From the Research
The recommended treatment for a Rookwood II acromioclavicular (AC) joint injury is conservative management. This approach is based on the most recent and highest quality evidence available, which suggests that conservative management is effective for type I and II injuries, with most patients experiencing manageable long-term symptoms without the need for surgical intervention 1.
Key Components of Conservative Management
- Rest, ice application for 20 minutes every 2-3 hours during the first 48-72 hours
- A sling for comfort for 1-2 weeks
- Pain control with over-the-counter medications such as ibuprofen (400-600mg three times daily with food) or acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily)
- Physical therapy beginning after the acute pain subsides, focusing on range of motion exercises followed by strengthening of the shoulder girdle muscles, particularly the deltoid and trapezius
Rationale for Conservative Management
The joint typically remains stable and heals well without surgical intervention, which is reserved for higher-grade injuries (Rookwood IV-VI) where there is significant displacement and instability 2, 1. Conservative management allows for the return to normal activities within 2-6 weeks, though contact sports should be avoided for at least 6 weeks.
Considerations for Surgical Intervention
While surgical intervention may be considered for patients with higher-grade injuries or those who fail conservative management, the current evidence suggests that conservative management is the preferred initial approach for Rookwood II injuries 3, 4. The potential benefits of surgical intervention, such as anatomic reduction, must be weighed against the risks of complications and the potential for satisfactory outcomes with conservative management.
Summary of Evidence
The evidence from studies such as 1 and 3 supports the use of conservative management for Rookwood II AC joint injuries, with surgical intervention reserved for more severe injuries or cases where conservative management fails. The most recent study 4 provides additional insight into the outcomes of surgical treatment for acute type III ACJ dislocations, but its findings do not alter the recommended approach for Rookwood II injuries.