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Acromioclavicular Joint Injuries

  • Simone Cerciello
  • Felix Dyrna
  • Leo Pauzenberger
  • Jeremiah D. Johnson
  • Knut Beitzel
  • Augustus D. MazzoccaEmail author
Chapter

Abstract

The acromioclavicular (AC) joint connects the arm to the chest and is seen as an important structure providing the “strut” function of the upper extremity. Injuries may result from direct or indirect trauma. The involvement of intrinsic and/or extrinsic ligaments is responsible for several injury patterns. The extent of AC joint injuries range from mild sprains of the AC capsule with preservation of the coracoclavicular (CC) ligaments to complete tearing of both the AC capsule complex and the CC ligaments.

Peculiar radiographs are needed for a precise diagnosis; however, more accurate analysis involving Magnetic Resonance Imaging (MRI) or Computerised Tomography (CT) helps detect associated injuries. Minor trauma typically only affects the AC capsuloligamentous complex and a conservative approach usually yields satisfactory functional outcomes. Persistent instability and unsatisfactory outcomes are common (20–40%) after conservative treatment when coraco-clavicular ligaments or the trapezius fascia are involved as a result of significant trauma. Surgery may be advised in these circumstances to control inferior-superior as well as horizontal instability; however, the timing of such surgery guides selection of appropriate technique for stabilisation. For example internal CC-fixation with synthetic loops and cortical buttons may be proposed in the acute situation. In chronic cases healing of the ligaments is no longer possible; therefore, any fixation device should ideally be reinforced with a biologic soft tissue graft. Great care should also be taken to control anterior-posterior instability especially in high demand patients since it is one of the most common reasons for poor results. Hence, an additional AC capsuloligamentous augmentation should be considered. When key treatment principles are followed, satisfactory outcomes can be expected.

Keywords

Acromioclavicular injury AC joint AC separation Coracoclavicular ligaments Shoulder injury 

