Skip to main content
Log in

Shoulder acromioclavicular joint reconstruction options and outcomes

  • Outcomes Research in Orthopedics (O Ayeni, Section Editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Acromioclavicular joint separations are a common cause of shoulder pain in the young athletic population. In high-grade injuries, acromioclavicular joint reconstruction procedures may be indicated for functional improvement. There is currently no gold standard for the surgical management of these injuries. Multiple reconstructive options exist, including coracoclavicular screws, hook plates, endobutton coracoclavicular fixations, and anatomic ligament reconstructions with tendon grafts. This article aims to review pertinent acromioclavicular joint anatomy and biomechanics, radiographic evaluation, classification system, as well as reconstruction options, outcomes, and complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Pallis M, Cameron KL, Svoboda SJ, Owens BD. Epidemiology of acromioclavicular joint injury in young athletes. Am J Sports Med. 2012;40:2072–7.

    Article  PubMed  Google Scholar 

  2. Hibberd EE, Kerr ZY, Roos KG, Djoko A, Dompier TP. Epidemiology of acromioclavicular joint sprains in 25 National Collegiate Athletic Association Sports 2009–2010 to 2014–2015 Academic Years. Am J Sports Med. 2016;363546516643721.

  3. Renfree KJ, Wright TW. Anatomy and biomechanics of the acromioclavicular and sternoclavicular joints. Clin Sports Med. 2003;22:219–37.

    Article  PubMed  Google Scholar 

  4. DePalma AF. The role of the discs of the sternoclavicular and acromioclavicular joints. Clin Orthop Relat Res. 1959;13:7–12.

    Google Scholar 

  5. Depalma AF. Surgical anatomy of acromioclavicular and sternoclavicular joints. Surg Clin North Am. 1963;43:1541–50.

    Article  CAS  PubMed  Google Scholar 

  6. Salter EG, Nasca RJ, Shelley BS. Anatomical observations on the acromioclavicular joint and supporting ligaments. Am J Sports Med. 1987;15:199–206.

    Article  PubMed  Google Scholar 

  7. Terry GC, Chopp TM. Functional anatomy of the shoulder. J Athl Train. 2000;35:248–55.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Rios CG, Arciero RA, Mazzocca AD. Anatomy of the clavicle and coracoid process for reconstruction of the coracoclavicular ligaments. Am J Sports Med. 2007;35:811–7.

    Article  PubMed  Google Scholar 

  9. Salzmann GM, Paul J, Sandmann GH, Imhoff AB, Schöttle PB. The coracoidal insertion of the coracoclavicular ligaments an anatomic study. Am J Sports Med. 2008;36:2392–7.

    Article  PubMed  Google Scholar 

  10. Mazzocca AD, Spang JT, Rodriguez RR, Rios CG, Shea KP, Romeo AA, et al. Biomechanical and radiographic analysis of partial coracoclavicular ligament injuries. Am J Sports Med. 2008;36:1397–402.

    Article  PubMed  Google Scholar 

  11. Fukuda K, Craig EV, An KN, Cofield RH, Chao EY. Biomechanical study of the ligamentous system of the acromioclavicular joint. J Bone Joint Surg Am. 1986;68:434–40.

    Article  CAS  PubMed  Google Scholar 

  12. 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 Elb Surg Am Shoulder Elb Surg Al. 1999;8:119–24.

    Article  CAS  Google Scholar 

  13. Stine IA, Vangsness Jr CT. Analysis of the capsule and ligament insertions about the acromioclavicular joint: a cadaveric study. Arthrosc J Arthrosc Relat Surg. 2009;25:968–74.

    Article  Google Scholar 

  14. Corteen DP, Teitge RA. Stabilization of the clavicle after distal resection: a biomechanical study. Am J Sports Med. 2005;33:61–7.

    Article  PubMed  Google Scholar 

  15. Ernberg LA, Potter HG. Radiographic evaluation of the acromioclavicular and sternoclavicular joints. Clin Sports Med. 2003;22:255–75.

    Article  PubMed  Google Scholar 

  16. Bossart PJ, Joyce SM, Manaster BJ, Packer SM. Lack of efficacy of “weighted” radiographs in diagnosing acute acromioclavicular separation. Ann Emerg Med. 1988;17:20–4.

