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Update on the Treatment of AC Shoulder Separations

Thanks to the availability of arthroscopic surgery, the surgical treatment of acromioclavicular (AC) separation is changing. The AC joint is where the end of the collar bone (clavicle) meets the acromion. The acromion is a bony projection from the shoulder blade. It curves around over the top of the humerus (upper arm) where the humerus sits in the shoulder socket.

Injury to this site can cause a rupture of the ligament holding the two bones together. This is called a shoulder or AC joint separation.Less invasive methods are being developed for this problem. In this article, orthopedic surgeons specializing in shoulders review the latest techniques for the treatment of AC joint separations.

Most surgeons agree that nonoperative treatment is still the best plan whenever possible. Surgery may be needed for more severe injuries. When needed, early operative treatment has the best results. Athletes may opt for surgery if the injury occurs at the end of the season. This will help get them back to play for the next season.

The authors review three types of operations that can be done for AC separations. The first is the one used most often. It's called the Weaver-Dunn reconstruction. This involves the transfer of a ligament to repair the problem.

The second operation uses a piece of tendon looped around and tied in placed or placed through a tunnel cut in the bone. The third method of operative repair is with the use of an endbutton to put the clavicle back in place and hold it there while it heals. This works better than the old method using wires or screws. It holds better with fewer problems during healing.

Specific information about how to do each procedure is included in this article. Studies have not been done to compare all three methods. A few studies have compared two of the surgical methods.

None of the operations described restore the AC joint. In cases where pain persists, it may be necessary to remove the end of the clavicle. Arthroscopic methods are less invasive but they cost more. And it's not clear that the results are any better than open repair. More research is needed in this area.

References: Steven J. Klepps and David W. Shenton. Current Treatment of Acromioclavicular Separations. In Current Opinion in Orthopaedics. July 2007. Vol. 18. No. 4. Pp. 373-379.

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