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Shoulder Arthroplasty pp 187–193Cite as

Acromioclavicular Joint Injuries

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Abstract

Acromioclavicular joint injuries are relatively frequent. The mechanism of injury can be either indirect trauma or more frequently direct trauma to the superolateral border of the shoulder. In order not to miss these injuries in clinics, history taking and careful physical examination are necessary. For the current management of AC joint injuries, nonsurgical and surgical methods are present. Currently, low-grade (I and II) and high-grade (IV, V, and VI) dislocations are managed conservatively and surgically, respectively. Regarding type III AC dislocation, although the best method has not been defined yet, nonsurgical treatment may be chosen as an initial management in patients with low expectations and low level of activities, and surgery should be reserved for active, young patients with high expectations in daily work and sports and for patients unresponsive to nonsurgical treatment. As a future prospect, higher level of evidence and comparative biomechanical and clinical studies are needed to clarify the uncertainty of choosing the best method of surgical treatment.

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References

  1. Lynch TS, Saltzman MD, Ghodasra JH, Bilimoria KY, Bowen MK, Nuber GW. Acromioclavicular joint injuries in the National Football League: epidemiology and management. Am J Sports Med. 2013;41(12):2904–8.

    PubMed  Google Scholar 

  2. Pallis M, Cameron KL, Svoboda SJ, Owens BD. Epidemiology of acromioclavicular joint injury in young athletes. Am J Sports Med. 2012;40(9):2072–7.

    PubMed  Google Scholar 

  3. Verna E, Parmentrier S, Richier A, et al. Duplication of the acromioclavicular joint: a case dating from the end of the 19th century. Morphologie. 2017;102(337):106–10.

    PubMed  Google Scholar 

  4. Milz S, Putz R, Haasters F, Ockert B. Anatomy of the acromioclavicular and coracoclavicular region. Functional and clinical aspects. Unfallchirurg. 2015;118(5):390–6.

    CAS  PubMed  Google Scholar 

  5. Goss TP. Double disruptions of the superior shoulder suspensory complex. J Orthop Trauma. 2003;7(2):99–106.

    Google Scholar 

  6. Shin SJ. Surgical treatment of acromioclavicular dislocation: coracoclavicular ligament reconstruction. J Korean Fract Soc. 2008;21(1):70–6.

    Google Scholar 

  7. Pastor MF, Averbeck AK, Welke B, Smith T, Claassen L, Wellmann M. The biomechanical influence of the deltotrapezoid fascia on horizontal and vertical acromioclavicular joint stability. Arch Orthop Trauma Surg. 2016;136(4):513–9. https://doi.org/10.1007/s00402-015-2389-1.

  8. Barth J, Boutsiadis A, Narbona P, Ladermann A, Arrigoni P, Adams CR, Burkhart SS, Denard PJ. The anterior borders of the clavicle and the acromion are not always aligned in the intact acromioclavicular joint: a cadaveric study. J Shoulder Elb Surg. 2017;26(7):1121–7.

    Google Scholar 

  9. Fukuda K, Craig EV, An KN, Cofield RH, Chao EY. Biomechanical study of the ligamentous structures of the acromioclavicular joint. J Bone Joint Surg Am. 1986;68(3):434–40.

    CAS  PubMed  Google Scholar 

  10. Nuber G, Bowen M. Acromioclavicular joint injuries and distal clavicle fractures. J Am Acad Orthop Surg. 1997;5(1):11–8.

    CAS  PubMed  Google Scholar 

  11. Flint JH, Wade AM, Giuliani J, Rue JP. Defining the terms acute and chronic in orthopaedic sports injuries: a systematic review. Am J Sports Med. 2014;42(1):235–41.

    PubMed  Google Scholar 

  12. Tossy JD, Mead NC, Sigmond HM. Acromioclavicular separations: useful and practical classification for treatment. Clin Orthop Relat Res. 1963;28:111–9.

    CAS  PubMed  Google Scholar 

  13. Allman FL Jr. Fractures and ligamentous injuries of the clavicle and its articulation. J Bone Joint Surg. 1967;49(4):774–84.

