Diagnosis and Treatment of Acute Acromioclavicular Joint Injuries


Sports Clinic Cologne, Department of Sports Traumatology, Cologne Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany



Acute acromioclavicular joint (ACJ) dislocations are very common in young and active adults. Despite the high incidence of this injury, there is still some controversy on its diagnosis and treatment.

Evidence Acquisition
This review was based on the knowledge of the current literature listed in PubMed. It summarizes the current strategies for acute AC joint injuries.

Acute injuries of the AC joint are very common among active individuals. Most authors recommend panorama- (stress-) view radiographs and additional radiographs for the horizontal instability. Low-grade injuries (Rockwood I-II) should be treated conservatively whereas high-grade injuries (Rockwood IV-VI) are best treated surgically. The most appropriate treatment for Rockwood III injuries is still a matter of debate and should be recommended based on the individual needs of the patient.

Based on the current literature, there still is no gold standard for the diagnosis of acute AC joint injuries. As surgical techniques, the hook plate as well as the arthroscopic button techniques are commonly used leading to good and reproducible results. However, evidence of the superiority of these techniques over alternative methods is lacking.


1. Balke M, Schneider MM, Akoto R, Bathis H, Bouillon B, Banerjee M. Acute acromioclavicular joint injuries. Changes in diagnosis and therapy over the last 10 years [in German]. Unfallchirurg. 2015;118(10):851–7. doi: 10.1007/s00113-013-2547-2. [PubMed: 24408200].
 2. Bannister GC, Wallace WA, Stableforth PG, Hutson MA. The management of acute acromioclavicular dislocation. A randomised prospective controlled trial. J Bone Joint Surg Br. 1989;71(5):848–50. [PubMed: 2684990].
 3. Imatani RJ, Hanlon JJ, Cady GW. Acute, complete acromioclavicular separation. J Bone Joint Surg Am. 1975;57(3):328–32. [PubMed: 1123385]. 4. Larsen E, Bjerg-Nielsen A, Christensen P. Conservative or surgical treatment of acromioclavicular dislocation: A prospective, controlled, randomized study. J Bone Joint Surg Am. 1986;68(4):552–5. [PubMed: 3514625].
 5. Bathis H, Tingart M, Bouillon B, Tiling T. Conservative or surgical therapy of acromioclavicular joint injury–what is reliable? A systematic analysis of the literature using "evidence-based medicine" criteria [in German]. Chirurg. 2000;71(9):1082–9. [PubMed: 11043125].
 6. Phillips AM, Smart C, Groom AF. Acromioclavicular dislocation. Conservative or surgical therapy. Clin Orthop Relat Res. 1998(353):10–7. [PubMed: 9728155].
7. Taft TN, Wilson FC, Oglesby JW. Dislocation of the acromioclavicular joint. An end-result study. J Bone Joint Surg Am. 1987;69(7):1045–51. [PubMed: 3654696].
8. Gstettner C, Tauber M, Hitzl W, Resch H. Rockwood type III acromioclavicular dislocation: surgical versus conservative treatment. J Shoulder Elbow Surg. 2008;17(2):220–5. doi: 10.1016/j.jse.2007.07.017. [PubMed: 18249565].
 9. Beitzel K, Cote MP, Apostolakos J, Solovyova O, Judson CH, Ziegler CG, et al. Current concepts in the treatment of acromioclavicular joint dislocations. Arthroscopy. 2013;29(2):387–97. doi: 10.1016/j.arthro.2012.11.023. [PubMed: 23369483].
 10. Cox JS. Current method of treatment of acromioclavicular joint dislocations. Orthopedics. 1992;15(9):1041–4. [PubMed: 1437863].
 11. Powers JA, Bach PJ. Acromioclavicular separations. Closed or open treatment? Clin Orthop Relat Res. 1974(104):213–23. [PubMed: 4411824]. 12. Bathis H, Tingart M, Bouillon B, Tiling T. The status of therapy of acromioclavicular joint injury. Results of a survey of trauma surgery clinics in Germany[in German]. Unfallchirurg. 2001;104(10):955–60. [PubMed: 11699305].
