Acromioclavicular joint injuries in overhead athletes: a concise review of injury mechanisms, treatment options, and outcomes

Deans, Christopher; Gentile, Joseph; Tao, Matthew A.

doi:10.1007/s12178-019-09542-w

Cited by 11 publications

(8 citation statements)

References 38 publications

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“…In coracoid-related diseases, acromioclavicular joint dislocation is very common, which is the separation of the outer end of clavicle from acromion that is indirectly related to violence suffered by the coracoid process, since the stability on vertical direction of the acromioclavicular joint is maintained by the coracoclavicular ligament. 16 In recent years, CC ligament reconstruction using double button device [17][18][19][20][21]6 with allografts 22,23 have become a common surgical treatment, which requires to drill a bone tunnel in the coracoid process and the clavicle. The thiner sclerotin or malposition of bone tunnel on the coracoid process are liable to cause iatrogenic fracture.…”

Section: Discussionmentioning

confidence: 99%

Classification and morphological parameters of the coracoid process in Chinese population

Zhang

Xiong

et al. 2022

J Orthop Surg (Hong Kong)

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Introduction The coracoid process is an important anatomical structure of the scapula, which can be used as a landmark in the diagnosis and treatment of scapula related diseases, such as acromioclavicular joint dislocation, anterior shoulder instability, and coracoid fractures. The aim of this study was to classify the coracoid process according to morphology and to measure the morphological parameters of the coracoid process. Materials and methods A total of 377 dry and intact scapulae were collected and classified in terms of the connection between the shape of coracoid process and common things in life. The anatomical morphology and the position related to acromion and glenoid socket of the coracoid process were measured in each type by three independent researchers with a digital caliper. The measurements were averaged and recorded. Results Based on obvious morphological features, five specific types of the coracoid process were described: Type I, Vertical 8-shape; Type II, Long stick shape; Type III, Short stick shape; Type IV, Water drop shape, and Type V, Wedge shape. Type I (30%) and Type III (29%) were more prevalent in China. The tip width of the coracoid process of Type IV was the shortest and significantly different compared to the other types ( p <.05), contrary to the longest in Type V. The tip thickness of the coracoid process of Type I was the shortest and significantly different from the other types ( p <.05). Conclusions The coracoid process was classified into five types based on obvious morphological features. Knowing of morphological classification and anatomical parameters of different types of the coracoid process, to some extent, may be helpful to diagnose and treat the shoulder joint disease, such as acromioclavicular joint dislocation, anterior shoulder instability, and coracoid fractures, and to theoretically reduce postoperative complications.

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Section: Discussionmentioning

confidence: 99%

Classification and morphological parameters of the coracoid process in Chinese population

Zhang

Xiong

et al. 2022

J Orthop Surg (Hong Kong)

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“…3,21,23 More interesting, patients with even low-grade injuries, such as Rockwood I and II, which are widely considered to be eligible for nonoperative treatment, were symptomatic and experienced pain during heavy and overhead activities after nonoperative treatment, with some patients needing subsequent ACJ surgery. 3,8,21,23,34,35 The development of ACJ arthrosis after ACJ injuries is one possible explanation for these findings. 11 However, the question arises: What structures other than those in our current treatment strategies (eg, a ruptured intra-articular disk) might be a source of chronic pain?…”

Section: Discussionmentioning

confidence: 99%

“…13 The main role of these intra-articular fibrocartilaginous disks is to enhance the congruency of the articulating surfaces; additionally, they act as a bumper to distribute contact pressures within the joint. 8,13 The acromioclavicular articulation has an intra-articular fibrocartilaginous disk, which has been shown to be a complete disk (very rare) or is meniscoid-like. 9,29 The fibrocartilaginous disklike structures of the uncovertebral joints, the temporomandibular joint, the wrist joint, and the knee joint all have sensory innervation; thus, it has been reported in the literature that these structures are a potential source of pain within those joints.…”

