Disorders of the acromioclavicular joint

Our understanding of the biomechanics of the acromioclavicular (AC) joint continues to evolve, and treatment methods, both conservative and surgical, continue to be refined. Controversy over the ideal treatment for a type III AC joint injury persists, with the pendulum swinging once again toward an initial attempt at nonsurgical management. Rehabilitation techniques in conservative treatment have focused on a more functional approach and a quicker return to activities. The optimal amount of bone to remove in a distal clavicle resection is still unknown. Some studies have shown that as little as 5 mm need be resected to achieve adequate decompression and pain relief. Recent biomechanical studies have reexamined the functional contributions of the four components of the AC ligament in an effort to determine which ones should be preserved during an arthroscopic AC resection to avoid destabilizing the joint. Finally, the potential pitfalls of AC co-planing during acromioplasty have been examined both clinically and biomechanically. This paper attempts to bring the most recent issues, concerns, and controversies surrounding the acromioclavicular joint into focus.Curr Opin Orthop 1999, 10:316–321 © 1999 Lippincott Williams & Wilkins, Inc.