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World J Orthop. Dec 18, 2017; 8(12): 861-873
Published online Dec 18, 2017. doi: 10.5312/wjo.v8.i12.861
New insights in the treatment of acromioclavicular separation
Christiaan J A van Bergen, Annelies F van Bemmel, Tjarco D W Alta, Arthur van Noort
Christiaan J A van Bergen, Department of Orthopaedic Surgery, Amphia Hospital, Breda 4818 CK, The Netherlands
Annelies F van Bemmel, Tjarco D W Alta, Arthur van Noort, Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp 2134 TM, The Netherlands
Author contributions: All authors equally contributed to this paper with conception and design, literature review and analysis, drafting and critical revision and editing, and approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Christiaan J A van Bergen, MD, PhD, Surgeon, Department of Orthopaedic Surgery, Amphia Hospital, Molengracht 21, Breda 4818 CK, The Netherlands. cvanbergen@amphia.nl
Telephone: +31-76-5955000
Received: August 22, 2017
Peer-review started: September 16, 2017
First decision: October 23, 2017
Revised: November 27, 2017
Accepted: December 5, 2017
Article in press: December 5, 2017
Published online: December 18, 2017
Processing time: 93 Days and 18.6 Hours
Abstract

A direct force on the superior aspect of the shoulder may cause acromioclavicular (AC) dislocation or separation. Severe dislocations can lead to chronic impairment, especially in the athlete and high-demand manual laborer. The dislocation is classified according to Rockwood. Types I and II are treated nonoperatively, while types IV, V and VI are generally treated operatively. Controversy exists regarding the optimal treatment of type III dislocations in the high-demand patient. Recent evidence suggests that these should be treated nonoperatively initially. Classic surgical techniques were associated with high complication rates, including recurrent dislocations and hardware breakage. In recent years, many new techniques have been introduced in order to improve the outcomes. Arthroscopic reconstruction or repair techniques have promising short-term results. This article aims to provide a current concepts review on the treatment of AC dislocations with emphasis on recent developments.

Keywords: Acromioclavicular dislocation; Rockwood classification; Coracoclavicular ligament reconstruction; Hookplate; Arthroscopically assisted acromioclavicular reconstruction; Weaver and Dunn procedure; Conoid and trapezoid ligaments

Core tip: Current literature suggests that the decision for treatment of type III injuries should be made on a case-by-case basis, with an emphasis on initial nonoperative treatment. Early operative treatment for grades III-VI dislocations may result in better functional and radiological outcomes than delayed surgery. There are numerous surgical techniques presented in the literature. The authors prefer an autograft tendon reconstruction of the coracoclavicular joint without bone tunnels in combination with direct suture fixation of the acromioclavicular joint. Arthroscopic techniques are evolving but there is currently no evidence to support arthroscopic over open surgery.