References

  1. 1.
    Adams FL. The genuine works of Hippocrates. Vols 1 and 2. New York: William Wood; 1886.Google Scholar
  2. 2.
    Kaplan LD, Flanigan DC, Norwig J, Jost P, Bradley J. Prevalence and variance of shoulder injuries in elite collegiate football players. Am J Sports Med. 2005;33(8):1142–6.CrossRefGoogle Scholar
  3. 3.
    Bosworth BBM. Complete acromioclavicular dislocation. N Engl J Med. 1949;241:221–5.CrossRefGoogle Scholar
  4. 4.
    Beim GM, Werner JJ. Clinical and radiographic evolution of the acromioclavicular joint. Oper Tech Sports Med. 1997;5:65–71.CrossRefGoogle Scholar
  5. 5.
    DePalma AF. The role of the discs of the sternoclavicular and acromioclavicular joints. Clin Orthop Relat Res. 1959;13:7–12.Google Scholar
  6. 6.
    Debski RE, Parsons IM 4th, Woo SL, Fu FH. Effect of capsular injury on acromioclavicular joint mechanics. J Bone Joint Surg Am. 2001;83(9):1344–51.CrossRefGoogle Scholar
  7. 7.
    Warth RJ, Martetschlager F, Gaskill TR, Millett PJ. Acromioclavicular joint separations. Curr Rev Muscoskelet Med. 2013;6:71–8.CrossRefGoogle Scholar
  8. 8.
    Stine IA, Vangsness CT. Analysis of the capsule and ligament insertions about the acromioclavicular joint: a cadaveric study. J Arthrosc Relat Surg. 2009;25:968–74.CrossRefGoogle Scholar
  9. 9.
    Fukuda K, Craig EV, An KN, Cofield RH, Chao EY. Biomechanical study of the ligamentous system of the acromioclavicular joint. J Bone Joint Surg Am. 1986;68:434–40.CrossRefGoogle Scholar
  10. 10.
    Epstein D, Day M, Rokito A. Current concepts in the surgical management of acromioclavicular joint injuries. Bull NYU Hosp Jt Dis. 2012;70:11–24.PubMedGoogle Scholar
  11. 11.
    Klimkiewicz JJ, Williams GR, Sher JS, Karduna A, Des Jardins J, Iannotti JP. The acromioclavicular capsule as a restraint to posterior translation of the clavicle: a biomechanical analysis. J Shoulder Elb Surg. 1999;8(2):119–24.CrossRefGoogle Scholar
  12. 12.
    Rios CG, Arciero RA, Mazzocca AD. Anatomy of the clavicle and coracoid process for reconstruction of the coracoclavicular ligaments. Am J Sports Med. 2007;35(5):811–7.CrossRefGoogle Scholar
  13. 13.
    Rockwood CA Jr, Young DC. Disorders of the acromioclavicular joint. In: Rockwood Jr CA, Hi MFA, editors. The shoulder. Philadelphia: WB Saunders; 1990. p. 413–76.Google Scholar
  14. 14.
    Copeland S. Shoulder surgery. London: WB Saunders; 1997.Google Scholar
  15. 15.
    Webb J, Bannister G. Acromioclavicular disruption in first class rugby players. Br J Sports Med. 1992;26:247–8.CrossRefGoogle Scholar
  16. 16.
    Lee KW, Debski RE, Chen CH, Woo SL, Fu FH. Functional evaluation of the ligaments at the acromioclavicular joint during anteroposterior and superoinferior translation. Am J Sports Med. 1997;25(6):858–62.CrossRefGoogle Scholar
  17. 17.
    Rockwood CA Jr. Injuries to the acromioclavicular joint. In: Rockwood Jr CA, Green DP, editors. Fractures in adults, vol. 1. 2nd ed. Philadelphia: JB Lippincott; 1984. p. 860–910.Google Scholar
  18. 18.
    Chronopoulos E, Kim TK, Park HB, Ashenbrenner D, McFarland EG. Diagnostic value of physical tests for isolated chronic acromioclavicular lesions. Am J Sports Med. 2004;32(3):655–61.CrossRefGoogle Scholar
  19. 19.
    Gerber C, Rockwood CA Jr. Subcoracoid dislocation of the lateral end of the clavicle. A report of three cases. J Bone Joint Surg Am. 1987;69(6):924–7.CrossRefGoogle Scholar
  20. 20.
    Zanca P. Shoulder pain: involvement of the acromioclavicular joint. (analysis of 1,000 cases). Am J Roentgenol Radium Therapy, Nucl Med. 1971;112(3):493–506.CrossRefGoogle Scholar
  21. 21.
    Alexander OM. Radiography of the acromioclavicular articulation. Med Radiogr Photogr. 1954;30(2):34–9.PubMedGoogle Scholar
  22. 22.
    Bearden JM, Hughston JC, Whatley GS. Acromioclavicular dislocation: method of treatment. J Sports Med. 1973;1(4):5–17.CrossRefGoogle Scholar
  23. 23.
    Tischer T, Salzmann GM, El-Azab H, Vogt S, Imhoff AB. Incidence of associated injuries with acute acromioclavicular joint dislocations types III through V. Am J Sports Med. 2009;37(1):136–9; Epub 2008 Aug 25.CrossRefGoogle Scholar
  24. 24.
    Mouhsine E, Garofalo R, Crevoisier X, Farron A. Grade I and II acromioclavicular dislocations: results of conservative treatment. J Shoulder Elb Surg. 2003;12(6):599–602.CrossRefGoogle Scholar
  25. 25.
    Park JP, Arnold JA, Coker TP, Harris WD, Becker DA. Treatment of acromioclavicular separations. A retrospective study. Am J Sports Med. 1980;8(4):251–6.CrossRefGoogle Scholar
  26. 26.
    Bjerneld H, Hovelius L, Thorling J. Acromio-clavicular separations treated conservatively. A 5-year follow-up study. Acta Orthop Scand. 1983;54(5):743–5.CrossRefGoogle Scholar
  27. 27.
    Shaw MB, McInerney JJ, Dias JJ, Evans PA. Acromioclavicular joint sprains: the post-injury recovery interval. Injury. 2003;34(6):438–42.CrossRefGoogle Scholar
  28. 28.
    Smith TO, Chester R, Pearse EO, Hing CB. Operative versus non-operative management following Rockwood grade III acromioclavicular separation: a metaanalysis of the current evidence base. J Orthop Traumatol. 2011;12(1):19–27.CrossRefGoogle Scholar
  29. 29.
    Schlegel TF, Burks RT, Marcus RL, Dunn HK. A prospective evaluation of untreated acute grade III acromioclavicular separations. Am J Sports Med. 2001;29(6):699–703.CrossRefGoogle Scholar
