Treatment Of Acromioclavicular Joint Injuries Research Articles

Bibliometric and visualized analysis of arthroscopic treatment of acromioclavicular joint injury

BackgroundSince arthroscopy was discovered to treat acromioclavicular joint injury, people have had great interest and attention to this beautiful and minimally invasive operation, and related research has been increasing worldwide. At present, there is no bibliometric and visualized analysis in this field. The purpose of this study is to explore the research hotspots and trends of arthroscopic treatment of acromioclavicular joint injury through bibliometric and visualized analysis and look forward to the future development direction of clinical practice.MethodsThe publications on arthroscopic treatment of acromioclavicular joint injury diseases from its establishment to April 2023 were obtained from the Web of Science (WOS) Core Collection database. CiteSpace, VOSviewer, Scimago graphica and Origin were used for bibliometric and visualized analysis.ResultsThis study included a total of 330 publications. The number of publications tends to increase every year. The USA has the most significant number of publications and citations. Imhoff AB is the most relevant scholar with the largest number of publications in this field, and the scholar with the highest citation and average citations is Mazzocca AD. Tech Univ Munich, Rush University and Charite are the three institutions with the greatest contribution. Tech Univ Munich, Rush University and Charite are the three institutions with the greatest contribution. In addition, “Arthroscopy-the Journal of Arthroscopic and Related Surgery” and “American Journal of Sports Medicine” are the institutions with the most significant number of publications and average citations, respectively. The most common keywords are “acromioclavicular joint dislocation,” “arthroscopic resection,” “arthroscopic reconstruction” and “coracoclavicular ligament.”ConclusionThe number of publications shows a steady upward trend as a whole. However, there is still a lack of cooperation among countries, institutions and scholars around the world, so various countries, institutions and scholars need to strengthen academic exchanges and expand the field of cooperation, so as to promote further research and development in related fields. However, minimally invasive methods such as arthroscopy are still the hotspots and frontiers in the treatment of acromioclavicular joint injury in the future.

Is coracoclavicular ossification a complication or a good prognostic factor after surgical treatment of acromioclavicular joint injury?

BackgroundThe purpose of this study was to investigate whether heterotopic ossification (HO) in the coracoclavicular (CC) space after surgical treatment of acromioclavicular joint (ACJ) injury is a complication or a sign of good prognosis.MethodsFifty-nine consecutive patients who underwent CC reconstruction with or without augmentation of the ACJ for acute ACJ injuries were analyzed. Postoperative American Shoulder and Elbow Surgeons (ASES) score, Constant score (CS), subjective shoulder value (SSV), and visual analog scale (VAS) results were evaluated. For radiological evaluation, HO was evaluated, and CC distances were measured.ResultsFifty-one patients (11 women and 40 men; mean age, 36 years [range, 17-68 years]) were evaluated after a mean follow-up of 3 years (range, 2-8 years). The mean ASES score at the follow-up was 82.73 (range, 51.6-100), mean CS was 85 (range, 50-100), mean SSV was 80 (range, 40-100), and mean VAS was 1.9 (range, 0-5). It was observed that the clinical outcomes (ASES, CS, SSV, VAS) of patients who developed ossification in the CC space were better than those who did not although it was not statistically significant. No statistically significant differences were found in the clinical outcomes (ASES, CS, SSV, VAS) between patients who underwent CC reconstruction without augmentation of the ACJ and those who were combined (P > .05).ConclusionHO in the CC space is a common finding following AC joint fixation injury. We suggest that HO is not a complication and might possibly have positive effects on clinical outcomes.

The Morphology of the Acromioclavicular Joint Does Not Influence the Postoperative Outcome Following Acute Stabilization—A Case Series of 81 Patients

