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Review
. 2023 Feb 16:15:1-12.
doi: 10.2147/ORR.S340531. eCollection 2023.

Management of Acromioclavicular Injuries - Current Concepts

Charlotte de Groot  1 , Daniel E Verstift  2 , Jelle Heisen  3 , Derek F P van Deurzen  2 , Michel P J van den Bekerom  2   4
Affiliations
Review

Management of Acromioclavicular Injuries - Current Concepts

Charlotte de Groot et al. Orthop Res Rev. .

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.

Keywords: Rockwood classification; acromioclavicular joint injury; instability; operative treatment; rehabilitation; semitendinosus graft.

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Conflict of interest statement

Dr Derek FP van Deurzen reports personal fees and grants from Wright Medical and reports fellowship funding from Smith and Nephew. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flowchart of study selection.
Figure 2
Figure 2
Anatomy of the shoulder (courtesy of shoulder and elbow expertise center).
Figure 3
Figure 3
Rockwood classification (courtesy of shoulder and elbow expertise center).
Figure 4
Figure 4
Reconstruction of chronic ACJ injury with semitendinosus graft. (A) Pre-operation luxation. (B) Pre-operation luxation. (C) Preparation of semitendinosus graft. (D) Preparation of clavicle. (E) Positioning of clavicle. (F) Bone tunnels. (G) Ligament reconstruction. (H) Ligament reconstruction.
Figure 5
Figure 5
Flowchart of our opinion of the current literature and management of ACJ dislocations.
See this image and copyright information in PMC

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