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Arthroscopic Treatment of Acromioclavicular Dislocations

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Intraarticular Fractures

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Abstract

Acromioclavicular (AC) joint is commonly involved in traumatic injuries to the shoulder, and these injuries force surgeons in the diagnostic and therapeutic sense. The AC joint injury constitutes 30–50% of athletic shoulder injuries and represents 8% of all joint dislocations in the body. These injuries can be seen as a result of direct or indirect forces. The most common mechanism of injury is a direct trauma, caused by fall or blow to the lateral aspect of the shoulder with the arm in adduction. Indirect mechanisms of AC joint injuries are rare and may occur by falling on out-stretched hand or elbow in adducted position. This results in superior displacement of humeral head, leading to a pushing force against acromion.

Clinical evaluation should be done in comparison with contralateral normal joint. In acute injuries, pain, tenderness, and swelling at the AC joint are the main complaints. Significant deformity and stepping can be seen between distal end of the clavicle and acromion, especially in complete dislocations. Radiographical images should be obtained when AC joint injury is suspected in the patient’s history and physical examination. Anteroposterior, lateral and axillary views are the standard views used for this purpose. But improved visualization of the AC joint can be obtained by the Zanca view which is performed with a 10–15 ° cephalic tilt of the X-ray beam and using only 50% of the standard shoulder anteroposterior penetration strength. Stress views can be obtained to assess AC joint instability by holding weights in each arm.

Various surgical treatment modalities of unstable AC joint injuries have been described for years in the orthopaedic literature. All of these surgical strategies share a common goal of stabilization and realigning of the distal clavicle. In the last 10–15 years, arthroscopically assisted treatment methods for unstable AC joint injuries have been developed and popularized with several advantages. The possibility of detection and treatment of additional glenohumeral lesions, better cosmetic results with smaller incisions, minimal soft tissue dissection, and direct visualization of the base of the coracoid are the main advantages of the arthroscopic approaches.

Shoulder pain, fractures, loss of reduction, infection, and coracoclavicular (CC) calcification are most commonly documented complications following arthroscopically assisted treatment of AC joint injuries.

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Authors and Affiliations

  1. Department of Orthopaedics, Uludag University Medical School, Bursa, Turkey

    Ali Cavit

  2. Faculty of Medicine, Department of Orthopaedics, Akdeniz University, Antalya, Turkey

    Haluk Ozcanli

  3. Department of Orthopaedics, Medical Park Hospital, Antalya, Turkey

    A. Merter Ozenci

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  1. Ali Cavit
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Editors and Affiliations

  1. Department of Orthopedics and Traumatology, T.C. Ufuk University, Ankara, Turkey

    Mahmut Nedim Doral

  2. Department of Orthopaedics, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden

    Jón Karlsson

  3. Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, KY, USA

    John Nyland

  4. Helfentalweg 1A, Landeskrankenhaus Feldkirch Abt. Unfallchirurgie, Innsbruck, Austria

    Karl Peter Benedetto

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Cavit, A., Ozcanli, H., Merter Ozenci, A. (2019). Arthroscopic Treatment of Acromioclavicular Dislocations. In: Doral, M., Karlsson, J., Nyland, J., Benedetto, K. (eds) Intraarticular Fractures. Springer, Cham. https://doi.org/10.1007/978-3-319-97602-0_8

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