Published online Dec 18, 2017. doi: 10.5312/wjo.v8.i12.861
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
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.
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.