Journal of Shoulder and Elbow Surgery
Volume 20, Issue 2, Supplement , Pages S70-S82 , March 2011

Acromioclavicular joint injuries: indications for treatment and treatment options

  • John A. Johansen, MD

      Affiliations

    • Cardinal Orthopaedics, Columbus, OH, USA
  • ,
  • Paul W. Grutter, MD

      Affiliations

    • Southern Sports Medicine Institute, Gallatin, TN, USA
  • ,
  • Edward G. McFarland, MD

      Affiliations

    • Division of Shoulder Surgery, Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
  • ,
  • Steve A. Petersen, MD

      Affiliations

    • Division of Shoulder Surgery, Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
    • Corresponding Author InformationReprint requests: Steve A. Petersen, MD, c/o Elaine P. Henze, BJ, ELS, Medical Editor and Director, Editorial Services, Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, 4940 Eastern Ave, #A665, Baltimore, MD 21224-2780.

References 

  1. Allman FL. Fractures and ligamentous injuries of the clavicle and its articulation. J Bone Joint Surg Am. 1967;49:774–784
  2. Baker JE, Nicandri GT, Young DC, Owen JR, Wayne JS. A cadaveric study examining acromioclavicular joint congruity after different methods of coracoclavicular loop repair. J Shoulder Elbow Surg. 2003;12:595–598
  3. Bannister GC, Wallace WA, Stableforth PG, Hutson MA. The management of acute acromioclavicular dislocation. A randomised prospective controlled trial. J Bone Joint Surg Br. 1989;71:848–850
  4. Bargren JH, Erlanger S, Dick HM. Biomechanics and comparison of two operative methods of treatment of complete acromioclavicular separation. Clin Orthop Relat Res. 1978;130:267–272
  5. Bearden JM, Hughston JC, Whatley GS. Acromioclavicular dislocation: method of treatment. Am J Sports Med. 1973;1:5–17
  6. Bergfeld JA, Andrish JT, Clancy WG. Evaluation of the acromioclavicular joint following first- and second-degree sprains. Am J Sports Med. 1978;6:153–158discussion 158-9. doi:10.1177/036354657800600402
  7. Bostrom Windhamre HA, von Heideken JP, Une-Larsson VE, Ekelund AL. Surgical treatment of chronic acromioclavicular dislocations: a comparative study of Weaver-Dunn augmented with PDS-braid or hook plate. J Shoulder Elbow Surg. 2010;19:1040–1048
  8. Breslow MJ, Jazrawi LM, Bernstein AD, Kummer FJ, Rokito AS. Treatment of acromioclavicular joint separation: suture or suture anchors?. J Shoulder Elbow Surg. 2002;11:225–229
  9. Cadenat FM. The treatment of dislocations and fractures of the outer end of the clavicle. Int Clin. 1917;1:145–169
  10. Calvo E, Lopez-Franco M, Arribas IM. Clinical and radiologic outcomes of surgical and conservative treatment of type III acromioclavicular joint injury. J Shoulder Elbow Surg. 2006;15:300–305
  11. Carofino BC, Mazzocca AD. The anatomic coracoclavicular ligament reconstruction: surgical technique and indications. J Shoulder Elbow Surg. 2010;19:37–46
  12. Ceccarelli E, Bondi R, Alviti F, Garofalo R, Miulli F, Padua R. Treatment of acute grade III acromioclavicular dislocation: a lack of evidence. J Orthop Traumatol. 2008;9:105–108
  13. Choi SW, Lee TJ, Moon KH, Cho KJ, Lee SY. Minimally invasive coracoclavicular stabilization with suture anchors for acute acromioclavicular dislocation. Am J Sports Med. 2008;36:961–965
  14. 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;32:655–661
  15. Collins DN. Disorders of the acromioclavicular joint. In:  Rockwood CA,  Matsen FA,  Wirth MA,  Lippitt SB editor. The shoulder. Philadelphia: Saunders (Elsevier); 2009;p. 453–526
  16. Constant CR, Murley AHG. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160–164
  17. Cook FF, Tibone JE. The Mumford procedure in athletes. An objective analysis of function. Am J Sports Med. 1988;16:97–100
  18. 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;32:1929–1936
  19. Cox JS. Current method of treatment of acromioclavicular joint dislocations. Orthopedics. 1992;15:1041–1044
  20. Cox JS. The fate of the acromioclavicular joint in athletic injuries. Am J Sports Med. 1981;9:50–53
