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Acromioclavicular Joint Repair and Reconstruction: Anatomic Considerations and Technical Tips
Various surgical methods for managing AC joint injuries have been reported in the literature. Rockwood was the first to note that most of these surgical techniques are simple variations and combinations of previously described procedures. In an effort to simplify decision making, Rockwood classified these procedures into four categories: AC repair, CC repair, distal clavicle excision, and dynamic muscle transfer. Type I (AC sprain) and type II (AC torn, CC sprain; reducible) AC separations typically are managed nonsurgically, type III (AC and CC torn; reducible) separations are managed on a case-by-case basis, and type IV through VI injuries are managed surgically because of the severity of soft-tissue damage and the substantial morbidity of a persistently dislocated AC joint. It is generally agreed that type III injuries should be managed nonsurgically for 8 to 12 weeks, after which the patient should be examined for residual pain and/or dysfunction. are managed surgically because of the severity of soft-tissue damage and the substantial morbidity of a persistently dislocated AC joint. It is generally agreed that type III injuries should be managed nonsurgically for 8 to 12 weeks, after which the patient should be examined for residual pain and/or dysfunction. In addition to the lack of a single preferred surgical technique to manage AC joint injury, there is also uncertainty regarding surgical versus nonsurgical management, early versus delayed management, anatomic versus nonanatomic repair, and arthroscopic versus open repair. This chapter reviews the controversies, alternative approaches, and outcomes for AC joint repair. Technical keys for successful repair and reconstruction, as well as recommended rehabilitation protocols are also presented.