 13. Rosslenbroich S, Wellmann M, Raschke MJ, Zantop T, Petersen W. Minimalinvasive Akromioklavikulargelenk-Rekonstruktion (MINAR). Obere Extremitat. 2009;4(3):154–9. doi: 10.1007/s11678-009-0036- 6.
 14. Elser F, Chernchujit B, Ansah P, Imhoff AB. [A new minimally invasive arthroscopic technique for reconstruction of the acromioclavicular joint]. Unfallchirurg. 2005;108(8):645–9. doi: 10.1007/s00113-005-0933- 0. [PubMed: 15915362].
 15. Kraus N, Scheibel M. Treatment of acute acromioclavicular joint instability with modern reconstruction procedures [in German]. Unfallchirurg. 2012;115(10):872–8. doi: 10.1007/s00113-012-2248-2. [PubMed: 23007123].
 16. Balke M, Schneider MM, Shafizadeh S, Bathis H, Bouillon B, Banerjee M. Current state of treatment of acute acromioclavicular joint injuries in Germany: is there a difference between specialists and non-specialists? A survey of German trauma and orthopaedic departments. Knee Surg Sports Traumatol Arthrosc. 2015;23(5):1447–52. doi: 10.1007/s00167-013-2795-2. [PubMed: 24306123].
 17. Riand N, Sadowski C, Hoffmeyer P. [Acute acromioclavicular dislocations]. Acta Orthop Belg. 1999;65(4):393–403. [PubMed: 10675933]. 18. Daly PJ, Sim FH, Simonet WT. Ice hockey injuries. A review. Sports Med. 1990;10(2):122–31. [PubMed: 2204098].
 19. Sage FP, Salvatore JE. Injuries of the acromioclavicular joint: a study of results in 96 patients. South Med J. 1963;56:486–95. [PubMed: 13976050].
 20. Webb J, Bannister G. Acromioclavicular disruption in first class rugby players. Br J Sports Med. 1992;26(4):247–8. [PubMed: 1490217].
 21. Dias JJ, Gregg PJ. Acromioclavicular joint injuries in sport. Recommendations for treatment. Sports Med. 1991;11(2):125–32. [PubMed: 2017605].
 22. Rowe CR. Acute and recurrent dislocations of the shoulder. J Bone Joint Surg Am. 1962;44-A:998–1008. [PubMed: 14038813].
 23. Weaver JK. Skiing-related injuries to the shoulder.Clin Orthop Relat Res. 1987(216):24–8. [PubMed: 3815953].
 24. Kocher MS, Dupre MM, Feagin JAJ. Shoulder injuries from alpine skiing and snowboarding. Aetiology, treatment and prevention. Sports Med. 1998;25(3):201–11. [PubMed: 9554030].
 25. Kocher MS, Feagin JAJ. Shoulder injuries during alpine skiing. Am J Sports Med. 1996;24(5):665–9. [PubMed: 8883689].
 26. Headey J, Brooks JH, Kemp SP. The epidemiology of shoulder injuries in English professional rugby union. Am J Sports Med. 2007;35(9):1537– 43. doi: 10.1177/0363546507300691. [PubMed: 17452514].
 27. Stuart MJ, Smith A. Injuries in Junior A ice hockey. A three-year prospective study. Am J Sports Med. 1995;23(4):458–61. [PubMed: 7573657].
 28. Cadenat FM. The treatment of dislocations and fractures of the outer end of the clavicle. Int Clin. 1917;1:145–69.
 29. Tossy JD, Mead NC, Sigmond HM. Acromioclavicular separations: useful and practical classification for treatment. Clin Orthop Relat Res. 1963;28:111–9. [PubMed: 5889033].