PurposeTo specifically evaluate the influence of the acromioclavicular (AC)-joint morphology on the outcome after arthroscopically assisted coracoclavicular (CC) stabilization surgery with suspensory fixation systems and to investigate whether an additional open AC-joint reduction and AC cerclage improves the clinical outcome for patients with certain morphologic AC-joint subtypes.MethodsPatients with an acute acromioclavicular joint injury, who underwent arthroscopically assisted CC stabilization with suspensory fixation systems with or without concomitant AC cerclage between January 2009 and June 2017 were identified and included in this retrospective cohort analysis. AC-joint morphology was assessed on preoperative radiographs and categorized as “flat” or “non-flat” (“oblique”/“curved”) subtypes. After a minimum of 2 years of follow-up, postoperative Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Surgeons (ASES), and visual analog scale (VAS) scores for pain were collected. A subgroup analysis of clinical outcomes depending on the surgical technique and morphological subtype of the AC joint was performed.ResultsEighty-one patients (95% male, mean age 35 ± 12 years) could be included at a mean follow-up of 57 ± 14 months. Radiographic assessment of AC-joint morphology showed 24 (30%) cases of flat type, 38 (47%) cases of curved type, and 19 (23%) cases of oblique morphology. Postoperatively, no clinically significant difference could be detected after the treatment of AC joint injury via CC stabilization with or without concomitant AC cerclage (VASrest: P = .067; VASmax: P = .144, ASES: P = .548; SANE: P = .045). No clinically significant differences were found between the surgical techniques for the flat morphologic subtype (VASrest: P = .820; VASmax: P = .251; SANE: P = .104; ASES: P = .343) or the non-flat subtype (VASres: P = .021; VASmax: P = .488; SANE: P = .243, ASES: P = .843).ConclusionsIn arthroscopically assisted AC stabilization surgery with suspensory fixation systems for acute AC-joint injury, the AC-joint morphology did not influence the postoperative outcome, independent of the surgical technique. No clinical benefit of performing an additional horizontal stabilization could be detected in our collective at mid-term follow-up.Level of EvidenceLevel IV, therapeutic case series.

Comparison of trans-articular Kirschner wire fixation and TightRope System for the treatment of acromioclavicular joint injuries

Aim: Acromioclavicular joint (ACJ) injuries are common among the young and middle-aged population. The management of Grade III ACJ injuries is still controversial. The purpose of the present study was to compare the clinical results and complication rates of trans-articular Kirschner (K) wire fixation and the TightRope System for surgically treated ACJ injuries.
 Material and Method: Patients with Grade III or more ACJ injuries surgically treated for acute ACJ injuries were included in the study. The patients were grouped according to the fixation method; the patients treated with the TightRope System were called Group 1 (n=17). The patients treated with trans-articular K-wire fixation were called Group 2 (n=21). The American Shoulder and Elbow Surgeons (ASES), Constant-Murley (CS), Visual Analog Scale (VAS) scores, and shoulder range of motion (ROM) values were evaluated, and the complications were recorded and compared between the two groups.
 Results: Thirty-eight patients (7 females, 31 males) were included in the study with a mean age of 33±9.04. There was no significant difference between the two groups in terms of demographic and preoperative variables. ASES (P=0.400), CS (P=0.172), VAS (P=0.234), and ROM values were similar between the two groups. The rate of complications was significantly higher in Group 2 (P=0.025). 
 Conclusion: Trans-articular K-wire fixation and the TightRope System have similar clinical scores and ROM values; on the other hand, trans-articular K-wire fixation has significantly higher complication rates.

A relook at the reliability of Rockwood classification for acromioclavicular joint injuries.

Controversies for treatment of acromioclavicular joint injuries in particular type III injuries may be partially attributed to the lack of a standardized method of radiography and measurement technique. Previous studies looking at the Rockwood classification showed poor inter- and intraobserver reliability (Kappa value approximately 0.20-0.50). We hypothesized that the use of unilateral instead of bilateral acromioclavicular joint radiographs was the cause of this finding. In this article, we standardized the methodology to perform the radiograph and to measure the coracoclavicular distances. We designed the study to focus on the reliability of differentiating type III and type V injuries. A standardized radiographic protocol for bilateral Zanca view was established in our institution. All patients who underwent this radiographic examination over a 3-year period were reviewed. Radiographs of 55 patients with significant (type III or V) injury met the inclusion criteria. For the interobserver reliability, a retrospective radiographic review was performed by 6 orthopedic surgeons and graded as either type III or V. For intraobserver reliability, a similar process was repeated by 3 observers after a period of 6 weeks. Going by the majority agreement of the 6 reviewers, there were 34 type III injuries and 19 type V injuries. The Fleiss kappa for interobserver reliability was calculated to be 0.624. The Cohen kappa for intraobserver reliability was calculated to be 0.696. The use of a standardized radiographic protocol-taking bilateral Zanca views on the same radiographic plate-would help eliminate a significant amount of variability and improve the reliability of classifying acromioclavicular joint injuries using the Rockwood classification, which uses a relative measure to the contralateral site as its definition criteria. Other possible sources of poor reliability may include the masking of injuries by muscle spasm, resulting in a misdiagnosis of a high-grade injury as a lower-grade one and the possible need to subclassify type III injuries. Reliability of the Rockwood classification can be improved through the use of a standardized radiographic protocol to improve the detection of vertical instability. Similar to Rockwood dividing up Tossy grade 3 injuries when he noted the differential outcome and intervention, Rockwood type III injuries would likely require further subclassification as it remains an anomalous tool with high variability. Further studies are required to understand the pathologic basis of transition of type III into type V injury.