    Article  CAS  PubMed  Google Scholar 

  17. Zanca P. Shoulder pain: involvement of the acromioclavicular joint. (Analysis of 1,000 cases). Am J Roentgenol Radium Therapy Nucl Med. 1971;112:493–506.

    Article  CAS  Google Scholar 

  18. Ibrahim EF, Forrest NP, Forester A. Bilateral weighted radiographs are required for accurate classification of acromioclavicular separation: an observational study of 59 cases. Injury. 2015;46:1900–5.

    Article  CAS  PubMed  Google Scholar 

  19. Waldrop JI, Norwood LA, Alvarez RG. Lateral roentgenographic projections of the acromioclavicular joint. Am J Sports Med. 1981;9:337–41.

    Article  CAS  PubMed  Google Scholar 

  20. Schaefer FK, Schaefer PJ, Brossmann J, Hilgert RE, Heller M, Jahnke T. Experimental and clinical evaluation of acromioclavicular joint structures with new scan orientations in MRI. Eur Radiol. 2006;16:1488–93.

    Article  PubMed  Google Scholar 

  21. Nemec U, Oberleitner G, Nemec SF, Gruber M, Weber M, Czerny C, et al. MRI versus radiography of acromioclavicular joint dislocation. AJR Am J Roentgenol. 2011;197:968–73.

    Article  PubMed  Google Scholar 

  22. Pauly S, Gerhardt C, Haas NP, Scheibel M. Prevalence of concomitant intraarticular lesions in patients treated operatively for high-grade acromioclavicular joint separations. Knee Surg Sports Traumatol Arthrosc. 2008;17:513–7.

    Article  PubMed  Google Scholar 

  23. Peetrons P, Bédard JP. Acromioclavicular joint injury: enhanced technique of examination with dynamic maneuver. J Clin Ultrasound JCU. 2007;35:262–7.

    Article  PubMed  Google Scholar 

  24. Faruch Bilfeld M, Lapègue F, Chiavassa Gandois H, Bayol MA, Bonnevialle N, Sans N. Ultrasound of the coracoclavicular ligaments in the acute phase of an acromioclavicular disjonction: comparison of radiographic, ultrasound and MRI findings. Eur. Radiol. 2016.

  25. Williams G, Nguyen V, Rockwood C. Classification and radiographic analysis of acromioclavicular dislocations. Appl Radiol. 1989.

  26. Tossy JD, Mead NC, Sigmond HM. Acromioclavicular separations: useful and practical classification for treatment. Clin Orthop. 1963;28:111–9.

    CAS  PubMed  Google Scholar 

  27. Tamaoki MJS, Belloti JC, Lenza M, Matsumoto MH, Gomes Dos Santos JB, Faloppa F. Surgical versus conservative interventions for treating acromioclavicular dislocation of the shoulder in adults. Cochrane Database Syst. Rev. 2010;CD007429.

  28. Cox JS. The fate of the acromioclavicular joint in athletic injuries. Am J Sports Med. 1981;9:50–3.

    Article  CAS  PubMed  Google Scholar 

  29. Mouhsine E, Garofalo R, Crevoisier X, Farron A. Grade I and II acromioclavicular dislocations: results of conservative treatment. J Shoulder Elb Surg Am Shoulder Elb Surg Al. 2003;12:599–602.

    Article  Google Scholar 

  30. Mulier T, Stuyck J, Fabry G. Conservative treatment of acromioclavicular dislocation. Evaluation of functional and radiological results after six years follow-up. Acta Orthop Belg. 1993;59:255–62.

    CAS  PubMed  Google Scholar 

  31. Rawes ML, Dias JJ. Long-term results of conservative treatment for acromioclavicular dislocation. J Bone Joint Surg (Br). 1996;78:410–2.

    CAS  Google Scholar 

  32. 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;69:719–22.

    CAS  Google Scholar 

  33. Glick JM, Milburn LJ, Haggerty JF, Nishimoto D. Dislocated acromioclavicular joint: follow-up study of 35 unreduced acromioclavicular dislocations. Am J Sports Med. 1977;5:264–70.

    Article  CAS  PubMed  Google Scholar 

  34. Bjerneld H, Hovelius L, Thorling J. Acromio-clavicular separations treated conservatively. A 5-year follow-up study. Acta Orthop Scand. 1983;54:743–5.

