Osteoartrite da Articulação Acromioclavicular Folheto

O que você está sentindo

Você provavelmente sente uma dor aguda ou latejante logo na parte superior do ombro. Este é o local onde a clavícula se encontra com a escápula. O ponto é sensível à palpação. Você pode notar inchaço ou um pequeno nódulo nessa área.

A dor frequentemente piora quando você move o braço através do corpo. Tarefas diárias simples podem se tornar difíceis. Alcançar atrás das costas para fechar um sutiã ou guardar uma camisa pode doer. Levantar objetos acima da cabeça ou alcançar itens em uma prateleira alta pode desencadear desconforto. Dormir do lado afetado é frequentemente doloroso e pode perturbar o seu descanso.

Você também pode sentir rigidez ao acordar pela primeira vez. Essa rigidez geralmente melhora à medida que você se move ao longo do dia. No entanto, após um longo dia de atividade, a dor pode retornar. Algumas pessoas descobrem que repousar o braço ajuda, enquanto outras acham que o movimento suave proporciona mais alívio.

É importante saber que nem todas as pessoas com alterações em uma radiografia sentem dor. Na verdade, a artrose assintomática por desgaste permaneceu assintomática em 90% dos pacientes durante um período de 7 anos. Se você não tiver sintomas, seu cirurgião provavelmente não recomendará cirurgia. Mesmo se você estiver passando por outra cirurgia no ombro, como a reparação do manguito rotador, a artrose não tratada que não causa dor está associada a uma baixa taxa de falha.

Seu cirurgião se concentrará no tratamento da dor que você realmente sente, não apenas no que aparece em uma imagem. As distinções entre alterações radiográficas sintomáticas e assintomáticas são desnecessárias, pois a satisfação do paciente com tratamentos como injeções é igual, independentemente da aparência da radiografia. Se os tratamentos conservadores não ajudarem, seu cirurgião pode discutir opções cirúrgicas. Tanto as técnicas de ressecção aberta quanto as artroscópicas proporcionam alívio da dor previsível nos casos sintomáticos.

O que está realmente acontecendo

Sua articulação acromioclavicular situa-se na parte superior do ombro, onde a clavícula encontra a escápula. Pense nela como uma dobradiça pequena e resistente que permite que seu braço se mova suavemente. Com o tempo, o revestimento liso nas extremidades ósseas — chamado cartilagem — pode se desgastar. Isso é a osteoartrite, ou artrite por desgaste. Quando essa camada protetora se torna mais fina, os ossos podem atritar-se, causando dor e rigidez.

Esse processo de desgaste é muito comum. Frequentemente ocorre sem aviso prévio. De fato, a OA-AC assintomática permaneceu assintomática em 90% dos pacientes ao longo de um período de 7 anos. Isso significa que, para a maioria das pessoas, alterações visíveis em um raio-X não causam automaticamente dor ou limitam o movimento. Você pode ter artrite em uma imagem, mas não sentir nenhuma diferença.

Às vezes, esse problema articular é encontrado durante o tratamento de outras condições do ombro. Por exemplo, a osteoartrite não tratada da articulação acromioclavicular, seja sintomática ou não, encontrada durante a reparação artroscópica do manguito rotador está associada a uma baixa taxa de falha. Isso sugere que a presença de artrite nessa articulação geralmente não compromete o resultado de outras cirurgias do ombro. No entanto, em alguns casos, a osteoartrite grave da articulação acromioclavicular está associada a fraturas por estresse do acrômio após artroplastia reversa do ombro. Seu cirurgião avaliará esses riscos antes de qualquer procedimento.

Quando a articulação causa sintomas, isso ocorre frequentemente porque as estruturas ao redor estão sob estresse. A cápsula articular é a bainha ao redor do ombro que mantém tudo no lugar. Se os ligamentos que estabilizam essa área estiverem distendidos ou danificados, a articulação pode deslocar-se ligeiramente. Esse desalinhamento pode alterar a forma como sua escápula se move, levando à dor e à disfunção.

Seu cirurgião compreende que nem toda artrite exige cirurgia. Tanto as técnicas de artroplastia por ressecção aberta quanto artroscópica proporcionam alívio da dor previsível para a osteoartrite AC sintomática. Esses procedimentos envolvem a remoção de uma pequena parte do osso para criar mais espaço. Isso ajuda a reduzir o atrito e permite um movimento mais suave. O objetivo é aliviar sua dor enquanto mantém a funcionalidade do ombro.