Results of treatment of acromioclavicular joint injuries

Introduction. Acromioclavicular joint has an important role in the shoulder function. Loss of joint function due to injury or disease affects the biomechanics of the shoulder. The aim of this study was to evaluate the results of surgical treatment of acromioclavicular joint injuries, identify risk groups within the age groups, and to indicate the most common mechanisms of injury. Material and Methods. A retrospective study included 20 patients with acromioclavicular injury. We analyzed the results of surgical treatment in patients with acromioclavicular injury from January 2017 to January 2019. Patients were treated using Bosworth and Phemister surgical techniques. The Constant shoulder score was used to assess the results of surgeries. We compared the results of the operated and non-operated shoulders in each patient. Statistical analysis was performed using Student?s T-test and ?? test. Results. Functional assessment was done using the Constant shoulder score: 9 patients had excellent results, 7 had good results and 3 had satisfactory results; there were no patients with poor outcome. We compared the total Constant shoulder score of the operated shoulder with the results of the opposite healthy shoulder, as well as the range of motion of external rotation, and internal rotation range of motion of the operated and the opposite healthy shoulder. There was a statistically significant difference (p < 0.05) in all compared parameters. The total Constant shoulder score of the operated shoulder was by 14% lower in relation to the healthy shoulder. Conclusion. The basic precondition for positive treatment results is timely diagnosis and early surgical intervention. Shoulder function was surgically restored and 95% of patients can perform all activities of daily living.

Acromioclavicular joint injuries in overhead athletes: a concise review of injury mechanisms, treatment options, and outcomes.

To review the relevant literature surrounding acromioclavicular (AC) joint injuries particularly pertaining to overhead athletes. The AC joint is a unique anatomic and biomechanical portion of the shoulder that can be problematic for athletes, particularly throwers, when injured. Treatment of these injuries remains a topic in evolution. Low-grade injuries (Rockwood types I & II) are typically treated non-operatively while high-grade injuries (types IV, V, and VI) are considered unstable and often require operative intervention. Type III AC separations remain the most controversial and challenging as no clear treatment algorithm has been established. A wide variety of surgical techniques exist. Unfortunately, relatively little literature exists with regard to overhead athletes specifically. Treatment of AC joint injuries remains challenging, at times, particularly for overhead athletes. Operative indications and techniques are still evolving, and more research is needed specifically surrounding overhead athletes.

EXPERIENCE IN ARTHROSCOPIC TREATMENT OF ACUTE ACROMIOCLAVICULAR JOINT INJURIES

Purpose of study: to evaluate surgical treatment results in patients with closed dislocation of the acromial end of the clavicle.Patients and methods. Eighteen patients, aged 23-54 years, with acute acromioclavicular joint injuries of IIIIV type by Rockwood were operated on during 2015 – 2018. Surgical treatment was performed at terms up to 2 weeks after injury. Reduction of the acromial end of the clavicle, arthroscopic fixation and stabilization of acromioclavicular joint by TightRope system was performed. Postoperative follow-up was cjnducted in 4 and 6 weeks, 3 months and subsequently every 6 months after surgical intervention. To evaluate the results the Constant Score and radiographs were used.Results.Follow-up period made up 1 year. Functional result, i.e. range of motion and quality of life, by Constant Score was good already on day 14 after surgery and excellent (89.6±2.9 points) at the end of treatment course (2 months after intervention). Brachial plexopathy (reduction of the thumb and 2nd finger sensitivity and muscular force in the early postoperative period) was observed in 1 case. Six months conservative treatment resulted in positive effect. In 6 months range of motion in the operated joint was equal to that in a healthy one.Conclusion.Arthroscopic treatment of acromioclavicular joint injuries by TightRope system is a highly effective and minimum invasive method but requires experience and practical skills in shoulder arthroscopy.