    Article  CAS  PubMed  Google Scholar 

  35. Gumina S, Carbone S, Postacchini F. Scapular dyskinesis and SICK scapula syndrome in patients with chronic type III acromioclavicular dislocation. Arthrosc J Arthrosc Relat Surg. 2009;25:40–5.

    Article  Google Scholar 

  36. Carbone S, Postacchini R, Gumina S. Scapular dyskinesis and SICK syndrome in patients with a chronic type III acromioclavicular dislocation. Results of rehabilitation. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. 2015;23:1473–80.

    Article  Google Scholar 

  37. 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.

    CAS  PubMed  Google Scholar 

  38. Trainer G, Arciero RA, Mazzocca AD. Practical management of grade III acromioclavicular separations. Clin J Sport Med Off J Can Acad Sport Med. 2008;18:162–6.

    Article  Google Scholar 

  39. Bosworth B. Acromioclavicular separation: a new method of repair. Surg Gynecol Obstet. 1941;866–871.

  40. Assaghir YM. Outcome of exact anatomic repair and coracoclavicular cortical lag screw in acute acromioclavicular dislocations. J Trauma. 2011;71:E50–4.

    Article  PubMed  Google Scholar 

  41. Balser D. Eine neue. Moethode zur operative Behandlung der akromioklavikularen Luxation. Chir Prax. 1976;275.

  42. Wolter D, Eggers C. Reposition and fixation of acromioclavicular luxation using a hooked plate. Hefte Unfallheilkd. 1984;170:80–6.

    CAS  PubMed  Google Scholar 

  43. Kienast B, Thietje R, Queitsch C, Gille J, Schulz A, Meiners J. Mid-term results after operative treatment of Rockwood grade III-V acromioclavicular joint dislocations with an AC-hook-plate. Eur J Med Res. 2011;16:52.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Salem KH, Schmelz A. Treatment of Tossy III acromioclavicular joint injuries using hook plates and ligament suture. J Orthop Trauma. 2009;23:565–9.

    Article  PubMed  Google Scholar 

  45. Di Francesco A, Zoccali C, Colafarina O, Pizzoferrato R, Flamini S. The use of hook plate in type III and V acromio-clavicular Rockwood dislocations: clinical and radiological midterm results and MRI evaluation in 42 patients. Injury. 2012;43:147–52.

    Article  PubMed  Google Scholar 

  46. Lin H-Y, Wong P-K, Ho W-P, Chuang T-Y, Liao Y-S, Wong C-C. Clavicular hook plate may induce subacromial shoulder impingement and rotator cuff lesion—dynamic sonographic evaluation. J Orthop Surg. 2014;9:6.

    Article  Google Scholar 

  47. Chiang C-L, Yang S-W, Tsai M-Y, Kuen-Huang CC. Acromion osteolysis and fracture after hook plate fixation for acromioclavicular joint dislocation: a case report. J Shoulder Elb Surg Am Shoulder Elb Surg Al. 2010;19:e13–5.

    Article  Google Scholar 

  48. Canadian Orthopaedic Trauma Society. Multicenter randomized clinical trial of nonoperative versus operative treatment of acute acromio-clavicular joint dislocation. J Orthop Trauma. 2015;29:479–87.

    Article  Google Scholar 

  49. Imhoff AB, Chernchujit B. Arthroscopic anatomic stabilization of acromioclavicular joint dislocation. Oper Tech Sports Med. 2004;12:43–8.

    Article  Google Scholar 

  50. Lädermann A, Gueorguiev B, Stimec B, Fasel J, Rothstock S, Hoffmeyer P. Acromioclavicular joint reconstruction: a comparative biomechanical study of three techniques. J Shoulder Elbow Surg. 2013;22:171–8.

    Article  PubMed  Google Scholar 

  51. Walz L, Salzmann GM, Fabbro T, Eichhorn S, Imhoff AB. The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices a biomechanical study. Am J Sports Med. 2008;36:2398–406.

