From the Research
Surgical repair of the ligaments is recommended for severe acromioclavicular (AC) joint dislocations, particularly for Rockwood type III and higher injuries, as it provides better early pain relief and superior coracoclavicular distance improvement, although it does not necessarily enhance long-term functional outcomes 1.
Key Considerations
- The management of AC joint dislocations should be individualized based on the severity of the injury, patient-specific factors, and activity level.
- Conservative management is typically preferred for lower-grade injuries (grades 1-3), while surgical intervention is often necessary for higher-grade dislocations (grades 4-6).
- The surgical approach involves repairing the torn coracoclavicular and acromioclavicular ligaments, often using suture anchors, tendon grafts, or synthetic materials to restore joint stability.
Post-Operative Care
- Patients should wear a sling for 4-6 weeks, followed by a progressive rehabilitation protocol starting with passive range of motion exercises at 2-3 weeks, advancing to active motion at 6 weeks, and strengthening exercises at 8-12 weeks.
- Full return to activities, especially overhead sports, typically requires 4-6 months.
Pain Management
- Pain management includes acetaminophen (1000mg every 6 hours) or NSAIDs like ibuprofen (400-600mg every 6-8 hours) for 1-2 weeks, with stronger options like tramadol (50mg every 6 hours) available for breakthrough pain.
Rationale
- Surgical repair is justified by the biomechanical importance of these ligaments in maintaining shoulder stability and function, particularly for physically active individuals who require overhead strength and stability 2.
- Without proper repair, chronic instability can lead to pain, weakness, and accelerated joint degeneration.
Recent Evidence
- A recent systematic review and meta-analysis of randomized controlled trials found that surgical treatment provided better early pain relief and superior coracoclavicular distance improvement, but did not improve long-term functional outcomes compared to conservative treatment 1.