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Acromioclavicular joint pathology in athletes

Prevalence, diagnostics, and therapy

Akromioklavikulargelenkverletzungen bei Sportlern

Prävalenz, Diagnostik und Therapie

  • Review Article
  • Published:
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Abstract

Acromioclavicular (AC) joint injuries are common in competitive and recreational athletes. These injuries are a significant cause of pain and instability, especially with overhead activities. Injuries are generally classified using the Rockwood Classification system, based on the degree of ligamentous injury to the AC joint and the coracoclavicular (CC) ligaments. In general, Rockwood type I and II injuries are managed nonoperatively, while types IV and VI are usually treated surgically. However, there is debate on the optimal treatment of type III and V injuries. Various surgical techniques have been described, including reconstruction with internal fixation, coracoacromial ligament transfer, reconstruction with suture fixation, anatomic coracoclavicular ligament reconstruction (ACCR), and arthroscopic-assisted techniques. The current review article describes the diagnosis and therapy of this injury with regard to the athlete and additionally presents the differences in treatment approaches between the United States and Germany (Europe).

Zusammenfassung

Akromioklavikular(AC)-Gelenkverletzungen sind bei Leistungs- und Freizeitsportlern eine häufige pathologische Veränderung. Diese Verletzungen sind eine wesentliche Ursache für Schmerzen und Instabilität, insbesondere bei Überkopfaktivitäten. Die Verletzung wird i. Allg. nach Rockwood klassifiziert, basierend auf dem Grad der Kapsel-Band-Verletzung des AC-Gelenks und der korakoklavikulären Bänder (CC). Grundsätzlich werden Rockwood-Verletzungen vom Typ I und II konservativ behandelt, während die Typen IV und VI i. Allg. chirurgisch behandelt werden. Die optimale Behandlung von Typ-III- (oft auch von Typ-IV-)Verletzungen wird jedoch kontrovers diskutiert. Es wurden verschiedene chirurgische Techniken beschrieben, darunter die Rekonstruktion mit interner Fixation, der Korakoakromialligamenttransfer, die Rekonstruktion mit Nahtfixation, die anatomische Rekonstruktion der korakoklavikulären Bänder (ACCR) und arthroskopisch assistierte Techniken. Im vorliegenden Übersichtsartikel werden die Diagnostik und Therapie dieser Verletzung im Hinblick auf den Sportler dargestellt und zusätzlich die Unterschiede zwischen einem US-amerikanischen und einem deutschen (europäischen) Behandlungskonzept gezeigt.

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Funding

The University of Connecticut Health Center/UConn Musculoskeletal Institute has received funding and material support from Arthrex Inc. (Naples, FL, USA). The company did not influence the data collection or writing of this manuscript.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, University of Connecticut, Farmington, CT, USA

    Benjamin C. Hawthorne BS, Patrick Garvin DO, James Messina MD, Antonio Cusano MD & Augustus D. Mazzocca MS MD

  2. Sporthopaedicum Regensburg, Hildegard-von Bingen-Str. 1, 93053, Regensburg, Germany

    Stefan Greiner MD &  Andreas Voss MD

  3. Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany

    Stefan Greiner MD &  Andreas Voss MD

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  1. Benjamin C. Hawthorne BS
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  2. Patrick Garvin DO
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Correspondence to Andreas Voss MD.

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A.D. Mazzocca reports research grants from Arthrex Inc., is a consultant for Arthrex Inc., and receives royalties from Arthrex Inc. B.C. Hawthorne, P. Garvin, J. Messina, A. Cusano, S. Greiner and A. Voss declare that they have no competing interests.

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Hawthorne, B.C., Garvin, P., Messina, J. et al. Acromioclavicular joint pathology in athletes. Obere Extremität 17, 12–20 (2022). https://doi.org/10.1007/s11678-021-00675-4

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