O que podemos fazer a respeito

No Mater Private Hospital Rockhampton, o Dr. Kieran Hirpara aborda o seu cuidado ao adequar o tratamento aos seus sintomas e estilo de vida específicos. Começamos com as opções menos invasivas para verificar se conseguimos gerir a sua dor sem cirurgia. Esta abordagem passo a passo ajuda a evitar procedimentos desnecessários, dando à sua ombreira a melhor hipótese de cicatrização natural.

Para muitas pessoas, mudanças simples fazem uma grande diferença. Pode precisar de ajustar atividades que causem dor, como levantar pesos pesados ou alcançar objetos acima da cabeça. A fisioterapia é uma parte fundamental deste processo. Os nossos terapeutas irão guiá-lo através de exercícios para fortalecer os músculos em torno da sua escápula e braço superior. Este suporte alivia a pressão sobre a articulação. Geralmente, sugerimos tentar este tratamento conservador durante um período definido para verificar se reduz o seu desconforto. Se tiver artrite por desgaste, modificar a forma como utiliza o seu braço pode ajudar a manter os sintomas controláveis por mais tempo.

Se a autogestão e a terapia não proporcionarem alívio suficiente, podemos discutir opções médicas. Os medicamentos para a dor e os anti-inflamatórios podem ajudar a controlar o inchaço e a dor. Também oferecemos injeções na articulação. Estas injecções administram medicamentos diretamente na fonte da dor para acalmar a inflamação. A investigação demonstra que estas injecções têm uma taxa de sucesso de 1 ano de 47% em pacientes com osteoartrite acromioclavicular. Isto significa que quase metade dos pacientes encontra alívio significativo durante um ano, embora os resultados variem. Utilizamos estas injecções para ajudar a manter-se ativo e continuar com a sua reabilitação.

A cirurgia é considerada apenas quando o tratamento conservador não proporcionou melhoria suficiente. O procedimento mais comum é uma excisão da clavícula distal. Nesta operação, removemos uma pequena porção da extremidade da clavícula para impedir que atrite contra a escápula. Isto cria mais espaço e reduz a dor. Recomendamos este procedimento para pacientes cuja dor persiste apesar de terem tentado outros tratamentos. Para lesões agudas ou luxações crónicas em que os ligamentos estão rotos, podemos recomendar uma reconstrução para restaurar a estabilidade. Discutimos todas as opções consigo para garantir que a escolha se adequa aos seus objetivos e necessidades de saúde.

O que esperar

Sua perspectiva depende em grande parte de seus sintomas estarem ativos ou silenciosos. Se você tem artrite por desgaste na articulação acromioclavicular (AC), mas sem dor, isso geralmente permanece assim. Em 90% dos pacientes, a artrite assintomática permaneceu assintomática ao longo de um período de 7 anos. Você pode não precisar de nenhum tratamento se isso não o incomodar.

Se você tiver dor, o tratamento conservador geralmente é o primeiro passo. Injeções podem ajudar, mas não são uma solução permanente. As injeções na articulação acromioclavicular oferecem uma taxa de sucesso de 1 ano de 47%. Isso significa que quase metade dos pacientes encontram alívio por um ano, enquanto outros podem precisar de outras opções. Se a dor persistir apesar do repouso e da medicação, a cirurgia é uma opção.

A cirurgia visa remover a parte irritada da clavícula. Isso proporciona um alívio da dor previsível para a osteoartrite sintomática da AC. Tanto as técnicas abertas quanto as artroscópicas funcionam bem para reduzir a dor e melhorar a função do ombro no acompanhamento intermediário. Você pode esperar sentir menos dor e se mover com mais liberdade. No entanto, algumas dores persistentes e a progressão da osteoartrite continuam sendo preocupações em casos de revisão.

É importante saber que a artrite pode afetar outros procedimentos no ombro. A osteoartrite da articulação AC não tratada, seja sintomática ou não, encontrada durante o reparo artroscópico do manguito rotador está associada a uma baixa taxa de falha. A osteoartrite também está associada a piores resultados clínicos finais após o reparo do manguito rotador. Um manguito rotador não cicatrizado ou que se rompeu novamente aumenta o risco de desenvolver osteoartrite.

Se você tiver artrite grave, há riscos adicionais a considerar. A osteoartrite grave da articulação AC está associada a fraturas por estresse do acrômio após a artroplastia reversa do ombro. A osteoartrite radiográfica da articulação AC é comum em pacientes que passam por esse tipo de cirurgia. Seu cirurgião ponderará esses fatores ao planejar seu cuidado.

No geral, o curso varia. Muitas pessoas se saem bem sem cirurgia. Outros encontram alívio duradouro após a remoção do osso problemático. Seu cirurgião o ajudará a decidir qual caminho se adapta melhor à sua vida e aos seus sintomas.