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confidence: 99%

Acromioclavicular Disk as a Potential Source of Pain in AC Joint Injuries

et al. 2022

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Background: Injuries of the acromioclavicular joint (ACJ) are common shoulder injuries that often lead to pain and dysfunction of the affected shoulder. Regardless of operative or nonoperative treatment, a relatively large number of patients remain symptomatic and experience pain. However, the specific source of persistent pain in the ACJ remains ambiguous. Purpose: To investigate the presence of sensory nerve fibers or pain-generating neurotransmitters within the intra-articular disk of the ACJ to determine its potential role as an independent pain generator in ACJ disorders. Study Design: Descriptive laboratory study. Methods: Twelve paired ACJs from 6 fresh human cadavers (mean age, 56 years; range, 41-82 years) were harvested and freed from surrounding soft tissues, leaving only the ACJ capsule intact. The specimens were placed in 4.5% formaldehyde fixative for a minimum of 48 hours. Coronal plane sections were obtained and demineralized in EDTA for a week, embedded in paraffin for 12 hours, and dehydrated overnight. With a rotation microtome, 2-μm sections were cut and stained with hematoxylin and eosin to investigate tissue architecture and confirm the presence of a fibrocartilaginous intra-articular disk. The sections were immunohistochemically stained with antisera against S100, neuropeptide Y (NPY), and substance P (SP) to detect for neural tissue. Additionally, a nerve fiber count per 10 high-power fields representing an area of 0.2 mm2 was conducted for S100 stains. All sections were examined for the presence of positive immunoreactivity to S100, NPY, and SP. Results: The presence of a fibrocartilaginous intra-articular disk could be observed in all 12 examined ACJs. In all specimens, an immunoreactivity to S100, NPY, and SP could be observed within the superior peripheral region of the intra-articular disk. High-power field nerve counts of the S100 stains revealed a mean ± SD of 7.9 ± 2.28 nerves per 10 high-power fields (range, 4-12). Conclusion: The documented immunoreactivity to S100, NPY, and SP indicates the presence of somatic and autonomic nerve fibers within the intra-articular disk of the ACJ. Clinical Relevance: Confirming the presence of nerve fibers within the intra-articular disk of the ACJ suggests that the disk itself could be an independent source of pain after injury and thus a possible explanation for recalcitrant pain after treatment.

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“…AC joint injuries are most common in younger individuals who participate in contact sports. 18 , 19 , 20 In those who undergo surgical treatment, up to 30% of patients will require reoperation. 3 This demonstrates the complexity of AC joint stabilization procedures and the multitude of techniques that can be applied in different cases.…”

Section: Discussionmentioning

confidence: 99%

Treatment of a Failed Type V Acromioclavicular Separation Due to Coracoid Fracture: Revision of Acromioclavicular-Coracoclavicular Reconstruction and Coracoid Fixation

Goliganin

Waltz

Peebles

et al. 2021

Arthroscopy Techniques

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Acromioclavicular (AC) injuries are common, especially in the young and active population. AC joint dislocations account for 8% of all joint dislocations and are even more common in contact sports. These injuries are graded as type I through type VI on the basis of the Rockwood classification method. Types I and II are generally treated without surgery whereas types IV, V, and VI are best treated operatively. Type III dislocations remain controversial in terms of treatment, and many surgeons recommend nonoperative treatment first and operative treatment in case of continued symptoms such as pain, instability, or shoulder girdle dysfunction. The goal of operative treatment is to restore AC joint stability, which involves addressing both the coracoclavicular and coracoacromial ligaments to achieve a desirable patient outcome. The objective of this Technical Note is to describe our technique for management of a failed acromioclavicular stabilization, treated with a coracoclavicular and AC joint capsular reconstruction using tibialis anterior and semitendinosus allografts.

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Acromioclavicular joint injuries in overhead athletes: a concise review of injury mechanisms, treatment options, and outcomes

Cited by 11 publications

References 38 publications

Classification and morphological parameters of the coracoid process in Chinese population

Classification and morphological parameters of the coracoid process in Chinese population

Acromioclavicular Disk as a Potential Source of Pain in AC Joint Injuries

Treatment of a Failed Type V Acromioclavicular Separation Due to Coracoid Fracture: Revision of Acromioclavicular-Coracoclavicular Reconstruction and Coracoid Fixation

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