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Acromioclavicular Joint Injuries

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Sports Injuries of the Shoulder

Abstract

Acromioclavicular joint (ACJ) injuries are very common sporting injuries. Acute traumatic injuries occur with contact and collision sports, horse riding and motorsports. Repetitive traumatic injuries occur with overhead sports, boxing and weightlifting. Many ACJ injuries can be managed with rest and activity modification, however sometimes surgery is indicated. There is a traditional consensus that dictates surgery is indicated for higher-grade (IV–VI) ACJ injuries and lower grade injuries can be managed non-operatively, however treatment based purely on classifications have been shown to be unreliable. Therefore, a more symptom-based management approach is more pragmatic. Traditional surgical fixation techniques have also had high failure rates, but recent anatomically-based reconstructions with stronger materials and biomechanics seem to provide more reliable outcomes in athletes.

The development of strong anatomical reconstructions and a more patient-specific approach to management, based on careful patient and procedure selection, has improved the management and outcomes for athletes. In this chapter, we aim to summarize the anatomy and biomechanics of the AC joint as well as the assessment, diagnosis, and treatment protocols, including our preferred protocol, for the range of ACJ injuries.

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Q&A

Q&A

  1. (1)

    Is there a role for MRI rather than standard radiographs in the diagnosis of AC joint injuries?

    No well-conducted comparative study exists- as yet- to correlate radiographic analysis of ACJ injuries with MRI and correlate this with classifications or treatment of these injuries. Evidence confirms the ability of MRI to demonstrate ACJ injuries and assess the integrity of the CC ligaments (level IV). However, the sensitivity and specificity of injury detection and accuracy of classification via MRI compared to radiograph remains to be determined, and indications for MRI in this setting remain controversial. There is insufficient evidence to recommend use of MRI imaging for ACJ injuries. A detailed history and clinical examination (Coper versus non-coper) remains the mainstay of diagnosing these injuries

  2. (2)

    What is the optimal non-operative treatment of an AC joint injury?

    Most patients with an ACJ injury especially in the milder forms would benefit from non-surgical intervention. These include: taping, bracing/splinting and slings.

  3. (3)

    When performing an arthroscopic distal clavicle excision for acromioclavicular joint arthrosis, which structures must be preserved to prevent post-operative anteroposterior instability of the clavicle?

    Numerous biomechanical studies demonstrated that the primary restraint to AP translation of the clavicle is the ligamentous thickenings of the AC capsule. Debski et al. [56] showed that the strongest ligament is the superior one (50% of the strength against AP translation) and it is thickest in its posterior aspect. In addition, the posterior AC ligament provides extra 25% of the overall strength. For this reason, these ligaments should be preserved when performing a distal clavicle resection.

  4. (4)

    When should sports-specific rehabilitation start after reconstruction?

    As long as the surgeon has achieved a strong and anatomical reconstruction, then incorporation of sport-specific exercises can be introduced very soon after surgery. Athletes can include aspects of their sports under supervision of their therapist and strength and conditioning coaches. Progressions though the rehabilitation phases should be personalized to the athlete and their sport, rather than being time-based.

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Funk, L., Imam, M.A. (2020). Acromioclavicular Joint Injuries. In: Funk, L., Walton, M., Watts, A., Hayton, M., Ng, C. (eds) Sports Injuries of the Shoulder. Springer, Cham. https://doi.org/10.1007/978-3-030-23029-6_8

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