Acromioclavicular joint injury treatment

Video Description

- Acromioclavicular joint injury acounts for About 9% of shoulder girdle injuries.

-Acromioclavicular joint anatomy: Diarthrodial joint comprising the lateral end of clavicle and anteromedial part of acromion.
-Acromioclavicular joint biomechanics and motion: 5% of clavicular rotation occurs at AC joint
- Stability of AC joint:Static: joint configuration, fibrous capsule, acromioclavicular ligament, coracoclavicular ligament / Dynamic : Deltoid, Trapezius
-AC ligament: superior ligament is strongest, followed by posterior
provides horizontal stability = anteroposterior translation
-Trapezoid ligament originates from anterolateral position on the coracoid and inserts broadly at the trapezoid line on the inferior clavicle 3cm from the AC joint.
-Conoid ligament originates more posteromedial on the angle of the coracoid and insert on the conoid tubercle just posteromedial to the trapezoid insertion 4.5cm from the AC joint.
-Normal values for AC and CC distance range from 1 to 3 mm (in zanca) and 1.1 to 1.3 cm (in AP). respectively
AC joint width of 7 mm in men and 6 mm in women is pathologic.
-PATHOPHYSIOLOGY of acromioclavicular:direct trauma and
indirect injury

-NATURAL HISTORY of ac joint: the role is non operative for I,II,III and operative for IV,V,VI
-Allman and Rockwood Classification of acromioclavicular joint
-Pseudodislocations which result from epiphyseal separation or distal clavicle fracture in children or young adults, can mimic the appearance of AC dislocation.
-Clinical Assessment:The injured AC+- CC is swollen and tender.
Abrasions over the superolateral area of the shoulder. If a visual or palpable step-off exists, or the distal clavicle feels unstable, then there is at least a type II injury. piano key" sign.O'Brien active compression test and The Scarf test

-Acromioclavicular joint Imaging:Routine imaging for the evaluation of the AC joint includes anteroposterior (AP), lateral axillary. and Zanca views. (comparison views)
The AP view identifies the amount of vertical displacement of the clavicle, whereas the axillary view identifies the extent of horizontal (anterior and posterior) displacement of the distal clavicle. as well as anatomical variations of the AC facets.
Zanca: It is obtained by tilting the radiographic beam 10 to 15 degrees cephalad and AP-axial= stryker notch


-Acromioclavicular joint Indications for Nonoperative Treatment: Rockwood type I and II AC injuries should be treated nonoperatively with the expectation of excellent short- to midterm results. In the event that late, symptomatic AC arthrosis occurs, elective distal clavicle excision can predictably relieve pain and restore function.
Type III AC dislocations, though some authors believe that the overhead throwing athlete and manual laborer should undergo reconstruction.
and include sling and physiotheraby

-Acromioclavicular joint Indications for Surgical Treatment IV to VI AC injuries to prevent chronic dysfunction and pain.
Operative interventions can be broadly divided into AC joint stabilization using hook plates, pins, or K-wires
CC space stabilization using Tightrope or Dog Bone Button Fixation
Ligament reconstruction: CC ligament and/or AC ligament reconstruction using autograft or allograft
Dynamic muscle transfer (proximally based conjoint tendon transfer)
Hook plate rigid fixation
generally require second surgery for plate removal
acromial erosion
Dog Bone Button Fixation The Dog Bone Button is a precontoured titanium button that allows the use of multiple FiberTapes for AC joint reduction.
Tightrope

-Bosworth CC screw fixation

-Modified Weaver-Dunn