<p>Optimal Management of Acromioclavicular Dislocation: Current Perspectives</p>

Abstract

Injuries to the acromioclavicular (AC) joint are common and mostly involve younger, male individuals. Whereas the majority of AC joint dislocations can be treated nonoperatively with a trial of immobilization, pain medication, cryotherapy, and physiotherapy, there are patients that do not respond well to conservative management and may require surgical treatment. Identifying and treating these patients according to the type and chronicity of AC joint dislocation is paramount. To date, a myriad of surgical techniques have been proposed to address unstable AC joint dislocations and are indicative of the uncertainty that exists in optimal management of these injuries. Historically research has focused on the restoration of the coracoclavicular ligament complex. However, recently the importance of the acromioclavicular capsule and ligaments has been emphasized. This review aims to provide the reader with an overview of current treatment strategies and research, as well as future perspectives.

Midterm Results of Tension Band Wiring Technique for Acute Rockwood Type III Acromioclavicular Joint Dislocation

“…Problems such as residual pain and weakness have been reported after non-operative treatment of Rockwood grade III ACJ dislocations [3,4,14]. Surgery is recommended to avoid potential shoulder deformity and poor functional outcomes, especially in young active individuals [4,8,14,15].…”

“…Although there are no clearly defined protocols, surgical treatment is recommended in young patients with overhead activity, those working in jobs requiring strength, those whose clavicle is locked superiorly and posteriorly to the acromion, and those with cosmetic deformity and shoulder stiffness [4][5][6][7][8]11,12,15]. The non-surgical treatment seems to be the preferred choice for elderly patients [6,7,10,14].…”

“…However, the learning curve for some techniques is long and complex [6]. Despite the many surgical techniques described, none of these techniques have been shown to be clinically superior to another [4,9,15]. Each surgical technique has its own unique complications [4,9,15].…”

“…AC fixation or primary coracoclavicular fixation is generally considered for acute cases (<tree weeks) in which the injured ligamentous structures are believed to have healing potential [4,15]. Biologic coracoclavicular ligament reconstructions are generally recommended in chronic (>three weeks) cases [4,15] and are utilized by some surgeons for all types of reconstructions [4].…”

“…Surgical treatments offer improved outcomes and functionality [ 5 , 14 ] compared with that of non-surgical modalities or surgical treatments that are performed more than three months after the injury [ 9 ]. The management of type III injuries is individualized for patients [ 3 , 5 , 10 , 14 , 15 ].…”