Experience in arthroscopic treatment of acute acromioclavicular joint injuries

Purpose of study: to evaluate surgical treatment results in patients with closed dislocation of the acromial end of the clavicle. Patients and methods. Eighteen patients, aged 23-54 years, with acute acromioclavicular joint injuries of III-IV type by Rockwood were operated on during 2015 - 2018. Surgical treatment was performed at terms up to 2 weeks after injury. Reduction of the acromial end of the clavicle, arthroscopic fixation and stabilization of acromioclavicular joint by TightRope system was performed. Postoperative follow-up was cjnducted in 4 and 6 weeks, 3 months and subsequently every 6 months after surgical intervention. To evaluate the results the Constant Score and radiographs were used. Results. Follow-up period made up 1 year. Functional result, i.e. range of motion and quality of life, by Constant Score was good already on day 14 after surgery and excellent (89.6±2.9 points) at the end of treatment course (2 months after intervention). Brachial plexopathy (reduction of the thumb and 2nd finger sensitivity and muscular force in the early postoperative period) was observed in 1 case. Six months conservative treatment resulted in positive effect. In 6 months range of motion in the operated joint was equal to that in a healthy one. Conclusion. Arthroscopic treatment of acromioclavicular joint injuries by TightRope system is a highly effective and minimum invasive method but requires experience and practical skills in shoulder arthroscopy.

The surgical treatment of acromioclavicular joint injuries.

Acromioclavicular joint (ACJ) injuries are common, but their incidence is probably underestimated. As the treatment of some sub-types is still debated, we reviewed the available literature to obtain an overview of current management.We analysed the literature using the PubMed search engine.There is consensus on the treatment of Rockwood type I and type II lesions and for high-grade injuries of types IV, V and VI. The treatment of type III injuries remains controversial, as none of the studies has proven a significant benefit of one procedure when compared with another.Several approaches can be considered in reaching a valid solution for treating ACJ lesions. The final outcome is affected by both vertical and horizontal post-operative ACJ stability. Synthetic devices, positioned using early open or arthroscopic procedures, are the main choice for young people.Type III injuries should be managed surgically only in cases with high-demand sporting or working activities.Cite this article: EFORT Open Rev 2017;2:432–437. DOI: 10.1302/2058-5241.2.160085.

Comparison of Short-term Complications Between 2 Methods of Coracoclavicular Ligament Reconstruction: A Multicenter Study.

Background:Numerous techniques have been used to treat acromioclavicular (AC) joint dislocation, with anatomic reconstruction of the coracoclavicular (CC) ligaments becoming a popular method of fixation. Anatomic CC ligament reconstruction is commonly performed with cortical fixation buttons (CFBs) or tendon grafts (TGs).Purpose:To report and compare short-term complications associated with AC joint stabilization procedures using CFBs or TGs.Study Design:Cohort study; Level of evidence, 3.Methods:We conducted a retrospective review of the operative treatment of AC joint injuries between April 2007 and January 2013 at 2 institutions. Thirty-eight patients who had undergone a procedure for AC joint instability were evaluated. In these 38 patients with a mean age of 36.2 years, 18 shoulders underwent fixation using the CFB technique and 20 shoulders underwent reconstruction using the TG technique.Results:The overall complication rate was 42.1% (16/38). There were 11 complications in the 18 patients in the CFB group (61.1%), including 7 construct failures resulting in a loss of reduction. The most common mode of failure was suture breakage (n = 3), followed by button migration (n = 2) and coracoid fracture (n = 2). There were 5 complications in the TG group (25%), including 3 cases of asymptomatic subluxation, 1 symptomatic suture granuloma, and 1 superficial infection. There were no instances of construct failure seen in TG fixations. CFB fixation was found to have a statistically significant increase in complications (P = .0243) and construct failure (P = .002) compared with TG fixation.Conclusion:CFB fixation was associated with a higher rate of failure and higher rate of early complications when compared with TG fixation.

Comparison of surgical outcomes between fixation with hook plate and loop suspensory fixation for acute unstable acromioclavicular joint dislocation: a systematic review and meta-analysis.

