Acromioclavicular joint (ACJ) dislocations represent the most frequent injuries of the shoulder girdle among athletes. Low grade injuries are more common than high grade injuries. Possible injury mechanisms are either a direct trauma to the shoulder or a fall on an adducted elbow with indirect trauma to the ACJ.
Accurate radiological diagnostics, including stress recordings for detection of a horizontal instability component are of utmost importance and allow correct classification of the ACJ injury.
Most ACJ injuries can be treated non-operatively with short-term immobilization, oral analgesia therapy and pain-oriented functional physiotherapeutic treatment. In principle, surgical indications are high grade injuries in the sense of Rockwood dislocations types IV and V; however, individual factors, such as the type of sport, handedness, career perspectives and economic aspects have to be involved in the decision-making process, particularly in professional athletes. Acute ACJ dislocations are treated arthroscopically including coracoclavicular and additional acromioclavicular stabilization in cases of horizontal instability. Chronic ACJ dislocations require coracoclavicular ligament reconstruction using autologous semitendinosus tendon grafting.
After relatively restrictive postoperative care including a 6-week immobilization period, competitive sport is normally possible after 3-4 months in cases of acute injury and after 6 months in cases of chronic injury.
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