Elsevier

Journal of Shoulder and Elbow Surgery

Volume 12, Issue 6, November–December 2003, Pages 599-602
Journal of Shoulder and Elbow Surgery

Original article
Grade I and II acromioclavicular dislocations: results of conservative treatment

https://doi.org/10.1016/S1058-2746(03)00215-5Get rights and content

Abstract

The purpose of this study was to assess the results of acute grade I and II acromioclavicular (AC) joint sprains treated by conservative measures. Between 1993 and 1997, 37 consecutive patients were treated conservatively for AC joint sprains, grade I and II in the Tossy classification. Of these patients, 4 were excluded (three lost to follow-up and one sustained a further AC injury), leaving a series of 33 patients. Among them, in 9 (27%), chronic AC joint pathology that required subsequent surgery developed at a mean of 26 months after injury. The remaining 24 were reviewed clinically and radiologically at a mean of 6.3 years (range, 4-8 years) after injury. At the latest follow-up, 17 of the 33 patients (52%) remained asymptomatic. Of the 24 patients reviewed, 7 complained of activity-related pain. Eight patients presented with residual anteroposterior instability. Tenderness at the AC joint as well as a positive cross-body test was observed in 12 patients. The mean Constant score at follow-up was 82 points. The x-ray films showed degenerative changes in 13 patients, ossification of the coracoclavicular ligaments in 2, an association of degenerative changes with ossification of the coracoclavicular ligaments in 3, and distal clavicular osteolysis in 3. Only 4 cases had no radiographic changes after this kind of AC injury. On the basis of these results, we conclude that the severity of the consequences after grade I and II AC sprains is underestimated.

Section snippets

Materials and methods

Thirty-seven consecutive patients were treated at our institution between 1993 and 1997 for an acute grade I and II AC joint sprain. Of these patients, 4 were excluded (3 were lost to follow-up and 1 sustained a further AC injury), leaving a series of 33 patients (16 patients with grade I AC sprain and 17 patients with grade II). The mean age at the time of trauma was 25 years (range, 23-32 years). Of the patients, 29 (85%) were athletes, and trauma occurred in 29 (of the 33) (85%) during

results

The results are summarized in Table II. Between the accident and the last follow-up, 9 of 33 patients (27%) (7 grade II and 2 grade I) required surgery. Isolated open distal clavicle resection was performed in 6 cases, 4 times for osteoarthrosis (1 grade I and 3 grade II AC joint sprains) and 2 times for a painful osteolysis of the distal clavicle (1 grade I and 1 grade II AC joint sprains). In 3 cases a transposition of the medial half of the coracoacromial ligaments on the distal clavicle was

Discussion

Our study revealed a surprisingly high rate of complications (need for further surgery, pain, radiographic changes) after grade I and II AC joint sprain treated conservatively. This is in contradiction with the current literature, which suggests that grade I and II AC sprains have a good prognosis, although percentages are not reported, and are not associated with joint instability.1, 15 Many authors advise conservative treatment12, 14, 15, 16, 17, 21, 24, 28 with nonsteroidal antiinflammatory

References (30)

  • L.U. Bigliani et al.

    Arthroscopic resection of the distal clavicle

    Orthop Clin North Am

    (1993)
  • H.D. Clarke et al.

    Acromioclavicular joint injuries

    Orthop Clin North Am

    (2000)
  • F.L. Allman

    Fractures and ligamentous injuries of the clavicle and its articulation

    J Bone Joint Surg Am

    (1967)
  • J.E. Bateman

    Athletic injuries about the shoulder in throwing and body contact sports

    Clin Orthop

    (1962)
  • J.A. Bergfeld et al.

    Evaluation of the acromioclavicular joint following first- and second-degree sprains

    Am J Sports Med

    (1978)
  • C.R. Constant et al.

    A clinical method of functional assessment of the shoulder

    Clin Orthop

    (1987)
  • J.S. Cox

    The fate of the acromioclavicular joint in athletic injuries

    Am J Sports Med

    (1981)
  • K. Fukuda et al.

    Biomechanical study of the ligamentous system of the acromioclavicular joint

    J Bone Joint Surg Am

    (1986)
  • J.M. Glick et al.

    Dislocation acromioclavicular jointfollow-up study of 35 unreduced acromioclavicular dislocations

    Am J Sports Med

    (1977)
  • A. Hedtmann et al.

    Management of old neglected posttraumatic acromioclavicular joint instability and arthrosis

    Orthopade

    (1998)
  • M.J. Lemos

    The evaluation and treatment of the injured acromioclavicular joint in athletes

    Am J Sports Med

    (1998)
  • B. Madsen

    Osteolysis of the acromial end of the clavicle following trauma

    Br J Radiol

    (1963)
  • G.W. Nuber et al.

    Acromioclavicular joint injuries and the distal clavicle fractures

    J Am Acad Orthop Surg

    (1997)
  • Nuber GW, Bowen MK. Disorders of the acromioclavicular joint: pathophysiology, diagnosis, and management. In: Iannotti...
  • Cited by (134)

    • The Acromioclavicular Joint

      2022, Skeletal Trauma of the Upper Extremity
    View all citing articles on Scopus
    View full text