    Article  PubMed  Google Scholar 

  52. Venjakob AJ, Salzmann GM, Gabel F, Buchmann S, Walz L, Spang JT, et al. Arthroscopically assisted 2-bundle anatomic reduction of acute acromioclavicular joint separations 58-month findings. Am J Sports Med. 2013;41:615–21. Recently published longest term follow-up of 58-month results in a series of 23 patients undergoing 2 suture-button fixation for acute AC joint dislocation.

  53. Scheibel M, Dröschel S, Gerhardt C, Kraus N. Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations. Am J Sports Med. 2011;39:1507–16.

    Article  PubMed  Google Scholar 

  54. Saier T, Plath JE, Beitzel K, Minzlaff P, Feucht JM, Reuter S, et al. Return-to-activity after anatomical reconstruction of acute high-grade acromioclavicular separation. BMC Musculoskelet Disord. 2016;17:145. Describes various outcomes for return to activity in patients undergoing anatomical reconstruction of acute high-grade acromioclavicular joint separation.

  55. Clavert P, Meyer A, Boyer P, Gastaud O, Barth J, Duparc F. Complication rates and types of failure after arthroscopic acute acromioclavicular dislocation fixation. Prospective multicenter study of 116 cases. Orthop Traumatol Surg Res. 2015;101:S313–6. Analysis of the surgical and radiographic complications associated with anatomic coracoclavicular ligament reconstruction on patient outcomes.

  56. Weaver JK, Dunn HK. Treatment of acromioclavicular injuries, especially complete acromioclavicular separation. J Bone Joint Surg Am. 1972;54:1187–94.

    Article  CAS  PubMed  Google Scholar 

  57. Sood A, Wallwork N, Bain GI. Clinical results of coracoacromial ligament transfer in acromioclavicular dislocations: a review of published literature. Int J Shoulder Surg. 2008;2:13–21.

    Article  PubMed  PubMed Central  Google Scholar 

  58. 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;28:103–8.

    CAS  PubMed  Google Scholar 

  59. 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;31:648–55.

    PubMed  Google Scholar 

  60. Carofino BC, Mazzocca AD. The anatomic coracoclavicular ligament reconstruction: surgical technique and indications. J Shoulder Elb Surg. 2010;19:37–46.

    Article  Google Scholar 

  61. Jones HP, Lemos MJ, Schepsis AA. Salvage of failed acromioclavicular joint reconstruction using autogenous semitendinosus tendon from the knee. Surgical technique and case report. Am J Sports Med. 2001;29:234–7.

    CAS  PubMed  Google Scholar 

  62. 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;38:1196–203.

    Article  PubMed  Google Scholar 

  63. Mazzocca AD, Santangelo SA, Johnson ST, Rios CG, Dumonski ML, Arciero RA. A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction. Am J Sports Med. 2006;34:236–46.

    Article  PubMed  Google Scholar 

  64. Mardani-Kivi M, Mirbolook A, Salariyeh M, Hashemi-Motlagh K, Saheb-Ekhtiari K. The comparison of Ethibond sutures and semitendinosus autograft in the surgical treatment of acromioclavicular dislocation. Acta Orthop Traumatol Turc. 2013;47:307–10.

    Article  PubMed  Google Scholar 

  65. Jensen G, Katthagen JC, Alvarado L, Lill H, Voigt C. Arthroscopically assisted stabilization of chronic AC-joint instabilities in GraftRopeTM technique with an additive horizontal tendon augmentation. Arch Orthop Trauma Surg. 2013;133:841–51.

    Article  PubMed  Google Scholar 

  66. Fauci F, Merolla G, Paladini P, Campi F, Porcellini G. Surgical treatment of chronic acromioclavicular dislocation with biologic graft vs synthetic ligament: a prospective randomized comparative study. J Orthop Traumatol. 2013;14:283–90.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Martetschläger F, Horan MP, Warth RJ, Millett PJ. Complications after anatomic fixation and reconstruction of the coracoclavicular ligaments. Am J Sports Med. 2013;41:2896–903.

    Article  PubMed  Google Scholar 

  68. Cook JB, Shaha JS, Rowles DJ, Bottoni CR, Shaha SH, Tokish JM. Clavicular bone tunnel malposition leads to early failures in coracoclavicular ligament reconstructions. Am J Sports Med. 2013;41:142–8.

