From the Guidelines
AC separations are graded from I to VI based on severity, and treatment options range from conservative management with rest, ice, and pain medication for lower grades to surgical repair for higher grades, with the goal of minimizing morbidity, mortality, and improving quality of life. The grades of AC joint separation are defined as follows:
- Grade I: minimal ligament damage with no joint displacement, treated with rest, ice, pain medication, and a sling for comfort for 1-2 weeks 1
- Grade II: partial ligament tears with slight displacement, requires similar conservative treatment but may take 2-4 weeks for recovery
- Grade III: complete disruption of the AC and coracoclavicular ligaments with noticeable deformity, treatment is typically non-surgical with sling support for 4-6 weeks, though some active individuals may consider surgery
- Grades IV-VI: severe injuries with significant displacement in various directions and almost always require surgical repair to restore normal anatomy and function, as noted in the context of traumatic shoulder pain and injuries requiring acute surgical management 1 Key considerations in treatment include:
- Physical therapy is essential for all grades after the initial healing period to restore range of motion and strength
- Most patients with Grade I-III injuries recover full function with appropriate conservative management
- Higher grades have more variable outcomes even with surgery, highlighting the importance of individualized treatment plans and careful consideration of the risks and benefits of surgical intervention, particularly in the context of traumatic shoulder injuries and the potential for underreported cases of low-grade acromioclavicular separations 1
From the Research
Grades of Acromioclavicular Joint Separation
- The grades of Acromioclavicular (AC) joint separation are classified according to the Rockwood classification, which ranges from grade I (mild sprain) to grade VI (severe dislocation with displacement) 2
- Grade I-III injuries are generally considered low-grade, while grade IV-VI injuries are considered high-grade 2, 3
Treatment Options for AC Joint Separation
- Conservative management is recommended for grade I-III AC joint separations, which includes sling immobilization, early shoulder motion, and physical therapy 2, 3
- Surgical treatment is often proposed for grade III or higher injuries, but there is controversy surrounding the best method of treatment for grade III AC separations 4, 5
- High-grade (≥type IV) AC joint injuries typically require surgical management to achieve anatomic reduction of the AC joint, reconstruction of the coracoclavicular ligaments, and repair of the deltotrapezial fascia 3
- Non-operative reduction and stabilization of high-grade AC joint separations is also a valuable treatment option, using a "closed reduction and external fixation" approach with the aid of a dedicated AC joint brace 6
Factors Influencing Treatment Decisions
- The decision to treat grade III AC separations operatively or non-operatively may depend on factors such as type of sport, timing of injury relative to athletic season, or the throwing demands in an injured dominant arm 5
- Patient satisfaction and functional outcomes appear to be identical regardless of treatment used, but surgery may be considered for patients whose AC joint is painful 7 days after the injury and whose function has not improved 4