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Anatomic Acromioclavicular Joint Reconstruction
Acromioclavicular (AC) joint injuries are common injuries that account for as many as half of all athletic shoulder injuries. The most frequent mechanism of AC joint separation is a direct fall onto an adducted shoulder. The forces transmitted often result in inferior and medial displacement of the acromion while the clavicle remains stabilized to the bony thorax through the sternoclavicular joint. Patients may present with local swelling, apparent deformity with prominence of the distal clavicle, pain over the AC joint, and accentuation of pain with cross-body adduction or abduction. The stability of an AC joint separation on physical examination may also be assessed, with the ability to reduce depending on the acuity of the injury and the severity of soft-tissue injuries. In higher-energy injuries, associated injuries to the clavicle, scapula, proximal humerus, and neurovascular structures such as the brachial plexus should be assessed. AC joint separations are often classified by the Rockwood classification scheme, which usually dictates the treatment options. Type I injuries, where there is no appreciable deformity of the AC joint, and type II injuries, where there may be disruption of the AC joint capsule but not of the coracoclavicular ligaments and thus no vertical instability, are almost uniformly treated nonsurgically.