Quando procurar um médico

Procure o seu médico de família se tiver dor persistente na parte superior do ombro que não melhora com repouso. Solicite uma avaliação por um especialista se notar fraqueza, instabilidade ou uma sensação de bloqueio ou cedência. Procure atendimento se os sintomas interferirem no seu sono ou nas suas funções laborais, ou se experimentar um agravamento súbito da dor. Embora muitos casos de osteoartrite por desgaste permaneçam assintomáticos durante anos, o desconforto persistente justifica uma avaliação. O seu cirurgião pode ajudar a determinar se é necessário um tratamento adicional para gerir eficazmente os seus sintomas.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

Asymptomatic AC-OA remained asymptomatic in 90% of patients over a 7-year period [2].
Untreated ACJ osteoarthritis, whether symptomatic or not, encountered during arthroscopic rotator cuff repair is associated with a low percentage of failure [3].
Radiographic ACJ osteoarthritis is common in patients undergoing reverse shoulder arthroplasty [7].
Severe acromioclavicular joint osteoarthritis is associated with acromial stress fractures after reverse shoulder arthroplasty [7].
Both open and arthroscopic resection arthroplasty techniques provide predictable pain relief for symptomatic AC osteoarthritis [8].
Open and arthroscopic resection arthroplasty techniques have unique sets of potential complications that may be minimized with improved understanding of anatomy, biomechanics, and meticulous surgical technique [8].
Limited distal clavicle excision reduced pain and improved shoulder function at midterm follow-up in patients with AC joint osteoarthritis resistant to conservative treatment [9].
A distinction between symptomatic and asymptomatic radiographic AC OA is unnecessary as all patients were equally satisfied with the outcome of preoperative acromioclavicular injection [6].
Further characterisation of patients in whom mild arthroscopic findings of OA of the AC joint are clinically significant and warrant resection is needed [1].
Acromioclavicular joint arthritis is not an indication for routine distal clavicle excision in arthroscopic rotator cuff repair [3].
Clinicians should consider overreduction of the AC joint because it may lead to favorable radiological results [5].
The authors recommend anatomic reconstruction procedures for the treatment of chronic complete AC dislocations [21].

Anatomy & Pathophysiology

Anatomic techniques that address both coracoclavicular ligaments and the AC capsule are recommended to restore horizontal and vertical stability while allowing physiological rotation [10].
None of the reconstruction strategies completely restored the shoulder girdle to its preinjured state [26].
Kinematic changes resulting from AC joint dislocation could be a potential source of pain and dysfunction in the shoulder [27].
Scapular and clavicular kinematics were affected in AC separation models [28].
The position of the hook portion of a clavicle hook plate can predispose anatomic structures to post-operative complications of subacromial impingement and bony erosion [29].
Future research should focus on addressing horizontal and rotational instability to restore native physiological and biomechanical properties of the AC joint [35].
Coracoclavicular reconstruction with augmentation of the acromioclavicular joint provides improved horizontal stability compared to isolated coracoclavicular reconstruction [41].
Adding a fixation of the AC joint minimizes lateral tilting of the scapula and maintains a more anatomic reposition result over time [45].

Classification

Asymptomatic acromioclavicular osteoarthritis diagnosed by MRI remained asymptomatic in 90% of patients over a 7-year period [2].
Untreated acromioclavicular joint osteoarthritis, whether symptomatic or not, encountered during arthroscopic rotator cuff repair is associated with a low percentage of failure [3].
Mild arthroscopic findings of acromioclavicular joint osteoarthritis may be clinically significant and warrant resection, but further characterization of such patients is needed [1].
Radiographic acromioclavicular joint osteoarthritis is common in patients undergoing reverse shoulder arthroplasty [7].
Osteolytic changes in the acromioclavicular joint seemed to be associated with incongruity of the joint but did not correlate with clinical results [11].
The acromial center line to dorsal clavicle radiographic measurement and the use of the Alexander view provide a more realistic appreciation of true acromioclavicular joint displacement, especially in defining watershed cases (Rockwood types IIIA, IIB, and IV) [12].
Evaluating the integrity of the capsuloligamentous structures stabilizing the acromioclavicular joint is reproducible and provides additional information on the severity of the injury [24].
Injuries to the sternoclavicular joint are uncommon, and recognition and classification are critical to proper management to minimize long-term sequelae [16].
Some persistent pain and osteoarthritis progression remain concerns in the arthroscopic revision of failed open anterior stabilization of the shoulder [4].