  21. Dawson PA, Adamson GJ, Pink MM, Kornswiet M, Lin S, Shankwiler JA, et al. Relative contribution of acromioclavicular joint capsule and coracoclavicular ligaments to acromioclavicular stability. J Shoulder Elbow Surg. 2009;18:237–244
  22. DeBerardino TM, Pensak MJ, Ferreira J, Mazzocca AD. Arthroscopic stabilization of acromioclavicular joint dislocation using the AC graftrope system. J Shoulder Elbow Surg. 2010;19:47–52
  23. Debski RE, Parsons IMI, Woo SLY, Fu FH. Effect of capsular injury on acromioclavicular joint mechanics. J Bone Joint Surg Am. 2001;83:1344–1351
  24. DePalma AF. The role of the disks of the sternoclavicular and the acromioclavicular joints. Clin Orthop Relat Res. 1959;13:222–233
  25. Deshmukh AV, Wilson DR, Zilberfarb JL, Perlmutter GS. Stability of acromioclavicular joint reconstruction: biomechanical testing of various surgical techniques in a cadaveric model. Am J Sports Med. 2004;32:1492–1498
  26. Dias JJ, Steingold RF, Richardson RA, Tesfayohannes B, Gregg PJ. The conservative treatment of acromioclavicular dislocation. Review after five years. J Bone Joint Surg Br. 1987;69:719–722
  27. Dust WN, Lenczner EM. Stress fracture of the clavicle leading to nonunion secondary to coracoclavicular reconstruction with Dacron. Am J Sports Med. 1989;17:128–129
  28. Echo BS, Donati RB, Powell CE. Bipolar clavicular dislocation treated surgically. A case report. J Bone Joint Surg Am. 1988;70:1251–1253
  29. Faraj AA, Ketzer B. The use of a hook-plate in the management of acromioclavicular injuries. Report of ten cases. Acta Orthop Belg. 2001;67:448–450discussion 50–51
  30. Flatow EL. The biomechanics of the acromioclavicular, sternoclavicular, and scapulothoracic joints. Instr Course Lect. 1993;42:237–245
  31. Flik K, Lyman S, Marx RG. American collegiate men’s ice hockey: an analysis of injuries. Am J Sports Med. 2005;33:183–187
  32. Fukuda K, Craig EV, An KN, Cofield RH, Chao EYS. Biomechanical study of the ligamentous system of the acromioclavicular joint. J Bone Joint Surg Am. 1986;68:434–440
  33. Galatz LM, Williams GR. Acromioclavicular joint injuries. In:  Bucholz RW,  Heckman JD editor. Rockwood and Green’s fractures in adults. Philadelphia: Lippincott Williams & Wilkins; 2001;p. 1209–1244
  34. Gerber C, Rockwood CA. Subcoracoid dislocation of the lateral end of the clavicle. A report of three cases. J Bone Joint Surg Am. 1987;69:924–927
  35. Glick JM, Milburn LJ, Haggerty JF, Nishimoto D. Dislocated acromioclavicular joint: follow-up study of 35 unreduced acromioclavicular dislocations. Am J Sports Med. 1977;5:264–270
  36. Grutter PW, Petersen SA. Anatomical acromioclavicular ligament reconstruction: a biomechanical comparison of reconstructive techniques of the acromioclavicular joint. Am J Sports Med. 2005;33:1723–1728
  37. Gstettner C, Tauber M, Hitzl W, Resch H. Rockwood type III acromioclavicular dislocation: surgical versus conservative treatment. J Shoulder Elbow Surg. 2008;17:220–225
  38. Harris RI, Wallace AL, Harper GD, Goldberg JA, Sonnabend DH, Walsh WR. Structural properties of the intact and the reconstructed coracoclavicular ligament complex. Am J Sports Med. 2000;28:103–108
  39. Hawkins RJ, Hobeika PE. Impingement syndrome in the athletic shoulder. Clin Sports Med. 1983;2:391–405
  40. Huang TW, Hsieh PH, Huang KC, Huang KC. Suspension suture augmentation for repair of coracoclavicular ligament disruptions. Clin Orthop Relat Res. 2009;467:2142–2148
  41. Imatani RJ, Hanlon JJ, Cady GW. Acute, complete acromioclavicular separation. J Bone Joint Surg Am. 1975;57:328–332
  42. Jari R, Costic RS, Rodosky MW, Debski RE. Biomechanical function of surgical procedures for acromioclavicular joint dislocations. Arthroscopy. 2004;20:237–245
  43. 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;33:1142–1146
  44. Kennedy JC. Complete dislocation of the acromioclavicular joint: 14 years later. J Trauma. 1968;8:311–318
  45. Kiefer H, Claes L, Burri C, Holzwarth J. The stabilizing effect of various implants on the torn acromioclavicular joint. A biomechanical study. Arch Orthop Trauma Surg. 1986;106:42–46
  46. 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 Elbow Surg. 1999;8:119–124
