Upper extremity: Acromioclavicular joint injuries

Acromioclavicular joint injuries are very common. Despite extensive study regarding treatment of these injuries, controversies remain. It is relatively well established that acute type I and II injuries are treated symptomatically, while types IV, V, and VI injuries generally require surgery. The appropriate management of acute type III injuries remains elusive, as many patients do well with nonoperative management, but others have residual pain or shoulder dysfunction. The optimal choice for surgical treatment of the dislocated acromioclavicular joint also has not yet been established. Many recent studies have focused on more anatomic reconstruction of the coracoclavicular and acromioclavicular ligaments. Biomechanical studies have shown this to be an improvement, but failures and complications continue to be a problem in most surgical series. This review attempts to give a brief historical overview of acromioclavicular joint injuries, options for nonoperative and operative treatment, and recent literature updates on reconstruction of the coracoclavicular and acromioclavicular ligaments.