    PubMed  Google Scholar 

  14. Rockwood CA, Williams GR, Young DC. Acromioclavicular injuries. In: Rockwood CA, Green DP, Bucholz RW, Heckman JD, editors. Fractures in adults, vol. I. 4th ed. Philadelphia, PA: Lippincott-Raven; 1996. p. 1341–413.

    Google Scholar 

  15. Schneider MM, Balke M, Koenen P, et al. Inter- and intraobserver reliability of the Rockwood classification in acute acromioclavicular joint dislocations. Knee Surg Sports Traumatol Arthrosc. 2014;24(7):2192–6.

    PubMed  Google Scholar 

  16. Granville-Chapman J, Torrance E, Rachid A, Funk L. The Rockwood classification in acute acromioclavicular joint injury does not correlate with symptoms. J Orthop Surg (Hong Kong). 2018;26(2):2309499018777886.

    CAS  Google Scholar 

  17. Ibrahim EF, Forrest NP, Forester A. Bilateral weighted radiographs are required for accurate classification of acromioclavicular separation: an observational study of 59 cases. Injury. 2014;46(10):1900–5.

    Google Scholar 

  18. Zumstein MA, Schiessl P, et al. New quantitative radiographic parameters for vertical and horizontal instability in acromioclavicular joint dislocations. Knee Surg Sports Traumatol Arthrosc. 2018;26(1):125–35.

    PubMed  Google Scholar 

  19. Beitzel K, Mazzocca AD, Bak K, Itoi E, Kibler WB, Mirzayan R, et al. ISAKOS upper extremity committee consensus statement on the need for diversification of the Rockwood classification for acromioclavicular joint injuries. Arthroscopy. 2014;30(2):271–8.

    PubMed  Google Scholar 

  20. Boffano M, Mortera S, Wafa H, Piana R. The surgical treatment of acromioclavicular injuries. EFORT Open Rev. 2017;2:432–7.

    PubMed  PubMed Central  Google Scholar 

  21. Stucken S, Cohen SB. Management of acromioclavicular joint injuries. Orthop Clin North Am. 2015;46(1):57–66.

    PubMed  Google Scholar 

  22. Mouhsine E, Garofalo R, Crevoisier X, Farron A. Grade I and II acromioclavicular dislocations: results of conservative treatment. J Shoulder Elb Surg. 2003;12:599–602.

    Google Scholar 

  23. Mumford EB. Acromioclavicular dislocation: a new operative treatment. J Bone Joint Surg Am. 1941;23:799–802.

    Google Scholar 

  24. Park KD, Kim TK, Lee J, Lee WY, Ahn JK, Park Y. Palpation versus ultrasound-guided acromioclavicular joint intraarticular corticosteroid injections: a retrospective comparative clinical study. Pain Physician. 2015;18(4):333–41.

    PubMed  Google Scholar 

  25. Cooper ES. New method of treating long-standing dislocations of the scapulo-clavicular articulation. Am J Med Sci. 1861;41:389–92.

    Google Scholar 

  26. Bosworth BM. Acromioclavicular separation: new method of repair. Surg Gynecol Obstet. 1941;73:866–71.

    Google Scholar 

  27. Leidel BA, Braunstein V, Kirchhoff C, et al. Consistency of long-term outcome of acute Rockwood grade III acromioclavicular joint separations after K-wire transfixation. J Trauma. 2009;66:1666–71.

    PubMed  Google Scholar 

  28. Mc Kee M, Pelet S, McCormack RG, et al. Multicentre randomized clinical trial of nonoperative versus operative treatment of acute acromioclavicular joint dislocation. J Orthop Trauma. 2013;29:479–87.

    Google Scholar 

  29. Norrell H Jr, Llewellyn RC. Migration of a threaded Steinmann pin from an acromioclavicular joint into the spinal canal: a case report. J Bone Joint Surg Am. 1965;47:1024–6.

    PubMed  Google Scholar 

  30. Nüchtern JV, Sellenschloh K, Bishop N, et al. Biomechanical evaluation of 3 stabilization methods on acromioclavicular joint dislocations. Am J Sports Med. 2013;41:1387–94.

    PubMed  Google Scholar 

  31. Sage FP, Salvatore JE. Injuries of the acromioclavicular joint: a study of results in 96 patients. South Med J. 1963;56:486–95.

