Management of Acromioclavicular Injuries – Current Concepts

Abstract

Charlotte de Groot,1 Daniel E Verstift,2 Jelle Heisen,3 Derek FP van Deurzen,2 Michel PJ van den Bekerom2,4 1Department of Orthopaedic Surgery and Trauma Surgery, OLVG, Amsterdam, the Netherlands; 2Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery and Trauma Surgery, OLVG, Amsterdam, the Netherlands; 3Movamento, Amsterdam, the Netherlands; 4Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the NetherlandsCorrespondence: Charlotte de Groot, Department of Orthopaedic Surgery and Trauma Surgery, OLVG, P.O. Box 95500, Amsterdam, 1090 HM, the Netherlands, Email [email protected]: 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: acromioclavicular joint injury, rehabilitation, operative treatment, Rockwood classification, instability, semitendinosus graft

Keywords

• acromioclavicular joint injury
• rehabilitation
• operative treatment
• rockwood classification
• instability
• semitendinosus graft.