Evaluation and Treatment of Acromioclavicular Joint Injuries

• Published in: The American journal of sports medicine 2007-02, Vol.35 (2), p.316-329
• Main Authors: Mazzocca, Augustus D., Arciero, Robert A., Bicos, James
• Format: Article
• Language: English
• Subjects: Acromioclavicular joint; Acromioclavicular Joint - injuries; Acromioclavicular Joint - physiopathology; Biological and medical sciences; Biomechanical Phenomena; Biomechanics; Care and treatment; Clinical outcomes; Fundamental and applied biological sciences. Psychology; Health aspects; Humans; Injuries; Joint and ligament injuries; Joint Dislocations - diagnosis; Joint Dislocations - therapy; Joint replacement; Joints; Ligaments; Medical sciences; Medical treatment; Methods; Shoulder; Sport (general aspects); Sports injuries; Sports medicine; Surgical techniques; Trauma Severity Indices; Traumas. Diseases due to physical agents; Vertebrates: body movement. Posture. Locomotion. Flight. Swimming. Physical exercise. Rest. Sports
• ISSN: 0363-5465; 1552-3365
• DOI: 10.1177/0363546506298022

Acromioclavicular joint injuries and, more specifically, separations are commonplace both in general practice and during athletic participation. This article reviews the traditional classification as well as the clinical evaluation of patients with acute and chronic acromioclavicular joint separations. It also highlights many recent advances, principally in the anatomy and biomechanics of the acromioclavicular joint ligamentous complex. The concept of increases in superior translation as well as disturbances in horizontal translation with injuries to this joint and ligaments are discussed. This information, coupled with the unpredictable long-term results with the Weaver-Dunn procedure and its modifications, have prompted many recent biomechanical studies evaluating potential improvements in the surgical management of acute and chronic injuries. The authors present these recent works investigating cyclic loading and ultimate failure of traditional reconstructions, augmentations, use of free graft, and the more recent anatomic reconstruction of the conoid and trapezoid ligaments. The clinical results (largely retrospective), including acromioclavicular joint repair, reconstruction and augmentation with the coracoclavicular ligament, supplemental sutures, and the use of free autogenous grafts, are summarized. Finally, complications and the concept of the failed distal clavicle resection and reconstruction are addressed. The intent is to provide a current, in-depth treatise on all aspects of acromioclavicular joint complex injuries to include anatomy, biomechanics, benchmark studies on instability and reconstruction, clinical and radiographic evaluation, and to present the most recent clinical research on surgical outcomes. Keywords: acromioclavicular joint separation acromioclavicular joint reconstruction acromioclavicular joint injury