    Article  PubMed  Google Scholar 

  69. Cook JB, Shaha JS, Rowles DJ, Bottoni CR, Shaha SH, Tokish JM. Early failures with single clavicular transosseous coracoclavicular ligament reconstruction. J Shoulder Elb Surg. 2012;21:1746–52.

    Article  Google Scholar 

  70. Milewski MD, Tompkins M, Giugale JM, Carson EW, Miller MD, Diduch DR. Complications related to anatomic reconstruction of the coracoclavicular ligaments. Am J Sports Med. 2012;40:1628–34.

  71. Yoo Y-S, Seo Y-J, Noh K-C, Patro BP, Kim D-Y. Arthroscopically assisted anatomical coracoclavicular ligament reconstruction using tendon graft. Int Orthop. 2010;35:1025–30.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Yoo J-C, Ahn J-H, Yoon J-R, Yang J-H. Clinical results of single-tunnel coracoclavicular ligament reconstruction using autogenous semitendinosus tendon. Am J Sports Med. 2010;38:950–7.

    Article  PubMed  Google Scholar 

  73. 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;37:181–90.

    Article  PubMed  Google Scholar 

  74. Nicholas SJ, Lee SJ, Mullaney MJ, Tyler TF, McHugh MP. Clinical outcomes of coracoclavicular ligament reconstructions using tendon grafts. Am J Sports Med. 2007;35:1912–7.

    Article  PubMed  Google Scholar 

  75. Millett PJ, Horan MP, Warth RJ. Two-year outcomes after primary anatomic coracoclavicular ligament reconstruction. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc. 2015;31:1962–73.

    Article  Google Scholar 

  76. Coale RM, Hollister SJ, Dines JS, Allen AA, Bedi A. Anatomic considerations of transclavicular-transcoracoid drilling for coracoclavicular ligament reconstruction. J Shoulder Elb Surg Am Shoulder Elb Surg Al. 2013;22:137–44.

    Article  Google Scholar 

  77. Izadpanah K, Jaeger M, Maier D, Ogon P, Honal M, Vicari M, et al. Tendon graft fixation sites at the coracoid process for reconstruction of the coracoclavicular ligaments: a kinematic evaluation of three different surgical techniques. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc. 2013;29:317–24.

    Article  Google Scholar 

  78. Dumont GD, Russell RD, Knight JR, Hotchkiss WR, Pierce WA, Wilson PL, et al. Impact of tunnels and tenodesis screws on clavicle fracture: a biomechanical study of varying coracoclavicular ligament reconstruction techniques. Arthrosc J Arthrosc Relat Surg. 2013;29:1604–7. Comparison of with different tunnel techniques and evaluation of the effect of inserting tenodesis screws on the distal clavicle load to fracture.

  79. Geaney LE, Beitzel K, Chowaniec DM, Cote MP, Apostolakos J, Arciero RA, et al. Graft fixation is highest with anatomic tunnel positioning in acromioclavicular reconstruction. Arthrosc J Arthrosc Relat Surg. 2013;29:434–9.

    Article  Google Scholar 

  80. Spiegl UJ, Smith SD, Euler SA, Dornan GJ, Millett PJ, Wijdicks CA. Biomechanical consequences of coracoclavicular reconstruction techniques on clavicle strength. Am J Sports Med. 2014;42:1724–30. Biomechanical comparison of clavicle strength following two common coracoclavicular reconstruction techniques with different bone tunnel diameters.

  81. Millett PJ, Warth RJ, Greenspoon JA, Horan MP. Arthroscopically assisted anatomic coracoclavicular ligament reconstruction technique using coracoclavicular fixation and soft-tissue grafts. Arthrosc Tech. 2015;4:e583–7.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Warth RJ, Lee JT, Millett PJ. Arthroscopically-assisted anatomic coracoclavicular ligament reconstruction with tendon grafts: biomechanical rationale, surgical technique, and a review of clinical outcomes. Oper Tech Sports Med. 2014;22:234–47.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Asheesh Bedi.

Ethics declarations

Conflict of Interest

Simon Lee and Asheesh Bedi declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Outcomes Research in Orthopedics

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, S., Bedi, A. Shoulder acromioclavicular joint reconstruction options and outcomes. Curr Rev Musculoskelet Med 9, 368–377 (2016). https://doi.org/10.1007/s12178-016-9361-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12178-016-9361-8

Keywords

Navigation