 30. Rockwood CA. Injuries to the acromioclavicular joint. In: Rockwood CA, Green DP, editors. Fractures in adults. 2 ed. Philadelphia: JB Lippincott; 1984. pp. 860–910.
 31. Schneider MM, Balke M, Koenen P, Frohlich M, Wafaisade A, Bouillon B, et al. Inter- and intraobserver reliability of the Rockwood classifi- cation in acute acromioclavicular joint dislocations. Knee Surg Sports Traumatol Arthrosc. 2016;24(7):2192–6. doi: 10.1007/s00167-014-3436-0. [PubMed: 25399347].
32. Scheibel M, Droschel S, Gerhardt C, Kraus N. Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations. Am J Sports Med. 2011;39(7):1507–16. doi: 10.1177/0363546511399379. [PubMed: 21436458].
 33. Alexander OM. Radiography of the acromioclavicular articulation. Med Radiogr Photogr. 1954;30(2):34–9. [PubMed: 13202745].
 34. Zanca P. Shoulder pain: involvement of the acromioclavicular joint. (Analysis of 1,000 cases). Am J Roentgenol Radium Ther Nucl Med. 1971;112(3):493–506. [PubMed: 5570359].
35. Bucholz RW, Heckmann JD. Acromioclavicular joint injuries. In: Bucholz RW, Heckmann JD, Rockwood CA, Green DP, editors. Rockwood and Green’s fractures in adults. Philadelphia: Lippincott Williams and Wilkins; 2001. p. 1210–44.
36. Tauber M. Management of acute acromioclavicular joint dislocations: current concepts. Arch Orthop Trauma Surg. 2013;133(7):985–95. doi: 10.1007/s00402-013-1748-z. [PubMed: 23632779].
 37. Barnes CJ, Higgins LD, Major NM, Basamania CJ. Magnetic resonance imaging of the coracoclavicular ligaments: its role in defining pathoanatomy at the acromioclavicular joint. J Surg Orthop Adv. 2004;13(2):69–75. [PubMed: 15281402].
38. Antonio GE, Cho JH, Chung CB, Trudell DJ, Resnick D. Pictorial essay. MR imaging appearance and classification of acromioclavicular joint injury. AJR Am J Roentgenol. 2003;180(4):1103–10. doi: 10.2214/ajr.180.4.1801103. [PubMed: 12646463].
39. Schaefer FK, Schaefer PJ, Brossmann J, Hilgert RE, Heller M, Jahnke T. Experimental and clinical evaluation of acromioclavicular joint structures with new scan orientations in MRI. Eur Radiol. 2006;16(7):1488–93. doi: 10.1007/s00330-005-0093-1. [PubMed: 16435136]. 40. Alyas F, Curtis M, Speed C, Saifuddin A, Connell D. MR imaging appearances of acromioclavicular joint dislocation. Radiographics. 2008;28(2):463–79. doi: 10.1148/rg.282075714. [PubMed: 18349451] quiz 619.
41. Varney JH, Coker JK, Cawley JJ. Treatment of acromioclavicular dislocation by means of a harness. J Bone Joint Surg Am. 1952;34-A(1):232–3. [PubMed: 14907812].
 42. Spigelman L. A harness for acromioclavicular separation. J Bone Joint Surg Am. 1969;51(3):585–6. [PubMed: 5781592].
43. Darrow JCJ, Smith JA, Lockwood RC. A new conservative method for treatment of Type III acromioclavicular separations. Orthop Clin North Am. 1980;11(4):727–33. [PubMed: 7454243].
 44. Urist MR. Complete dislocations of the acromiclavicular joint; the nature of the traumatic lesion and effective methods of treatment with an analysis of forty-one cases. J Bone Joint Surg Am. 1946;28(4):813–37. [PubMed: 21003194].
 45. Mouhsine E, Garofalo R, Crevoisier X, Farron A. Grade I and II acromioclavicular dislocations: results of conservative treatment. J Shoulder Elbow Surg. 2003;12(6):599–602. doi: 10.1016/S1058274603002155. [PubMed: 14671526].
