosmetic outcome by using SPSS version 20.0. However, they did not provide the concrete statistical methods for these comparisons, which might reduce its credibility. We are wondering how to calculate these results such as 3.13 versus 2.77 (p = 0.406) and so on. To solve these potential problems, we suggest that a meta-analysis should be conducted to compare the subjective shoulder function, complications, osteoarthritis, calcification and cosmetic outcome between operative and conservative groups.

Furthermore, there was a slip of the pen in the subgroup analysis section. They clarified that “Four studies reported the deformities and cosmetic outcomes [1, 13, 14, 25]”. With careful reading, we think that the “25” should be replaced by “26”.

Finally, the investigators did not compare the outcomes of the objective shoulder function in the studies, which we consider as the most important outcome of AC joint injuries. Therefore, we suggest that at a minimum the investigators should describe the details of objective shoulder function in different studies.

We agree that physically active young adults seem to have a slight advantage in outcome when treated operatively. In our opinion, more randomized clinical trials with long-term follow-up should be conducted to provide evidence for the best treatment in patients with Rockwood type III AC dislocations.