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Review
. 2017 Dec 18;8(12):861-873.
doi: 10.5312/wjo.v8.i12.861.

New insights in the treatment of acromioclavicular separation

Christiaan J A van Bergen  1 , Annelies F van Bemmel  2 , Tjarco D W Alta  2 , Arthur van Noort  2
Affiliations
Review

New insights in the treatment of acromioclavicular separation

Christiaan J A van Bergen et al. World J Orthop. .

Abstract

A direct force on the superior aspect of the shoulder may cause acromioclavicular (AC) dislocation or separation. Severe dislocations can lead to chronic impairment, especially in the athlete and high-demand manual laborer. The dislocation is classified according to Rockwood. Types I and II are treated nonoperatively, while types IV, V and VI are generally treated operatively. Controversy exists regarding the optimal treatment of type III dislocations in the high-demand patient. Recent evidence suggests that these should be treated nonoperatively initially. Classic surgical techniques were associated with high complication rates, including recurrent dislocations and hardware breakage. In recent years, many new techniques have been introduced in order to improve the outcomes. Arthroscopic reconstruction or repair techniques have promising short-term results. This article aims to provide a current concepts review on the treatment of AC dislocations with emphasis on recent developments.

Keywords: Acromioclavicular dislocation; Arthroscopically assisted acromioclavicular reconstruction; Conoid and trapezoid ligaments; Coracoclavicular ligament reconstruction; Hookplate; Rockwood classification; Weaver and Dunn procedure.

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Conflict of interest statement

Conflict-of-interest statement: No potential conflicts of interest. No financial support.

Figures

Figure 1
Figure 1
Digital pictures of a patient with a type-V acromioclavicular dislocation. A: Anterior view; B: Lateral view: The shoulder is passively adducted in the horizontal plain to test horizontal stability. Note the horizontal instability in this case.
Figure 2
Figure 2
Standard radiographic series of the shoulder. A: A true anterior-posterior view; B: Scapular Y lateral view; C: Axillary view; D: Zanca view; E: In case of acromioclavicular separation, a bilateral Zanca view can be useful.
Figure 3
Figure 3
Rockwood classification (Case courtesy of Dr Roberto Schubert, Radiopaedia.org, rID: 19124).
Figure 4
Figure 4
Intra-operative pictures of an autograft tendon reconstruction technique of the coracoclavicular joint without bone tunnels in combination with direct suture fixation of the acromioclavicular joint. A: The lateral clavicle is resected, and a double nonabsorbale suture is used for AC joint repair; B-D: A semitendinosus tendon is passed under the coracoid and over the clavicle for CC joint repair. AC: Acromioclavicular; CC: Coracoclavicular.
See this image and copyright information in PMC

References

    1. Babhulkar A, Pawaskar A. Acromioclavicular joint dislocations. Curr Rev Musculoskelet Med. 2014;7:33–39. - PMC - PubMed
    1. Beitzel K, Cote MP, Apostolakos J, Solovyova O, Judson CH, Ziegler CG, Edgar CM, Imhoff AB, Arciero RA, Mazzocca AD. Current concepts in the treatment of acromioclavicular joint dislocations. Arthroscopy. 2013;29:387–397. - PubMed
    1. Adam FF, Farouk O. Surgical treatment of chronic complete acromioclavicular dislocation. Int Orthop. 2004;28:119–122. - PMC - PubMed
    1. 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;37:136–139. - PubMed
    1. Mazzocca AD, Spang JT, Rodriguez RR, Rios CG, Shea KP, Romeo AA, Arciero RA. Biomechanical and radiographic analysis of partial coracoclavicular ligament injuries. Am J Sports Med. 2008;36:1397–1402. - PubMed

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