Surgical Treatment of Acute Acromioclavicular Separation

Background: High grade separation of the acromioclavicular joint (ACJ) involves disruption of both coracoclavicular (CC) and acromioclavicular (AC) ligaments, hence resulting in both vertical and antero-posterior (AP) instability of the clavicle. Early intervention allows for reduction and reconstitution of the ACJ along with primary repair of the AC ligaments. The need for concomitant CC ligaments reconstruction in this setup has not been demonstrated.

Patients and Methods: In this IRB approved study we present the short term outcome (25.8 months post operatively SD 10.8) of a cohort of patients treated for acute traumatic high grade (Rockwood 3-5) ACJ separation. All patients were treated surgically within a month of the injury by open reduction and hook plate stabilization of the ACJ along with primary closure of the ACJ capsule. No CC ligament reconstruction was performed. Plates were removed 3-4 months following index surgery. Outcome was evaluated by physical examination, subjective self-assessment questionnaires and plain radiographs to yield SANE, VAS, DASH and Constant-Murley shoulder scores.

Results: Twelve patients fulfilled the inclusion criteria including clinical follow-up of at least a year from original injury. The majority were males (92%) with an average age of 33.6±12.3. Plates removed at 4.5±2 months post primary operation. At last follow-up five patients reported minimal to mild pain in the operation site and one patient reported occasional usage of analgesics. Four patients had mild local deformity. Mild anteroposterior translation of the ACJ during shoulder motion was noticed in three cases, but none was painful. Radiographic assessment showed reduction of the ACJ. Active range of motion to the contralateral shoulder. The average SANE, VAS, DASH and Constant-Murley scores were 88.4±8.2, 1.3±2.2, 10.2±14.6 and 85±12.3 respectively.

Conclusions: Early open reduction of high grade ACJ separation injuries with primary repair of the AC capsule and ligaments results in good to excellent clinical outcome. Thus, in this setup, reconstruction of the CC ligaments is not needed.