Acromioclavicular Joint Injuries

Acromioclavicular dislocations are one of the most common sports injuries. They occur mainly in the context of direct shoulder trauma with the arm adducted. Acromioclavicular pain and functional limitation are the most frequent symptoms. The semiological maneuvers of Paxino’s and O′Brien’s have high sensitivity to perform the physical examination. Anteroposterior radiography with 10°–15° cephalic inclination (Zanca projection) is useful to diagnose and quantify the degree of displacement. The Rockwood classification is the most frequently used, dividing AC injuries into six types according to the degree of ligament involvement and associated displacement. Low grade lesions (I-III Rockwood) are the most frequent, being candidates for conservative treatment with good results in the majority of cases. High-grade lesions (IV–VI Rockwood) are candidates for surgical treatment. The author’s preference is, if possible, to treat high-grade injuries during the acute period (in the first 3 weeks after injury). The preferred surgical method is acromioclavicular stabilization with a suspensory system without the use of grafts. In case of chronic injuries, reconstructive techniques are preferred. A considerable percentage of patients may present partial loss of reduction, without any consequences in functional results. If required, revision of a failed acromioclavicular stabilization using a reconstructive technique is associated with good long-term outcomes.