  47. Larsen E, Bjerg-Nielsen A, Christensen P. Conservative or surgical treatment of acromioclavicular dislocation. A prospective, controlled, randomized study. J Bone Joint Surg Am. 1986;68:552–555
  48. Lee KW, Debski RE, Chen CH, Woo SLY, Fu FH. Functional evaluation of the ligaments at the acromioclavicular joint during anteroposterior and superoinferior translation. Am J Sports Med. 1997;25:858–862
  49. Lee SJ, Nicholas SJ, Akizuki KH, McHugh MP, Kremenic IJ, Ben-Avi S. Reconstruction of the coracoclavicular ligaments with tendon grafts: a comparative biomechanical study. Am J Sports Med. 2003;31:648–654
  50. Lemos MJ. The evaluation and treatment of the injured acromioclavicular joint in athletes. Am J Sports Med. 1998;26:137–144
  51. Lizaur A, Marco L, Cebrian R. Acute dislocation of the acromioclavicular joint. Traumatic anatomy and the importance of deltoid and trapezius. J Bone Joint Surg Br. 1994;76:602–606
  52. Ludewig PM, Behrens SA, Meyer SM, Spoden SM, Wilson LA. Three-dimensional clavicular motion during arm elevation: reliability and descriptive data. J Orthop Sports Phys Ther. 2004;34:140–149
  53. Lyons FA, Rockwood CA. Migration of pins used in operations on the shoulder. J Bone Joint Surg Am. 1990;72:1262–1267
  54. MacDonald PB, Alexander MJ, Frejuk J, Johnson GE. Comprehensive functional analysis of shoulders following complete acromioclavicular separation. Am J Sports Med. 1988;16:475–480
  55. Mazzocca AD, Arciero RA, Bicos J. Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med. 2007;35:316–329
  56. McConnell AJ, Yoo DJ, Zdero R, Schemitsch EH, McKee MD. Methods of operative fixation of the acromio-clavicular joint: a biomechanical comparison. J Orthop Trauma. 2007;21:248–253
  57. McFarland EG, Blivin SJ, Doehring CB, Curl LA, Silberstein C. Treatment of grade III acromioclavicular separations in professional throwing athletes: results of a survey. Am J Orthop (Belle Mead NJ). 1997;26:771–774
  58. Michlitsch MG, Adamson GJ, Pink M, Estess A, Shankwiler JA, Lee TQ. Biomechanical comparison of a modified Weaver-Dunn and a free-tissue graft reconstruction of the acromioclavicular joint complex. Am J Sports Med. 2010;38:1196–1203
  59. Mikek M. Long-term shoulder function after type I and II acromioclavicular joint disruption. Am J Sports Med. 2008;36:2147–2150
  60. Miller MD, Hinkin DT, Gordon WT. Closed treatment of type IV acromioclavicular injuries. Pittsburgh Orthop J. 2000;11:111–114
  61. Moneim MS, Balduini FC. Coracoid fracture as a complication of surgical treatment by coracoclavicular tape fixation. A case report. Clin Orthop Relat Res. 1982;168:133–135
  62. Motamedi AR, Blevins FT, Willis MC, McNally TP, Shahinpoor M. Biomechanics of the coracoclavicular ligament complex and augmentations used in its repair and reconstruction. Am J Sports Med. 2000;28:380–384
  63. Mouhsine E, Garofalo R, Crevoisier X, Farron A. Grade I and II acromioclavicular dislocations: results of conservative treatment. J Shoulder Elbow Surg. 2003;12:599–602
  64. Nissen CW, Chatterjee A. Type III acromioclavicular separation: results of a recent survey on its management. Am J Orthop (Belle Mead NJ). 2007;36:89–93
  65. Norrell H, 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;47:1024–1026
  66. Nuber GW, Bowen MK. Acromioclavicular joint injuries and distal clavicle fractures. J Am Acad Orthop Surg. 1997;5:11–18
  67. O’Brien SJ, Pagnani MJ, Fealy S, McGlynn SR, Wilson JB. The active compression test: a new and effective test for diagnosing labral tears and acromioclavicular joint abnormality. Am J Sports Med. 1998;26:610–613
  68. Phillips AM, Smart C, Groom AFG. Acromioclavicular dislocation. Conservative or surgical therapy. Clin Orthop Relat Res. 1998;353:10–17
  69. Powers JA, Bach PJ. Acromioclavicular separations. Closed or open treatment?. Clin Orthop Relat Res. 1974;104:213–223
  70. Rehbein K, Jung C, Becker U, Bauer G. [Treatment of acute AC joint dislocation by transosseal acromioclavicular and coracoclavicular fiberwire cerclage]. Z Orthop Unfall. 2008;146:339–343
