Management of Acromioclavicular Joint Injuries

Abstract

Acromioclavicular joint injuries are among the most common shoulder girdle injuries in athletes and most commonly result from a direct force to the acromion with the arm in an adducted position. Acromioclavicular joint injuries often present with associated injuries to the glenohumeral joint, including an increased incidence of superior labrum anterior posterior (SLAP) tears that may warrant further evaluation and treatment. Anteroposterior stability of the acromioclavicular joint is conferred by the capsule and acromioclavicular ligaments, of which the posterior and superior ligaments are the strongest. Superior-inferior stability is maintained by the coracoclavicular (conoid and trapezoid) ligaments. Type-I or type-II acromioclavicular joint injuries have been treated with sling immobilization, early shoulder motion, and physical therapy, with favorable outcomes. Return to activity can occur when normal shoulder motion and strength are obtained and the shoulder is asymptomatic as compared with the contralateral normal extremity. The management of type-III injuries remains controversial and is individualized. While a return to the previous level of functional activity with nonsurgical treatment has been documented in a number of case series, surgical reduction and coracoclavicular ligament reconstruction has been associated with a favorable outcome and can be considered in patients who place high functional demands on their shoulders or in athletes who participate in overhead sports. Surgical management is indicated for high-grade (≥type IV) acromioclavicular joint injuries to achieve anatomic reduction of the acromioclavicular joint, reconstruction of the coracoclavicular ligaments, and repair of the deltotrapezial fascia. Outcomes after surgical reconstruction of the coracoclavicular ligaments have been satisfactory with regard to achieving pain relief and return to functional activities, but further improvements in the biomechanical strength of these constructs are necessary to avoid loss of reduction and creep with cyclic loading.

Functional outcome following coracoclavicular ligament reconstruction using a gracilis tendon graft for acute type III acromioclavicular dislocation: a case report

“…The good initial strength enables early active and passive shoulder mobilization exercises. 11,12 A similar technique was first reported in 2001 in a 34-year-old-woman. It entailed salvaging a failed acromioclavicular reconstruction with coracoclavicular ligament reconstruction using a loop of autogenous semitendinosus tendon from the ipsilateral knee.…”

“…They are the third most common injury seen in college hockey players and account for 41% of all shoulder injuries seen in elite college football players. 12 However, despite the high frequency of AC separations, there continues to be substantial controversy about their management. Type III injuries are the most controversial because there has long been debate over whether they should be treated operatively or nonoperatively.…”

“…Furthermore, numerous surgical techniques have been described for the surgical management of AC separations, and controversy remains over which method is the most effective. 12 Although there are more than 60 procedures described for surgical treatment of acromioclavicular joint dislocations, there is still no gold standard. When overall surgical options are considered, there are two groups of surgical treatment: primary repair or reconstruction of the coracoclavicular ligament.…”

Current practice in the management of Rockwood type III acromioclavicular joint dislocations—National survey

“…within 3 weeks), as anatomical reduction of the joint is more readily enabled. 10 However, immediate intervention without a trial of conservative management for type III injuries may well lead to unwanted complications, which may not have existed had surgery not been undertaken. 10,17 There also appears to be a paucity of evidence, based upon systematic reviews, that the outcomes from early operative intervention are superior to conservative management, in the acute period.…”

“…10 However, immediate intervention without a trial of conservative management for type III injuries may well lead to unwanted complications, which may not have existed had surgery not been undertaken. 10,17 There also appears to be a paucity of evidence, based upon systematic reviews, that the outcomes from early operative intervention are superior to conservative management, in the acute period. 18,19 In type III ACJ injuries, each patient and pathology must be carefully analysed to ensure that the correct treatment option is chosen.…”