Clinical Presentation

Preventive arthroscopic distal clavicle resection is not recommended in patients with radiological but asymptomatic ACJ arthritis [19].
Osteolytic changes seemed to be associated with incongruity of the AC joint, but did not correlate with clinical results [11].
Additional research is needed to determine the main cause of pain in isolated acromioclavicular osteoarthritis and to compare clinical outcomes of intra-articular versus extra-articular injections [13].
Risk factors for subsequent distal clavicle excision after rotator cuff repair include tenderness to palpation at the AC joint, female sex, and surgery on the dominant side [18].
Subsequent distal clavicle excision was performed in 40% of cases with a combination of the three identified risk factors (tenderness to palpation, female sex, dominant side surgery) [18].
Recurrence of the initial dislocation after arthroscopically assisted reduction appears to be related to the onset of degenerative ACJ arthropathy [14].
Some persistent pain and osteoarthritis progression remain concerns in the revision of failed open anterior stabilization of the shoulder [4].

Investigations

Preventive arthroscopic distal clavicle resection (DCR) is not recommended in patients with radiological but asymptomatic ACJ arthritis [19].
Further characterization is needed to determine which patients with mild arthroscopic findings of AC joint OA are clinically significant and warrant resection [1].
Radiographic ACJ osteoarthritis is common in patients undergoing reverse shoulder arthroplasty (RSA) [7].
Severe ACJ osteoarthritis is associated with acromial stress fractures after reverse shoulder arthroplasty [7].
Osteolytic changes in the AC joint seemed to be associated with incongruity but did not correlate with clinical results [11].
Patients with edema on MRI were more likely to present with pain than patients without edema [43].
Subchondral bone edema on histologic examination was more frequent in patients with pain [43].
The outcomes of a preoperative AC injection suggest that a distinction between symptomatic and asymptomatic radiographic AC OA is unnecessary, as all patients were equally satisfied with the outcome [6].
Additional research is needed to determine the main cause of pain and to compare clinical outcomes of intra-articular versus extra-articular steroid injections for isolated AC osteoarthritis [13].
Subsequent distal clavicle excision was performed in 40% of cases with a combination of the three identified risk factors (tenderness, female sex, dominant side) [18].
The arthroscopic approach offers an advantage in diagnosing and treating occult intra-articular pathology during distal clavicle excision [20].
Some persistent pain and osteoarthritis progression remain concerns in the revision of failed open anterior stabilization of the shoulder using arthroscopy [4].
Evaluating the integrity of the capsuloligamentous structures stabilizing the AC joint is reproducible and provides additional information on injury severity, which may influence treatment decisions [24].
The AC-DC measurement and use of the Alexander view provide a more realistic appreciation of true AC joint displacement, particularly in defining watershed cases (IIIA/IIB/IV) [12].
Radiological failures were observed in 41% of cases in a prospective multicenter study of arthroscopic acute AC dislocation fixation [50].

Treatment

Non-Operative Management

Conservative therapy is a valid initial treatment option for Rockwood Type V acromioclavicular dislocations [15].
Non-operative reduction and stabilization is a valuable treatment option for acute high-grade acromioclavicular joint separations [33].
Nonoperative treatment is helpful for most patients with painful conditions of the acromioclavicular joint, although those with osteolysis may need to modify their activities [44].
Conservative and surgical treatments are both effective in the management of acromioclavicular joint osteoarthritis [17].
Acromioclavicular injections offer a 1-year success rate of 47% in patients with acromioclavicular osteoarthritis [22].
Additional research is needed to determine the main cause of pain and to compare clinical outcomes of intra-articular versus extra-articular steroid injections for isolated acromioclavicular osteoarthritis [13].

Operative Management

Both open and arthroscopic resection arthroplasty techniques provide predictable pain relief for symptomatic acromioclavicular osteoarthritis [8].
Limited distal clavicle excision reduces pain and improves shoulder function at midterm follow-up in patients with acromioclavicular joint osteoarthritis resistant to conservative treatment [9].
Further characterization is needed to identify patients in whom mild arthroscopic findings of acromioclavicular joint osteoarthritis are clinically significant and warrant resection [1].
Conversion to anatomic coracoclavicular ligament reconstruction shows similar clinical outcomes compared to successful non-operative treatment in chronic primary type III to V acromioclavicular joint injuries at a minimum 5-year follow-up [49].
The authors recommend anatomic reconstruction procedures for the treatment of chronic complete acromioclavicular dislocations [21].
Osteoarthritis is associated with poorer final clinical outcomes after rotator cuff repair, and an unhealed or re-torn cuff increases the risk of osteoarthritis [23].

