Anatomic Acromioclavicular Joint Reconstruction

Patient Selection

TABLE 1

Rockwood Classification of Acromioclavicular Joint Injuries

Type	AC Ligaments	CC Ligaments	Delto-pectoral Fascia	Radio-graphic CC Distance Increase	Radio-graphic AC Appearance	AC Joint Reducible?
I	Sprained	Intact	Intact	Normal (1.1-1.3 cm)	Normal	N/A
II	Disrupted	Sprained	Intact	<25%	Widened	Yes
III	Disrupted	Disrupted	Disrupted	25%-100%	Widened	Yes
IV	Disrupted	Disrupted	Disrupted	Increased	Posterior clavicle displacement	No
V	Disrupted	Disrupted	Disrupted	100% to 300%	N/A	No
VI	Disrupted	Intact	Disrupted	Decreased	N/A	No

Acromioclavicular (AC) joint injuries are common; they account for up to half of all athletic shoulder injuries.
Typically due to a direct fall onto an adducted shoulder with the acromion displaced inferiorly and medially with respect to the clavicle
Presentation—Local swelling, prominent distal clavicle, and AC joint pain with palpation and cross-body adduction or abduction
In high-energy injuries, suspect associated injuries to the clavicle, scapula, proximal humerus, and neurovascular structures.
AC joint separations are classified by the Rockwood classification system (Table 1).

Type IV, V, and VI separations represent high-energy mechanisms of injury and associated soft-tissue disruption.
- Type IV—Posterior displacement of the clavicle through the trapezius
- Type V—Detachment of the deltoid, trapezius, and fascia or the dynamic stabilizers of the AC joint from the clavicle
- Type VI—A rare inferior displacement of the clavicle under the coracoid with associated brachial plexus and shoulder girdle fractures
Type III—Represents injuries to both the AC joint capsule and the coracoclavicular ligaments, resulting in horizontal and vertical instability.
- Surgical treatment is typically reserved for patients who have persistent pain after a 3-month trial of nonsurgical treatment.
- A relative indication is a sport or job that places a high demand on the shoulder.

Axillary lateral view (for type IV injury [Figure 1])
Zanca view (10° to 15° cephalic tilt) with arm unsupported
Contralateral views may be helpful to compare injury with uninjured shoulder.
Stryker notch view if coracoid fracture is suspected but not visualized on other films.

May 13, 2023 | Posted by admin in Uncategorized | Comments Off