Traumatic acromioclavicular joint separation – Current concepts

Abstract

BACKGROUND: The concept of treatment strategies in dislocations of the acromioclavicular joint has changed in recent years. The recommended indication for operative treatment of complete dislocations has been questioned due to the lack of evidence-based results indicating the superiority of such treatment. Although the traumatic acromioclavicular joint separation is a well-known topic, there are different classifications, diagnostic procedures, concepts of intervention and a great variety of implants. Therefore, a comparison of the numerous papers dealing with this topic is difficult. METHODS: An overview of the recent literature is given in this paper. The different therapeutical methods, ranging from nonoperative techniques to different operative procedures such as percutaneous K-wires or other transarticular techniques, extra-articular techniques or secondary procedures like tendon transfers are compared. RESULTS: The current therapeutical algorithms that help to decide on whether operative or nonoperative treatment is the best solution are oriented on the morphological classification, the clinical appearance of the injury and the individual patient's expectations. The wide range of implants available demand a decision based on anatomical and biomechanical considerations. CONCLUSIONS: In this paper an overview of current concepts is given and possible treatment options for acute and chronic cases are discussed. The indication for operative intervention is restricted to the young and physically active patient with a high-grade dislocation of the AC-joint.