Current concepts in acromioclavicular joint (AC) instability – a proposed treatment algorithm for acute and chronic AC-joint surgery

Abstract

Background There exists a vast number of surgical treatment options for acromioclavicular (AC) joint injuries, and the current literature has yet to determine an equivocally superior treatment. AC joint repair has a long history and dates back to the beginning of the twentieth century. Main body Since then, over 150 different techniques have been described, covering open and closed techniques. Low grade injuries such as Type I-II according to the modified Rockwood classification should be treated conservatively, while high-grade injuries (types IV-VI) may be indicated for operative treatment. However, controversy exists if operative treatment is superior to nonoperative treatment, especially in grade III injuries, as functional impairment due to scapular dyskinesia or chronic pain remains concerning following non-operative treatment. Patients with a stable AC joint without overriding of the clavicle and without significant scapular dysfunction (Type IIIA) may benefit from non-interventional approaches, in contrast to patients with overriding of the clavicle and therapy-resistant scapular dysfunction (Type IIIB). If these patients are considered non-responders to a conservative approach, an anatomic AC joint reconstruction using a hybrid technique should be considered. In chronic AC joint injuries, surgery is indicated after failed nonoperative treatment of 3 to 6 months. Anatomic AC joint reconstruction techniques along with biologic augmentation (e.g. Hybrid techniques, suture fixation) should be considered for chronic high-grade instabilities, accounting for the lack of intrinsic healing and scar-forming potential of the ligamentous tissue in the chronic setting. However, complication and clinical failure rates remain high, which may be a result of technical failures or persistent horizontal and rotational instability. Conclusion Future research should focus on addressing horizontal and rotational instability, to restore native physiological and biomechanical properties of the AC joint.

Long-Term Functional Outcomes and Athletic Ability in Shoulder Sports After Anatomic Coracoclavicular Ligament Reconstruction for Chronic Type 3 and 5 Acromioclavicular Joint Injuries

“…Although all patients underwent a trial of conservative treatment for at least 1 month, further studies are needed to truly identify whether greater improvement is seen with operative management. Finally, the patient population in the present study was older than the younger athletic population in whom these injuries usually occur, 2,4 limiting the external validity and generalizability of the results.…”

“…Multiple surgical techniques have been proposed in the literature to achieve sufficient reduction in the setting of acute and chronic acromioclavicular joint (ACJ) injuries. 2,4 As such, anatomic coracoclavicular ligament reconstruction (ACCR) techniques utilize a semitendinosus or peroneus longus allograft to replicate the coracoclavicular ligaments in their anatomic location. 5,9,17 Biomechanically, along with other anatomic reconstruction techniques using free tendon grafts, this approach has been shown to be highly effective in restoring native ACJ properties.…”

Simultaneous acromioclavicular dislocation, proximal humeral fracture, and reverse Hill–Sachs lesion: a case report

“…The goal of treatment of ACJ injuries is to maintain the shoulder kinematics, and this is attainable by restoring the anatomy of the joint. For this purpose, several methods have been introduced to date, such as coracoclavicular screw, hook plate, and tightrope [ 5 ]. Approximately 30% of ACJ injuries have a simultaneous injury in GH joint [ 6 ].…”

External Rotation of the Shoulder against Resistance as a Clinical Sign to Aid in the Diagnosis of Acromioclavicular Injury

“…Acromioclavicular joint (ACJ) injuries are a frequent cause for presentation to the emergency department, accounting for more than 40% of all sports-related shoulder injuries [ 1 ]. Early and effective diagnosis of ACJ injury is crucial, particularly in cases with a higher degree of separation wherein acute surgical management may be favored [ 2 ].…”