  71. Renfree KJ, Riley MK, Wheeler D, Hentz JG, Wright TW. Ligamentous anatomy of the distal clavicle. J Shoulder Elbow Surg. 2003;12:355–359
  72. Rios CG, Arciero RA, Mazzocca AD. Anatomy of the clavicle and coracoid process for reconstruction of the coracoclavicular ligaments. Am J Sports Med. 2007;35:811–817
  73. Rockwood CA, Williams GR, Young DC. Disorders of the acromioclavicular joint. In:  Rockwood CA,  Matsen FA editor. The shoulder. Philadelphia: WB Saunders; 1998;p. 483–553
  74. Salter EG, Nasca RJ, Shelley BS. Anatomical observations on the acromioclavicular joint and supporting ligaments. Am J Sports Med. 1987;15:199–206
  75. Salzmann GM, Paul J, Sandmann GH, Imhoff AB, Schottle PB. The coracoidal insertion of the coracoclavicular ligaments: an anatomic study. Am J Sports Med. 2008;36:2392–2397
  76. Salzmann GM, Walz L, Buchmann S, Glabgly P, Venjakob A, Imhoff AB. Arthroscopically assisted 2-bundle anatomical reduction of acute acromioclavicular joint separations. Am J Sports Med. 2010;38:1179–1187
  77. Scapinelli R. Bipolar dislocation of the clavicle: 3D CT imaging and delayed surgical correction of a case. Arch Orthop Trauma Surg. 2004;124:421–424
  78. Schlegel TF, Burks RT, Marcus RL, Dunn HK. A prospective evaluation of untreated acute grade III acromioclavicular separations. Am J Sports Med. 2001;29:699–703
  79. Sethi GK, Scott SM. Subclavian artery laceration due to migration of a Hagie pin. Surgery. 1976;80:644–646
  80. Sim E, Schwarz N, Hocker K, Berzlanovich A. Repair of complete acromioclavicular separations using the acromioclavicular-hook plate. Clin Orthop Relat Res. 1995;314:134–142
  81. Simovitch R, Sanders B, Ozbaydar M, Lavery K, Warner JJ. Acromioclavicular joint injuries: diagnosis and management. J Am Acad Orthop Surg. 2009;17:207–219
  82. Taft TN, Wilson FC, Oglesby JW. Dislocation of the acromioclavicular joint. An end-result study. J Bone Joint Surg Am. 1987;69:1045–1051
  83. Tauber M, Gordon K, Koller H, Fox M, Resch H. Semitendinosus tendon graft versus a modified Weaver-Dunn procedure for acromioclavicular joint reconstruction in chronic cases: a prospective comparative study. Am J Sports Med. 2009;37:181–190
  84. Tibone J, Sellers R, Tonino P. Strength testing after third-degree acromioclavicular dislocations. Am J Sports Med. 1992;20:328–331
  85. Tomlinson DP, Altchek DW, Davila J, Cordasco FA. A modified technique of arthroscopically assisted AC joint reconstruction and preliminary results. Clin Orthop Relat Res. 2008;466:639–645
  86. Tossy JD, Mead NC, Sigmond HM. Acromioclavicular separations: useful and practical classification for treatment. Clin Orthop Relat Res. 1963;28:111–119
  87. Walsh WM, Peterson DA, Shelton G, Neumann RD. Shoulder strength following acromioclavicular injury. Am J Sports Med. 1985;13:153–158
  88. Weinstein DM, McCann PD, McIlveen SJ, Flatow EL, Bigliani LU. Surgical treatment of complete acromioclavicular dislocations. Am J Sports Med. 1995;23:324–331
  89. Wellmann M, Zantop T, Petersen W. Minimally invasive coracoclavicular ligament augmentation with a flip button/polydioxanone repair for treatment of total acromioclavicular joint dislocation. Arthroscopy. 2007;23:1132 e1-5. doi:10.1016/j.arthro.2006.12.015
  90. Wellmann M, Zantop T, Weimann A, Raschke MJ, Petersen W. Biomechanical evaluation of minimally invasive repairs for complete acromioclavicular joint dislocation. Am J Sports Med. 2007;35:955–961
  91. White B, Epstein D, Sanders S, Rokito A. Acute acromioclavicular injuries in adults. Orthopedics. 2008;31:1219–1226
  92. Wojtys EM, Nelson G. Conservative treatment of Grade III acromioclavicular dislocations. Clin Orthop Relat Res. 1991;268:112–119
  93. Yoo JC, Ahn JH, Yoon JR, Yang JH. Clinical results of single-tunnel coracoclavicular ligament reconstruction using autogenous semitendinosus tendon. Am J Sports Med. 2010;38:950–957

 Investigational Review Board approval was not necessary for this review article.

PII: S1058-2746(10)00446-5

doi: 10.1016/j.jse.2010.10.030

Journal of Shoulder and Elbow Surgery
Volume 20, Issue 2, Supplement , Pages S70-S82 , March 2011