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Current Management of Type III AC Separation

Over the years, many changes have occurred in the treatment of acromioclavicular (AC) separation. In this report, the current management of this condition is reviewed.

AC separation occurs as a result of trauma causing a rupture of the ligaments that hold the clavicle (collarbone) to the acromion. The acromion is a piece of bone that's part of the shoulder blade. It curves around over the top of the shoulder and attaches to the clavicle to form the AC joint.

A type III complete separation is actually a dislocation of the AC joint. This occurs when the ligaments, joint capsule, and connective tissue are all ruptured. Usually a traumatic accident or sports injury is the cause of the rupture.

To find out how orthopedic surgeons treat this condition, the authors mailed surveys to surgeons treating college and professional athletes. Results were compared to a similar collection of data in 1974, 1992, and 1997.

Thirty years ago, surgery was the preferred treatment for a type III AC separation. Only about 10 per cent of the surgeons reported a nonoperative approach at that time. Today, most surgeons prefer conservative care. An AC immobilizer (sling) is used most often to reduce the dislocation.

A shift in the type of surgery done has also taken place. Many surgeons reconstruct the torn ligament by using a tendon graft. Others choose to repair the damage. Tape, screws, wires, and pins are popular repair methods. Future treatment will likely be influenced by improved graft materials.

References: Carl W. Nissen, MD, and Abhishek Chatterjee, BA. Type III Acromioclavicular Separation: Results of a Recent Survey on Its Management. In American Journal of Orthopedics. February 2007. Vol. 36. No. 2. Pp. 89-93.

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