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Acromioclavicular Joint Injury
Posted: May 15 2020 #(C101461)
A

Acromioclavicular Joint Separation in 55M

HPI

A 55-year-old male presents with severe right shoulder pain and deformity following a high-speed motorcycle collision. He was initially treated with 6 weeks of conservative management with physical therapy. His pain persisted and remained severe.

PMH

Otherwise healthy

PE

His right shoulder shows a profound prominence, mobility, and tenderness over the distal clavicle. His range of motion is limited in all planes. He has reduced strength. His neurovascular status is intact.

Poll
1 of 13
1. Would you obtain additional imaging studies to guide management?
No - current radiographs are sufficient
51%
934/1821
Yes - additional radiographic views (aXR)
14%
265/1821
Yes - CT scan of the shoulder (CT)
5%
94/1821
Yes - MRI of the shoulder (MRI)
19%
353/1821
Yes - aXR + CT
1%
23/1821
Yes - aXR + MRI
4%
90/1821
Yes - aXR + CT + MRI
1%
23/1821
Outside my area of expertise - best if I don't vote
2%
39/1821
2. How would you classify this injury with the Rockwood Classification?
I would not - a classification system would not help me
1%
33/1809
Rockwood type II
2%
38/1809
Rockwood type III
39%
715/1809
Rockwood type IV
18%
338/1809
Rockwood type V
34%
627/1809
Outside my area of expertise - best if I don't vote
3%
58/1809
3. How would you manage this injury at this time?
Nonoperative (continued physical therapy)
10%
179/1752
Operative
87%
1528/1752
Outside my area of expertise - best if I don't vote
2%
45/1752
4. If you choose Operative management, what type of fixation would you perform to hold your AC reduction?
I would not choose Operative management
1%
32/1697
Fixation across AC joint (AC fixation) Alone
10%
178/1697
Fixation to the Coracoid (CC fixation) Alone
32%
546/1697
AC fixation + CC fixation
51%
868/1697
Outside my area of expertise - best if I don't vote
4%
73/1697
5. It you choose Fixation across AC joint Alone, what fixation technique would you use?
I would not choose Fixation across AC joint only
42%
675/1578
CRPP (Percutaneous K wire)
5%
94/1578
Hook plate
24%
390/1578
Heavy Suture Fixation across AC joint
10%
167/1578
Graft (auto or allo) across AC joint
11%
179/1578
Outside my area of expertise - best if I don't vote
4%
73/1578
6. If you choose Fixation to the Coracoid (+/- fixation across AC joint), what type would you use?
I would not choose Fixation to the Coracoid
4%
68/1541
Coracoclavicular Screw Fixation (Screw) (ex. Bosworth screw)
5%
89/1541
Synthetic implant (Heavy Suture, Trans-cortical device, Anchor)
30%
469/1541
Ligament reconstruction (allograft, autograft)
20%
314/1541
Screw + Ligament reconstruction
16%
247/1541
Synthetic implant + Ligament reconstruction
18%
280/1541
Outside my area of expertise - best if I don't vote
4%
74/1541
Other
0%
0/1541
7. If you choose Fixation to the Coracoid with a Synthetic implant, what fixation type would you use on the Coracoid?
I would not choose Fixation to the Coracoid with Software
10%
141/1361
Heavy Suture loop around Coracoid (e.g., suture tape, Fiberwire, Lockdown))
32%
445/1361
Trans-bicortical device (Dogbone, Cortical button, Juggernaut))
45%
617/1361
Trans-unicortical device (Suture anchor, Juggernaut)
5%
77/1361
Outside my area of expertise - best if I don't vote
5%
81/1361
8. If you choose Ligament reconstruction, what surgical approach would you use?
I would not choose Ligament reconstruction
13%
186/1364
All arthroscopic
4%
65/1364
Arthroscopic-assisted open
23%
324/1364
Open only
51%
708/1364
Outside my area of expertise - best if I don't vote
5%
81/1364
9. If you choose Ligament reconstruction, what type of graft would you use?
I would not choose Ligament reconstruction
15%
202/1324
Allograft
31%
423/1324
Autograft - palmaris longus
12%
161/1324
Autograft - semi-tendinosus
29%
394/1324
Autograft - plantaris
1%
22/1324
Autograft - other
2%
36/1324
Outside my area of expertise - best if I don't vote
6%
86/1324
10. If you choose Ligament reconstruction, what fixation techniques would you use on the Coracoid and Clavicle?
I would not choose Ligament reconstruction
12%
143/1169
Coracoid loop + Clavicle loop (figure of eight)
15%
186/1169
Coracoid loop + Clavicle bone tunnel(s)
24%
292/1169
Coracoid loop + Clavicle cortical device to graft (cortical button)
11%
133/1169
Coracoid cortical device to graft (suture anchor) + Clavicle loop
3%
40/1169
Coracoid cortical device to graft + Clavicle bone tunnel(s)
6%
78/1169
Coracoid cortical device to graft + Clavicle cortical device to graft
2%
31/1169
Coracoid bone tunnel(s) + Clavicle loop
1%
22/1169
Coracoid bone tunnel(s) + Clavicle bone tunnel(s)
6%
80/1169
Coracoid bone tunnel(s) + Clavicle cortical device to Graft
1%
22/1169
Outside my area of expertise - best if I don't vote
12%
142/1169
11. If you choose Ligament reconstruction, in addition to graft fixation on the coracoid and clavicle, would you extend fixation of the graft to the acromium?
I would not choose Ligament reconstruction
13%
152/1104
No
42%
473/1104
Yes
35%
388/1104
Outside my area of expertise - best if I don't vote
8%
91/1104
12. If you choose Ligament reconstruction, would you include a distal clavicle resection?
I would not choose Ligament reconstruction
8%
95/1135
No - never
14%
166/1135
Yes - only if pre-existing arthritis
20%
228/1135
Yes - only if irreducible
6%
77/1135
Yes - if irreducible OR pre-existing arthritis
27%
314/1135
Yes - always
16%
182/1135
Outside my area of expertise - best if I don't vote
6%
73/1135
13. If you choose Ligament reconstruction, and obtained the fixation seen below, when would you start active ROM?
I would not choose Ligament reconstruction
6%
75/1124
Immediately
3%
37/1124
3 days post-op
2%
26/1124
7 days post-op
3%
37/1124
2 weeks post-op
11%
130/1124
3 weeks post-op
10%
123/1124
4 weeks post-op
15%
177/1124
6 weeks post-op
34%
388/1124
>6 weeks post-op
6%
74/1124
Outside my area of expertise - best if I don't vote
5%
57/1124
PROCEDURE #1

Diagnostic arthroscopy of the R shoulder; Open AC/CC reconstruction with allograft; Distal clavicle resection

Intra-procedure P1
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OUTCOMES
Post-procedure P1
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