    CAS  PubMed  Google Scholar 

  32. Sethi GK, Scott SM. Subclavian artery laceration due to migration of a Hagie pin. Surgery. 1976;80:644–6.

    CAS  PubMed  Google Scholar 

  33. Faraj AA, Ketzer B. The use of a hook-plate in the management of acromioclavicular injuries. Report of ten cases. Acta Orthop Belg. 2001;67:448–51.

    CAS  PubMed  Google Scholar 

  34. Gstettner C, Tauber M, Hitzl W, Resch H. Rockwood type III acromioclavicular dislocation: surgical versus conservative treatment. J Shoulder Elb Surg. 2008;17:220–5.

    CAS  Google Scholar 

  35. Kienast B, Thietje R, Queitsch C, et al. Mid-term results after operative treatment of Rockwood grade III–V acromioclavicular joint dislocations with an AC-hook-plate. Eur J Med Res. 2011;16:52–6.

    PubMed  PubMed Central  Google Scholar 

  36. Koukakis A, Manouras A, Apostolou CD, et al. Results using the AO hook plate for dislocations of the acromioclavicular joint. Expert Rev Med Devices. 2008;5:567–72.

    PubMed  Google Scholar 

  37. Sim E, Schwarz N, Höcker K, Berzlanovich A. Repair of complete acromioclavicular separations using the acromioclavicular hook-plate. Clin Orthop Relat Res. 1995;314:134–42.

    Google Scholar 

  38. Yoo YS, Seo TJ, Noh KC, et al. Arthroscopically assisted anatomical coracoclavicular ligament reconstruction using tendon graft. Int Orthop. 2011;35:1025–30.

    PubMed  Google Scholar 

  39. Di Francesco A, Zoccali C, Colafarina O, et al. The use of hook plate in type III and V acromio-clavicular Rockwood dislocations: clinical and radiological midterm results and MRI evaluation in 42 patients. Injury. 2012;43:147–52.

    PubMed  Google Scholar 

  40. Eschler A, Gradl G, Gierer P, Mittlmeier T, Beck M. Hook plate fixation for acromioclavicular joint separations restores coracoclavicular distance more accurately than PDS augmentation, however presents with a high rate of acromial osteolysis. Arch Orthop Trauma Surg. 2012;132(1):33–9.

    PubMed  Google Scholar 

  41. Adam FF, Farouk O. Surgical treatment of chronic complete acromioclavicular dislocation. Int Orthop. 2004;28:119–22.

    PubMed  Google Scholar 

  42. Boileau P, Old J, Gastaud O, et al. All-arthroscopic Weaver-Dunn-Chuinard procedure with double-button fixation for chronic acromioclavicular joint dislocation. Arthroscopy. 2010;26:149–60.

    PubMed  Google Scholar 

  43. Hegazy G, Safwat H, Seddik M, et al. Modified Weaver-Dunn Procedure versus the use of semitendinosus autogenous tendon graft for acromioclavicular joint reconstruction. Open Orthop J. 2016;10:166–78.

    PubMed  PubMed Central  Google Scholar 

  44. Jeon IH, Dewnany G, Hartley R, et al. Chronic acromioclavicular separation: the medium term results of coracoclavicular ligament reconstruction using braided polyester prosthetic ligament. Injury. 2007;38:1247–53.

    PubMed  Google Scholar 

  45. Kim SH, Lee YH, Shin SH, et al. Outcome of conjoined tendon and coracoacromial ligament transfer for the treatment of chronic type V acromioclavicular joint separation. Injury. 2012;43:213–8.

    PubMed  Google Scholar 

  46. Kumar V, Garg S, Elzein L, et al. Modified Weaver-Dunn procedure versus the use of a synthetic ligament for acromioclavicular joint reconstruction. J Orthop Surg (Hong Kong). 2014;22(2):199–203.

    Google Scholar 

  47. Lopez-Alameda S, Fernandez-Santas T, Garcia-Villanueva A, et al. Results of surgical treatment of acromioclavicular dislocations type III using modified Weaver-Dunn technique. Rev Esp Cir Ortop Traumatol. 2018;62(2):93–9.

    CAS  PubMed  Google Scholar 

  48. Millett PJ, Braun S, Gobezie R, Pacheco IH. Acromioclavicular joint reconstruction with coracoacromial ligament transfer using the docking technique. BMC Musculoskelet Disord. 2009;10:6.