  30. 30.
    Gumina S, Carbone S, Postacchini F. Scapular dyskinesis and SICK scapula syndrome in patients with chronic type III acromioclavicular dislocation. Arthroscopy. 2009;25(1):40–5; Epub 2008 Oct 10.CrossRefGoogle Scholar
  31. 31.
    Norrel H Jr, Lewellyn 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.CrossRefGoogle Scholar
  32. 32.
    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(5):448–51.PubMedGoogle Scholar
  33. 33.
    Bosworth BM. Acromioclavicullar separations. New method of repair. Surg Gynecol Obstet. 1941;73:866–71.Google Scholar
  34. 34.
    Stewart AM, Ahmad CS. Failure of acromioclavicular reconstruction using Gore-Tex graft due to aseptic foreign-body reaction and clavicle osteolysis: a case report. J Shoulder Elb Surg. 2004;13(5):558–61.CrossRefGoogle Scholar
  35. 35.
    Boldin C, Fankhauser F, Ratschek M, Haller-Schober EM. Foreign-body reaction after reconstruction of complete acromioclavicular dislocation using PDS augmentation. J Shoulder Elb Surg. 2004;13(1):99–100.CrossRefGoogle Scholar
  36. 36.
    Cadenat FM. Traitment des luxations et fractures externes de la clavicule. Thése médecine. Paris n° 195. 1913.Google Scholar
  37. 37.
    Weaver JK, Dunn HK. Treatment of acromioclavicular injuries, especially complete acromioclavicular separation. J Bone Joint Surg Am. 1972;5:1187–94.CrossRefGoogle Scholar
  38. 38.
    Lafosse L, Baier GP, Leuzinger J. Arthroscopic treatment of acute and chronic acromioclavicular joint dislocation. Arthroscopy. 2005;21(8):1017.CrossRefGoogle Scholar
  39. 39.
    Dewar FP, Barrington TW. The treatment of chronic acromio-clavicular dislocation. J Bone Joint Surg Br. 1965;47:32–5; PubMed PMID: 14296242.CrossRefGoogle Scholar
  40. 40.
    Corteen DP, Teitge RA. Stabilization of the clavicle after distal resection: a biomechanical study. Am J Sports Med. 2005;33(1):61–7.CrossRefGoogle Scholar
  41. 41.
    Bargren JH, Erlanger S, Dick HM. Biomechanics and comparison of two operative methods of treatment of complete acromioclavicular separation. Clin Orthop Relat Res. 1978;130:267–72.Google Scholar
  42. 42.
    Stam L, Dawson I. Complete acromioclavicular dislocations: treatment with a Dacron ligament. Injury. 1991;22(3):173–6. [PubMed].CrossRefGoogle Scholar
  43. 43.
    Venjakob AJ, Salzmann GM, Gabel F, et al. Arthroscopically assisted 2-bundle anatomic reduction of acute acromioclavicular joint separations. Am J Sports Med. 2013;41(3):615–21.  https://doi.org/10.2214/ajr.112.3.493.CrossRefPubMedGoogle Scholar
  44. 44.
    Di Francesco A, Zoccali C, Colafarina O, Pizzoferrato R, Flamini S. 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(2):147–52.  https://doi.org/10.1016/j.injury.2011.04.002.CrossRefPubMedGoogle Scholar
  45. 45.
    Carofino BC, Mazzocca AD. The anatomic coracoclavicular ligament reconstruction: surgical technique and indications. J Shoulder Elb Surg. 2010;19(2 Suppl):37–46.  https://doi.org/10.1016/j.jse.2010.01.004.CrossRefGoogle Scholar
  46. 46.
    Beitzel K, Obopilwe E, Apostolakos J, Cote MP, Russell RP, Charette R, Singh H, Arciero RA, Imhoff AB, Mazzocca AD. Rotational and translational stability of different methods for direct acromioclavicular ligament repair in anatomic acromioclavicular joint reconstruction. Am J Sports Med. 2014;42(9):2141–8.  https://doi.org/10.1177/0363546514538947; Epub 2014 Jul 2.CrossRefPubMedGoogle Scholar
  47. 47.
    Mayr E, Braun W, Eber W, Rüter A. Treatment of acromioclavicular joint separations. Central Kirschner wire and PDS augmentation. Unfallchirurg. 1999;102:278–86.CrossRefGoogle Scholar
  48. 48.
    Winkler H, Schlamp D, Wentzensen A. Treatment of acromioclavicular joint dislocation by tension band and ligament suture. Aktuelle Traumatol. 1994;24(4):133–9.PubMedGoogle Scholar
  49. 49.
    Hessmann M, Gotzen L, Gehling H. Acromioclavicular reconstruction augmented with polydioxanonsulphate bands. Surgical technique and results. Am J Sports Med. 1995;23:552–6.CrossRefGoogle Scholar
  50. 50.
    Lemos M, Tolo E. Complications of the treatment of the acromioclavicular and sternoclavicular joint injuries, including instability. Clin Sports Med. 2003;22(2):371–85.CrossRefGoogle Scholar
  51. 51.
    Gohring H, Matusewicz A, Friedl W, Ruf W. Results of treatment after different surgical procedures for management of acromioclavicular joint dislocation. Chirurg. 1993;64:565–71.PubMedGoogle Scholar
  52. 52.
    Fauci F, Merolla G, Paladini P, Campi F, Porcellini G. Surgical treatment of chronic acromioclavicular dislocation with biologic graft vs synthetic ligament: a prospective randomized comparative study. J Orthop Traumatol. 2013;14(4):283–90.  https://doi.org/10.1007/s10195-013-0242-2.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Simone Cerciello
    • 1
    • 2
  • Felix Dyrna
    • 3
  • Leo Pauzenberger
    • 4
  • Jeremiah D. Johnson
    • 4
  • Knut Beitzel
    • 3
  • Augustus D. Mazzocca
    • 4
    Email author
  1. 1.Casa di Cura Villa BetaniaRomeItaly
  2. 2.Marrelli hospitalCrotoneItaly
  3. 3.Department of Orthopaedic SportsmedicineTechnical UniversityMunichGermany
  4. 4.Department of Orthopaedic SurgeryUniversity of ConnecticutFarmingtonUSA

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