Treatment of acute (≤4weeks) high-grade acromioclavicular (AC) joint separation (types III-VI) is still controversial. Currently, the two modern techniques that are widely used include hook plate fixation and coracoclavicular (CC) ligament fixation using a suspensory loop device (tightrope, synthetic ligament or absorbable polydioxansulfate sling). These techniques are both reported to have superior clinical outcomes. This systematic review and meta-analysis aimed to assess and compare clinical outcomes of hook plate fixation versus fixation of the CC ligament using a loop suspensory fixation (LSF) device for the treatment of AC joint injury. These clinical outcomes consist of the Constant-Murley score (CMS), pain visual analog score (VAS) and postoperative complications. Relevant comparative studies were identified from MEDLINE and Scopus from inception to October 5, 2015. Five of 571 studies were eligible; 5, 3, 3, and 5 studies were included in the pooling of CMS, pain VAS, surgical time and postoperative complications, respectively. The unstandardized mean difference (UMD) of the CMS for LSF was 4.43 [95% confidence interval (CI) 0.73, 8.14], which was statistically significantly higher than the CMS in hook plate fixation. For VAS, the UMD was 0.02 points (95% CI -3.54, 3.73) higher than LSF but without statistical significance. The surgical time of LSF was 16.21min (95% CI 6.27, 26.15) statistically significantly higher than hook plate fixation. LSF had a lower chance of postoperative complications by 0.62 units (95% CI 0.30, 1.32) when compared to hook plate fixation, but this also was not statistically significant. In acute high-grade AC joint injuries, loop suspensory fixation had higher postoperative functional CMS and mean surgical time when compared to hook plate fixation. However, for postoperative VAS and complication rates, there were no statistically significant differences between groups.

Treatment of Acromioclavicular Joint Injuries in Athletes and in Young Active Patients

The latter generation of mankind is somehow evolved. The ordinary people under 50 years old are trying to live as professional sports guys. They all do various kinds of sports apart from their ordinary life. They all seek for a better body built and an active life. But most of them started active sports after 3rd decade. Improper physical background plus enthusiastic physical activity ends with various kinds of sports injuries. Our generation of orthopaedic surgeons starts to examine more and more sport related injuries in our daily practice. Acromioclavicular joint (ACJ) injuries are one of them. ACJ injuries rather frequent in athletes as well as the ordinary young, active people because of falls, sports injuries, and accidents. In this review, current treatment modalities for AC joint injuries in athletes and young active patients are given briefly. Those suggestions may also be beneficial for an ordinary person seeking for a faster recovery.

First experience of the surgical treatment of acute dislocation of clavicle acromial end

Over 100 methods of the surgical treatment of the dislocation of clavicle acromial end is known nowadays. Anatomic-biomechanic peculiarities of acromioclavicular joint and its ligamentous appa­ratus stipulate such a variety, at first, and secondly, this fact shows some disadvantages of every method. Moreover, it was defined, that complete restoration of function does not happen in 16.5–35.2 % cases. This fact shows the relevance of working out and implementa­tion of new treatment techniques. The goal: to improve the results of treatment of acromioclavicular joint injury using the restoration of coracoclavicular ligament with arthroscopic control. Methods: 5 patients (at the age from 18 to 42 years) with acute injury of ac­romioclavicular joint underwent an operation using arthroscopic equipment. The fixation of joint was carried out with «AKK rigging / АКК Такелаж» system in high-endurance nonabsorbable material. Immobilization duration in triangular bandage was equal to 2–3 weeks depending upon the severity of pain syndrome. Follow-up controls (clinical and radiographic assessment) were performed 1 and 3 months after surgery. Results: using of the method proposed for restoration of acute injures of acromioclavicular joint allowed to obtain good and excellent results in all patients after surgery. The range of motion in shoulder joint was restored in all patients completely. The proposed technique means surgery through little incisions (0.5 cm) that provide good cosmetic results. A positive feature of proposed technique is a minimal operation trauma, as far as you have not to expose a clavicle and subclavicular space for drilling it and fixator implementation. Conclusion: using of arthroscopic equipment for the restoration of acromioclavicular joint facilitates decreasing of operation trauma, terms of immobi­lization, allows predicting positive long-term results and restoring complete motion in shoulder joint.

