Editorial Commentary: Acute Treatment Including Cerclage Result in Best Surgical Outcomes for High-Grade Acromioclavicular Joint Separations

Abstract

Despite years of research, optimal treatment of acute high-grade acromioclavicular joint (ACJ) separations remains controversial. ACJ separations occur in a “multiplanar” fashion and identification of horizonal plane instability is paramount to differentiate between high-grade versus low-grade injuries. As surgeons, we treat a self-selected group of patients referred for surgery, and our physiotherapy colleagues may rehabilitate many patients with both "low-grade" and “high-grade” separations who compensate. Of importance, ACJ separations stabilized <3 weeks after injury have the best chance of healing in a close-to anatomic position. The addition of the ACJ cerclage augmentation improves horizontal plane stability while the soft tissues heal and likely improves outcome.