Conservative treatment of injuries of the acromioclavicular joint: Possibilities and limits

Abstract

Low-grade acromioclavicular joint (ACJ) injuries (Rockwood grades I and II) can be treated conservatively in most cases with a good outcome. There is no method of immobilization that has been shown to be superior. Higher grade injuries (grades IV and V) that result in relevant instability and often subsequent dyskinesia of the scapulothoracic rhythm benefit from surgical reconstruction. There is no consensus for grade III injuries despite broad academic discussion. Long-term studies and meta-analyses showed no benefits of a surgical intervention over conservative treatment after 1–2 years, whereas individual case series showed benefits in anatomic reconstruction, especially when outcome scores specific for the ACG were used. In borderline cases the individual work and sports profile, especially regular overhead activity, should be considered in therapeutic decision making. In both low-grade and high-grade injuries of the ACJ, using focused therapy to improve scapulothoracic mobility and stability, scapular dyskinesia can be prevented or successfully treated in many cases (occasionally in ≥ grade III according to Rockwood).