Operative treatment of acute acromioclavicular joint injuries graded Rockwood III and IV: risks and benefits in tight rope technique vs. k-wire fixation

BackgroundOperative treatment of acromioclavicular joint injuries is recommended for higher degree dislocations. Recently a new option has become available with the minimally-invasive tight rope technique. Whereas clinical studies justify the medical use, risks and benefits remain unclear. Therefore, this study analyzed these facts associated with this procedure and compared them to K-wire fixation.Material and MethodsA retrospective analysis was performed of patients surgically treated either with the TightRope™-technique (TR) or K-wires (KW) for a first event isolated Rockwood type III or higher acromioclavicular joint dislocation between 2004 and 2011. Timing for surgery, surgical duration, length of hospital stay, costs, complications and outpatient visits were recorded.Results41 patients were included (TR: n = 18; KW: n = 23) with comparable demographics and injury severity. A trend towards shorter operation time was seen in the TR group (TR: 64.3 ±19.8 min. vs. KW: 80.9 ±33.7 min., n.s.) A tendency for lower total operation theater costs was seen in the TR group (TR: 474 ±436.5€ vs. KW: 749.1 ±31.2€, n.s.). Patients from the TR group left hospital earlier (TR: 2 ±1d vs. KW: 3.6 ±1.8d, p = 0.002). Severe complications (i.e. a fracture of the clavicle or nerve damage) occurred in neither of the groups. Early loss of reduction (n = 1) and impaired wound healing (n = 2) was seen in the TR group. Migrating K-wires (n = 4), loss of reduction (n = 1) and impingement syndrome (n = 1) were recorded in the KW group.ConclusionUsage of the tight rope technique offered advantages, such as being a safe minimally-invasive technique and showed a tendency towards shorter operation time, and lower physician- and total operation and theater costs. Material costs were significantly higher for this device but patients were discharged earlier. The influence of different clinical long-term results on the financial outcome needs to be evaluated in further studies.

Free Tissue Graft Reconstruction of the Acromioclavicular Joint

Acromioclavicular (AC) joint injuries are commonly encountered in the contact athlete. Although most may be treated nonoperatively, more severe AC dislocations require surgical stabilization. Many procedures describe repair or reconstruction of the AC joint, focusing mainly on treatment of the ruptured coracoclavicular ligaments. Clinical results have been mixed, often reporting significant complications, postoperative clavicle subluxation, and patient dissatisfaction. In addition, cadaveric testing data often demonstrate inferior biomechanical properties, compared with the native AC joint. Multiple studies have concluded that the AC ligaments are important constraints to clavicle translation, and their reconstruction should be considered in the treatment of AC joint injuries. Despite these findings, there are few techniques reported that address the AC ligaments. This report describes a new procedure for the treatment of AC injuries, involving a free tissue intramedullary graft reconstruction of the AC ligaments, in addition to reconstruction of the coracoclavicular ligaments. By recreating the principal ligamentous structures, stability of the AC joint may be restored.

Tension band wiring in the treatment of acromioclavicular joint injuries: Do broken threaded K-wires migrate?

Tension band wiring in the treatment of acromioclavicular joint injuries: Do broken threaded K-wires migrate?

Nonoperative treatment ofacromioclavicular joint injuries

Nonoperative treatment is generally the choice for Type I and II acromioclavicular (AC) joint injuries. The situation issomewhat more controversial when Type III AC dislocations are considered, particularly with respect to athletes and heavy laborers. A number of recent studies have supported conservative treatment in these groups. There is general consensus as to the need for surgical intervention for Type IV, V, and VI AC injuries. Integral to any form of management, nonoperative or operative, is a rehabilitation program that addresses range of motion, strength, and neuromuscular control. We describe our program, which is divided into four phases: (1) Pain control and immediate protected range of motion and isometric exercises; (2) strengthening exercises using isotonic contractions and proprioceptive neuromuscular facilitation (PNF) exercises; (3) Unrestricted functional participation with the goal of increasing strength, power, endurance, and neuromuscular control; and (4) return to activity with sport specific functional drills. An athlete is ready to return to competitive sports once the following criteria are met: full range of motion (ROM), no pain or tenderness, satisfactory clinical exam, and demonstration of adequate strength on isokinetic testing. The unique considerations in a throwing athlete with an AC injury are also addressed. The primary goal of the nonoperative treatment protocol is to return the athlete to full activities as quickly and as safely as possible.