From the Research
The surgical management of an acromioclavicular (AC) joint dislocation through ligament repair involves a systematic approach to restore joint stability, with the most recent and highest quality study 1 supporting the use of surgical treatment for Rockwood types V to VI, and recommending surgery for acute acromioclavicular dislocation within 3 weeks. The procedure begins with patient positioning in either the beach chair or lateral decubitus position under general anesthesia. After standard surgical preparation, a 5-7 cm incision is made over the AC joint, extending from the lateral aspect of the clavicle to the acromion. Soft tissue dissection follows to expose the AC joint and identify the torn coracoclavicular (CC) and AC ligaments. The distal clavicle is typically preserved unless severely damaged, as it contributes to horizontal stability. For the repair, high-strength sutures (such as #2 FiberWire) are passed under the coracoid process using specialized instruments. These sutures are then threaded through drill holes in the clavicle to anatomically reduce the AC joint. The torn AC ligament is repaired with direct suturing, and the deltotrapezial fascia is meticulously reconstructed to provide additional stability. Wound closure proceeds in layers, followed by application of a shoulder immobilizer. Postoperatively, patients maintain immobilization for 4-6 weeks, with passive range of motion exercises beginning at 2 weeks. Active motion starts at 6 weeks, with strengthening at 12 weeks and return to full activities by 4-6 months. Some key points to consider in the management of AC joint dislocation include:
- The importance of addressing both vertical and horizontal stability in the repair, as emphasized in the study by 2
- The use of arthroscopic techniques, which have been found to be less invasive and advantageous in diagnosing and treating accompanying lesions, as noted in the study by 3
- The recommendation for surgery within three weeks of the trauma for acute injuries, and the consideration of additional tendon augmentation for chronic injuries, as discussed in the study by 4
- The need for large-scale, prospective, randomized comparative studies to define a clear standard of treatment, as highlighted in the study by 4. Overall, the goal of surgical management is to restore optimal shoulder biomechanics and function, and to prevent chronic, painful limitation of shoulder function.