    PubMed  PubMed Central  Google Scholar 

  49. Pavlik A, Csépai D, Hidas P. Surgical treatment of chronic acromioclavicular joint dislocation by modified weaver-Dunn procedure. Knee Surg Sports Traumatol Arthrosc. 2001;9:307–12.

    CAS  PubMed  Google Scholar 

  50. Lafosse L, Baier GP, Leuzinger J. Arthroscopic treatment of acute and chronic acromioclavicular joint dislocation. Arthroscopy. 2005;21(8):1017.

    Google Scholar 

  51. Costic RS, Labriola JE, Rodosky MW, Debski RE. Biomechanical rationale for development of anatomical reconstructions of coracoclavicular ligaments after complete acromioclavicular joint dislocations. Am J Sports Med. 2004;32:1929–36.

    PubMed  Google Scholar 

  52. Deshmukh AV, Wilson DR, Zilberfarb JL, Perlmutter GS. Stability of acromioclavicular joint reconstruction: biomechanical testing of various surgical techniques in a cadaver model. Am J Sports Med. 2004;32:1492–8.

    PubMed  Google Scholar 

  53. North AS, Wilkinson T. Surgical reconstruction of the acromioclavicular joint: Can we identify the optimal approach? Strategies Trauma Limb Reconstr. 2018;13(2):69–74.

    Google Scholar 

  54. Mazzocca AD, Santangelo SA, Johnson ST, et al. A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction. Am J Sports Med. 2006;34:236–46.

    PubMed  Google Scholar 

  55. Arirachakaran A, Boonard M, Piyapittayanun P, et al. Post-operative outcomes and complications of suspensory loop fixation device versus hook plate in acute unstable acromioclavicular dislocation: a systematic review and meta-analysis. J Orthop Traumatol. 2017;18:293. https://doi.org/10.1007/s10195-017-0451-1.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Salzmann GM, Walz L, Buchmann S, et al. Arthroscopically assisted 2-bundle anatomical reduction of acute acromioclavicular joint separations. Am J Sports Med. 2010;38:1179–87.

    PubMed  Google Scholar 

  57. Le Hanneur M, Thoreson A, Delgrande D, et al. Biomechanical comparison of anatomic and extra-anatomic reconstruction techniques using local grafts for chronic instability of the acromioclavicular joint. Am J Sports Med. 2018;46(8):1927–35.

    PubMed  Google Scholar 

  58. Moatshe G, Kruckeberg BM, Chahla J, et al. Acromioclavicular and coracoclavicular ligament reconstruction for acromioclavicular joint instability: a systematic review of clinical and radiographic outcomes. Arthroscopy. 2018;34(6):1979–95.

    PubMed  Google Scholar 

  59. Dimakopoulos P, Panagopoulos A, Syggelos SA, et al. Double-loop suture repair for acute acromioclavicular joint disruption. Am J Sports Med. 2006;34:1112–9.

    PubMed  Google Scholar 

  60. Hosseini H, Friedmann S, Tröger M, et al. Arthroscopic reconstruction of chronic AC joint dislocations by transposition of the coracoacromial ligament augmented by the tight rope device: a technical note. Knee Surg Sports Traumatol Arthrosc. 2009;17:92–7.

    PubMed  Google Scholar 

  61. Wolf EM, Pennington WT. Arthroscopic reconstruction for acromioclavicular joint dislocation. Arthroscopy. 2001;17:558–63.

    CAS  PubMed  Google Scholar 

  62. Grutter PW, Peterson SA. Anatomical acromioclavicular ligament reconstruction: a biomechanical comparison of reconstructive techniques of the acromioclavicular joint. Am J Sports Med. 2005;33:1723–8.

    PubMed  Google Scholar 

  63. Saccomanno MF, Fodale M, Capasso L, et al. Reconstruction of the coracoclavicular and acromioclavicular ligaments with semitendinosus tendon graft: a pilot study. Joints. 2014;2:6–14.

    PubMed  PubMed Central  Google Scholar 

  64. Saier T, Venjakob AJ, Minzlaft P, et al. Value of additional acromioclavicular cerclage for horizontal stability in complete acromioclavicular separation: a biomechanical study. Knee Surg Sports Traumatol Arthrosc. 2015;23:1498–505.

