Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 27, Issue 12, pp 3741–3746 | Cite as

Low prevalence of relevant associated articular lesions in patients with acute III–VI acromioclavicular joint injuries

  • Miguel Angel Ruiz IbánEmail author
  • Juan Sarasquete
  • Mario Gil de Rozas
  • Pedro Costa
  • Juan Daniel Tovío
  • Eduardo Carpinteiro
  • Abdul Ilah Hachem
  • Manuel Perez España
  • Cristina Asenjo Gismero
  • Jorge Diaz Heredia
  • Miguel García Navlet



To define the prevalence of associated articular injuries in patients with severe (Rockwood’s III–VI) acute acromioclavicular joint injuries and to find out how many of these were associated with the traumatic event and required surgical treatment.


Retrospective observational multicentric study performed in ten centres included patients who required surgery for acute acromioclavicular joint injuries between 2010 and 2017. The inclusion criteria were: presence of an acute acromioclavicular joint injury (grades III–IV–V–VI) and surgical treatment within 3 weeks of injury that included a full arthroscopic evaluation of the shoulder. Basic epidemiological data, severity of the original injury, prelesional sport level and prelesional work site requirements were recorded. The presence of intraarticular glenohumeral lesions and information of their characteristics, treatment, and whether each lesion was considered acute or pre-existing was also recorded.


Two-hundred one subjects [mean (SD) age 36.7 (11.7) years] with acute acromioclavicular joint injuries (110 Rockwood type III, 34 type IV, 56 type V and 1 type VI) fulfilled the inclusion criteria. A total of 28 (13.9%) associated articular lesions were found. These lesions were more often found in grade IV injuries (26.5% in grade IV vs 11.4% in grade III, p = 0.037) and presented in males (18.7% in males vs 4% in females, p = 0.015). Age, laterality, sport level or work requirements did not affect the prevalence of associated lesions. Twelve were rotator cuff tears (6 PASTA lesions, 3 partial supscapularis tears, 2 bursal supraspinatus tears and 1 full-thickness supraspinatus tear), 16 were labral tears (9 anterior, 1 posteroinferior and 6 SLAP). Only 14 (50% of lesions, 7% of total subjects) were considered acute and all but one (an SLAP type 2 tear) required further surgical attention. Most pre-existing lesions were left untreated (n = 7) or managed with minimal debridement (n = 6), and only two required further surgery. The prevalence of associated lesions that required surgical management was 7.46%.


The prevalence of relevant associated lesions in subjects with acute grade III to VI ACJI is relatively low. Only 14% of subjects have an associated lesion and only half of these required further surgical attention.

Level of evidence

Retrospective case series, level IV.


Acromioclavicular joint injury Acute acromioclavicular joint injury Associated lesions Arthroscopy Shoulder 



No funding was obtained to perform this research.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

IRB approval was obtained from the Clinical investigation and Ethics Committee of the Hospital Universitario Ramon y Cajal, Madrid, Spain.


