Management of Acromioclavicular Injuries – Current Concepts

Abstract

Introduction Treatment of a patient with acromioclavicular joint (ACJ) injury remains challenging for orthopedic surgeons. To date, there is debate over the optimal management of ACJ injuries. This review provides an overview of assessment, treatment, and future perspectives for the treatment of and research into ACJ. Material and Methods A scoping literature review was performed. The search was built including the following terms: acromioclavicular joint injuries or dislocation, and pathophysiology, etiology, anatomy, treatment, and trauma mechanism. The papers with evidence levels 1–3 were included in the current narrative review. Results A total of 2242 potential relevant studies were identified in the searches. After removal of duplicates, 432 studies were screened on their titles and abstracts, resulting in 35 studies being included in the review, based on the eligibility criteria. Conclusion The management of acute and chronic ACJ injuries is not clarified in the current literature. However, there is currently insufficient high-level evidence for the overall treatment options for ACJ injuries. If surgical intervention is decided upon in consultation with the patient, the complications may not outweigh the benefits. The multitude of existing techniques is indicative of the uncertainty surrounding this issue, and no gold standard has yet been established for treatment methods. An ideal classification would include not only vertical and horizontal instability, but also the severity of kinematic alterations of the shoulder complex. This indicates the need for a new and improved diagnostic tool for the classification of ACJ injuries.

Surgical treatment for fracture of the medial end of the clavicle associated with ipsilateral acromioclavicular dislocation

“…Since the best treatment of ACJ dislocation is still debated [ 6 ] today, we did not take an aggressive approach and decided not to perform a surgical treatment of this second injury. The excellent results at mid-term follow-up comfort us in this strategy and are consistent with other few cases of non-operative approach reported in the literature [ [7] , [8] , [9] , [10] ].…”

Current trends in surgical treatment of the acromioclavicular joint injuries in 2023: a review of the literature

“…However, the majority of the modern techniques include addressing the CC ligaments in isolation with constructs using suture suspensory construct, synthetic devices, hardware, and/or graft tissue. 5 , 13 , 15 , 16 , 17 , 21 , 24 , 27 , 30 Additionally, nonanatomic CC reconstruction options utilizing a hook plate and transfer of the CA ligament (Weaver-Dunn procedure) and modifications thereof have also been used. Over time, anatomic versus nonanatomic reconstruction options of the CC ligaments have been evaluated biomechanically.…”

Acromioclavicular joint dislocation Rockwood type III and V show no difference in functional outcome and 91% recovered well without the need for surgery

“…Two recent studies have shown good results with nonsurgical treatment of type V dislocations questioning the necessity of surgical treatment for this type [16,38]. Rockwood type III is the most common type of AC joint dislocation, but consensus regarding the treatment is lacking [10]. The majority of published studies compare predefined groups of patients treated surgically and nonsurgically and show comparable long-term clinical outcomes [5,14,32,38].…”