    PubMed  Google Scholar 

  65. Tauber M, Valler D, Lichtenburg S, et al. Arthroscopic stabilization of chronic acromioclavicular joint dislocation triple-versus single bundle-reconstruction. Am J Sports Med. 2016;44:482–9.

    PubMed  Google Scholar 

  66. Kraus N, Scheibel M. Injuries of the acromioclavicular joint in athletes. Chirurg. 2014;85(10):854–63.

    CAS  PubMed  Google Scholar 

  67. Tauber M. Acromioclavicular injuries in professional athletes. Orthopade. 2014;43(3):249–55.

    CAS  PubMed  Google Scholar 

  68. Longo UG, Ciuffreda M, Rizzello G, et al. Surgical versus conservative management of Type III acromioclavicular dislocation: a systematic review. Br Med Bull. 2017;122(1):31–49.

    PubMed  Google Scholar 

  69. Phillips AM, Smart C, Groom AF. Acromioclavicular dislocation. Conservative or surgical therapy. Clin Orthop Relat Res. 1998;353:10–7.

    Google Scholar 

  70. Tang G, Zhang Y, Liu Y, et al. Comparison of surgical and conservative treatment of Rockwood type-III acromioclavicular dislocation: a meta-analysis. Medicine (Baltimore). 2018;97(4):e9690.

    Google Scholar 

  71. Song T, Yan X, Ye T. Comparison of the outcome of early and delayed surgical treatment of complete acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc. 2016;24(6):1943–50.

    PubMed  Google Scholar 

  72. Helfen T, Siebenbürger G, Ockert B, Haasters F. Therapy of acute acromioclavicular joint instability. Meta-analysis of arthroscopic/minimally invasive versus open procedures. Unfallchirurg. 2015;118(5):415–26.

    CAS  PubMed  Google Scholar 

  73. Pensak M, Grumet RC, Slabaugh MA, Bach BR Jr. Open versus arthroscopic distal clavicle resection. Arthroscopy. 2010;26(5):697–704.

    PubMed  Google Scholar 

  74. Song HS, Song SY, Yoo YS, et al. Symptomatic residual instability with grade II acromioclavicular injury. J Orthop Sci. 2012;17(4):437–42.

    PubMed  Google Scholar 

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Conflict of interest: None.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Konya Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey

    Onur Bilge

  2. Department of Sports Medicine, Konya Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey

    Onur Bilge

  3. Department of Orthopaedics and Traumatology, Muğla Sıtkı Koçman University, Faculty of Medicine, Mugla, Turkey

    Nazım Karalezli

  4. Department of Orthopaedics and Traumatology, Hacettepe University, Faculty of Medicine, Ankara, Turkey

    Gazi Huri

  5. Department of Orthopaedics and Traumatology, Ufuk University, Faculty of Medicine, Dr. Rıdvan Ege Hospital, Ankara, Turkey

    Mahmut Nedim Doral

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  1. Onur Bilge
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  2. Nazım Karalezli
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  4. Mahmut Nedim Doral
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Editors and Affiliations

  1. Orthopaedics & Traumatology, Hacettepe University School of Medicine Orthopaedics & Traumatology, Ankara, Turkey

    Gazi Huri

  2. Department of Orthopedic Surgery, Villa del Sole Clinic and Magna Graecia University of Catanzaro, Catanzaro, Italy

    Filippo Familiari

  3. Orthopedic Department, Chosun University Hospital Orthopedic Department, Gwangju, Korea (Republic of)

    Young Lae Moon

  4. Department of Orthopedics & Traumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey

    Mahmut Nedim Doral

  5. II Clinica Ortopedica & Laboratory Biomeccanica, IRCCS Istituto Ortopedico Rizzoli - University of Bologna, Bologna, Italy

    Giulio Maria Marcheggiani Muccioli

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Bilge, O., Karalezli, N., Huri, G., Doral, M.N. (2020). Acromioclavicular Joint Injuries. In: Huri, G., Familiari, F., Moon, Y.L., Doral, M.N., Marcheggiani Muccioli, G.M. (eds) Shoulder Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-030-19285-3_19

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