  1. 1.
    Arrigoni P, Brady PC, Zottarelli L, Barth J, Narbona P, Huberty D et al (2014) Associated lesions requiring additional surgical treatment in grade 3 acromioclavicular joint dislocations. Arthroscopy 30:6–10CrossRefGoogle Scholar
  2. 2.
    Balke M, Schneider MM, Shafizadeh S, Bathis H, Bouillon B, Banerjee M (2015) Current state of treatment of acute acromioclavicular joint injuries in Germany: is there a difference between specialists and non-specialists? A survey of German trauma and orthopaedic departments. Knee Surg Sports Traumatol Arthrosc 23:1447–1452CrossRefGoogle Scholar
  3. 3.
    Jensen G, Katthagen JC, Alvarado LE, Lill H, Voigt C (2014) Has the arthroscopically assisted reduction of acute AC joint separations with the double tight-rope technique advantages over the clavicular hook plate fixation? Knee Surg Sports Traumatol Arthrosc 22:422–430CrossRefGoogle Scholar
  4. 4.
    Jensen G, Millett PJ, Tahal DS, Al Ibadi M, Lill H, Katthagen JC (2017) Concomitant glenohumeral pathologies associated with acute and chronic grade III and grade V acromioclavicular joint injuries. Int Orthop. CrossRefPubMedGoogle Scholar
  5. 5.
    Korsten K, Gunning AC, Leenen LP (2014) Operative or conservative treatment in patients with Rockwood type III acromioclavicular dislocation: a systematic review and update of current literature. Int Orthop 38:831–838CrossRefGoogle Scholar
  6. 6.
    Kramer MS (1988) Clinical epidemiology and biostatistics, Chapter 5, 1 ed. Springer, Berlin, pp 47–57CrossRefGoogle Scholar
  7. 7.
    Lee YB, Kim J, Lee HW, Kim BS, Yoon WY, Yoo YS (2017) Arthroscopically assisted coracoclavicular fixation using a single flip button device technique: what are the main factors affecting the maintenance of reduction? Biomed Res Int 2017:4859262PubMedPubMedCentralGoogle Scholar
  8. 8.
    Lemos MJ (1998) The evaluation and treatment of the injured acromioclavicular joint in athletes. Am J Sports Med 26:137–144CrossRefGoogle Scholar
  9. 9.
    Liu X, Huangfu X, Zhao J (2015) Arthroscopic treatment of acute acromioclavicular joint dislocation by coracoclavicular ligament augmentation. Knee Surg Sports Traumatol Arthrosc 23:1460–1466CrossRefGoogle Scholar
  10. 10.
    Pauly S, Gerhardt C, Haas NP, Scheibel M (2009) Prevalence of concomitant intraarticular lesions in patients treated operatively for high-grade acromioclavicular joint separations. Knee Surg Sports Traumatol Arthrosc 17:513–517CrossRefGoogle Scholar
  11. 11.
    Pauly S, Kraus N, Greiner S, Scheibel M (2013) Prevalence and pattern of glenohumeral injuries among acute high-grade acromioclavicular joint instabilities. J Shoulder Elbow Surg 22:760–766CrossRefGoogle Scholar
  12. 12.
    Ruiz Iban MA (2015) The acromioclavicular joint: lots of questions; too many answers? Rev Esp Artrosc Cir Articul 22:1–2Google Scholar
  13. 13.
    Schneider MM, Balke M, Koenen P, Frohlich M, Wafaisade A, Bouillon B et al (2016) Inter- and intraobserver reliability of the Rockwood classification in acute acromioclavicular joint dislocations. Knee Surg Sports Traumatol Arthrosc 24:2192–2196CrossRefGoogle Scholar
  14. 14.
    Shin SJ, Jeon YS, Kim RG (2017) Arthroscopic-assisted coracoclavicular ligament reconstruction for acute acromioclavicular dislocation using 2 clavicular and 1 coracoid cortical fixation buttons with suture tapes. Arthroscopy 33:1458–1466CrossRefGoogle Scholar
  15. 15.
    Stucken C, Cohen SB (2015) Management of acromioclavicular joint injuries. Orthop Clin N Am 46:57–66CrossRefGoogle Scholar
  16. 16.
    Tischer T, Salzmann GM, El-Azab H, Vogt S, Imhoff AB (2009) Incidence of associated injuries with acute acromioclavicular joint dislocations types III through V. Am J Sports Med 37:136–139CrossRefGoogle Scholar
  17. 17.
    Zhang LF, Yin B, Hou S, Han B, Huang DF (2017) Arthroscopic fixation of acute acromioclavicular joint disruption with TightRope: outcome and complications after minimum 2 (2–5) years follow-up. J Orthop Surg (Hong Kong) 25:2309499016684493Google Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  • Miguel Angel Ruiz Ibán
    • 1
    Email author
  • Juan Sarasquete
    • 2
  • Mario Gil de Rozas
    • 3
  • Pedro Costa
    • 4
  • Juan Daniel Tovío
    • 5
  • Eduardo Carpinteiro
    • 6
  • Abdul Ilah Hachem
    • 7
  • Manuel Perez España
    • 8
  • Cristina Asenjo Gismero
    • 9
  • Jorge Diaz Heredia
    • 1
  • Miguel García Navlet
    • 9
  1. 1.Hospital Universitario Ramón y CajalMadridSpain
  2. 2.Universitat Autónoma de BarcelonaBarcelonaSpain
  3. 3.Hospital Universitario MontepríncipeMadridSpain
  4. 4.Hospital Privado Boa NovaPortoPortugal
  5. 5.Hospital Universitario CrucesBilbaoSpain
  6. 6.Hospital da LuzLisbonPortugal
  7. 7.Hospital Universitari de BellvitgeBarcelonaSpain
  8. 8.Hospital Infanta LeonorMadridSpain
  9. 9.Hospital Asepeyo CosladaMadridSpain

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