46. Mikek M. Long-term shoulder function after type I and II acromioclavicular joint disruption. Am J Sports Med. 2008;36(11):2147–50. doi: 10.1177/0363546508319047. [PubMed: 18583520].
47. Balser D. Eine neue Methode zur operativen Behandlung der akromioklavikularen Luxation. Chir Prax. 1976;24:275–81.
48. Kienast B, Thietje R, Queitsch C, Gille J, Schulz AP, Meiners J. Mid-term results after operative treatment of rockwood grade III-V acromioclavicular joint dislocations with an AC-hook-plate. Eur J Med Res. 2011;16(2):52–6. [PubMed: 21463981].
49. Salem KH, Schmelz A. Treatment of Tossy III acromioclavicular joint injuries using hook plates and ligament suture. J Orthop Trauma. 2009;23(8):565–9. doi: 10.1097/BOT.0b013e3181971b38. [PubMed: 19704271].
50. Di Francesco A, Zoccali C, Colafarina O, Pizzoferrato R, Flamini S. The use of hook plate in type III and V acromio-clavicular Rockwood dislocations: clinical and radiological midterm results and MRI evaluation in 42 patients. Injury. 2012;43(2):147–52. doi: 10.1016/j.injury.2011.04.002. [PubMed: 21592473].
51. Chiang CL, Yang SW, Tsai MY, Kuen-Huang Chen C. Acromion osteolysis and fracture after hook plate fixation for acromioclavicular joint dislocation: a case report. J Shoulder Elbow Surg. 2010;19(4):13–5. doi: 10.1016/j.jse.2009.12.005. [PubMed: 20303294].
52. Wolf EM, Pennington WT. Arthroscopic reconstruction for acromioclavicular joint dislocation. Arthroscopy. 2001;17(5):558–63. doi: 10.1053/jars.2001.23578. [PubMed: 11337730].
53. Zooker CC, Parks BG, White KL, Hinton RY. TightRope versus fiber mesh tape augmentation of acromioclavicular joint reconstruction: a biomechanical study. Am J Sports Med. 2010;38(6):1204–8. doi: 10.1177/0363546509359064. [PubMed: 20392969].
54. Klimkiewicz JJ, Williams GR, Sher JS, Karduna A, Des Jardins J, Iannotti JP. The acromioclavicular capsule as a restraint to posterior translation of the clavicle: a biomechanical analysis. J Shoulder Elbow Surg. 1999;8(2):119–24. [PubMed: 10226962].
55. Petersen W, Wellmann M, Rosslenbroich S, Zantop T. Minimally Invasive Acromioclavicular Joint Reconstruction (MINAR) [in German]. Oper Orthop Traumatol. 2010;22(1):52–61. doi: 10.1007/s00064-010- 3004-4. [PubMed: 20349170].
56. Tischer T, Salzmann GM, El-Azab H, Vogt S, Imhoff AB. Incidence of associated injuries with acute acromioclavicular joint dislocations types III through V. Am J Sports Med. 2009;37(1):136–9. doi: 10.1177/0363546508322891. [PubMed: 18725652].
57. Pauly S, Kraus N, Greiner S, Scheibel M. Prevalence and pattern of glenohumeral injuries among acute high-grade acromioclavicular joint instabilities. J Shoulder Elbow Surg. 2013;22(6):760–6. doi: 10.1016/j.jse.2012.08.016. [PubMed: 23021905].
58. Jensen G, Katthagen JC, Alvarado LE, Lill H, Voigt C. Has the arthroscopically assisted reduction of acute AC joint separations with the double tight-rope technique advantages over the clavicular hook plate fixation? Knee Surg Sports Traumatol Arthrosc. 2014;22(2):422–30. doi: 10.1007/s00167-012-2270-5. [PubMed: 23124627].