Diagnostic Considerations

A distinction between symptomatic and asymptomatic radiographic acromioclavicular osteoarthritis appears unnecessary, as all patients were equally satisfied with the outcome of preoperative acromioclavicular injection [6].
Asymptomatic acromioclavicular osteoarthritis diagnosed by MRI remained asymptomatic in 90% of patients over a 7-year course [2].
Some persistent pain and osteoarthritis progression remain concerns following arthroscopy in the revision of failed open anterior stabilization of the shoulder [4].

Complications

Osteoarthritis is associated with poorer final clinical outcomes after rotator cuff repair [23].
An unhealed or re-torn rotator cuff increases the risk of developing osteoarthritis [23].
Severe AC joint osteoarthritis is associated with acromial stress fractures after reverse shoulder arthroplasty [7].
Some persistent pain and osteoarthritis progression remain concerns following arthroscopy in revision of failed open anterior stabilization of the shoulder [4].
Recurrence of the initial dislocation after arthroscopically assisted reduction of acute AC joint dislocation appears to be related to the onset of degenerative ACJ arthropathy [14].
Treatment of acute grade III and IV AC dislocations by synthetic ligament reconstruction carries a risk of significant early osteolysis [25].
Open and arthroscopic AC joint reconstruction techniques have no differences in loss of reduction, complication rate, or revision rate [38].
Both open and arthroscopic resection arthroplasty techniques provide predictable pain relief for symptomatic AC osteoarthritis but each has a unique set of potential complications [8].

Recovery

Limited distal clavicle excision for acromioclavicular joint osteoarthritis resistant to conservative treatment reduced pain and improved shoulder function at midterm follow-up [9].
A preoperative acromioclavicular injection study suggested that distinguishing between symptomatic and asymptomatic radiographic acromioclavicular osteoarthritis is unnecessary, as all patients were equally satisfied with the outcome [6].
Osteolytic changes in the acromioclavicular joint seemed to be associated with incongruity but did not correlate with clinical results [11].
Recurrence of initial acromioclavicular joint dislocation appears to be related to the onset of degenerative acromioclavicular joint arthropathy [14].
Treatment of acute grade III and IV acromioclavicular dislocations using synthetic ligament reconstruction gave satisfactory results in terms of recovery of strength, but evolution is not risk-free due to the onset of significant early osteolysis [25].
Arthroscopic coracoclavicular ligament reconstruction with double-bundle soft tissue allograft for chronic type V acromioclavicular dislocations showed sustained and statistically significant improvements in functional outcomes, high rates of return to sport, and maintenance of active-duty military status at minimum 10-year follow-up [39].
Minimally invasive coracoclavicular ligament augmentation with a flip button/polydioxanone repair for total acromioclavicular joint dislocation revealed excellent radiologic and clinical results with no subluxations or dislocations noted in short-term follow-up [48].
Type V acromioclavicular dislocations may be given a trial of conservative therapy [15].

Key Evidence

[L2] Further characterisation of patients in whom mild arthroscopic findings of OA of AC joint are clinically significant and warrant resection is needed. [1] (10.1007/s00167-014-3114-2)
[L2] Asymptomatic AC-OA remained asymptomatic in 90% over 7 years. [2] (10.1016/j.jse.2019.04.004)
[L2] Untreated ACJ osteoarthritis, symptomatic or not, encountered during arthroscopic RCR is associated with a low percentage of failure. [3] (10.1007/s00167-020-06098-y)
[L4] Some persistent pain and osteoarthritis progression remain concerns. [4] (10.1016/j.arthro.2009.04.073)
[L3] Clinicians should consider overreduction of the AC joint because it may lead to favorable radiological results. [5] (10.1177/0363546519862850)
[L4] The outcomes of this study seem to suggest that a distinction between symptomatic and asymptomatic radiographic AC OA is unnecessary, as all patients were equally satisfied with the outcome. [6] (10.5397/cise.2023.00073)
[L3] Radiographic ACJ osteoarthritis is common in patients undergoing RSA. [7] (10.1016/j.jseint.2021.11.008)
[L5] Both open and arthroscopic resection arthroplasty techniques provide predictable pain relief for symptomatic AC osteoarthritis, though each has a unique set of potential complications that may be minimized with improved understanding of anatomy, biomechanics, and meticulous surgical technique. [8] (10.1177/0363546513485359)
[L4] Limited distal clavicle excision of patients with AC joint osteoarthritis resistant to conservative treatment reduced pain and improved shoulder function at midterm follow-up. [9] (10.1016/j.otsr.2016.01.008)
[L5] Anatomic techniques that address both coracoclavicular ligaments and the AC capsule are recommended to restore horizontal and vertical stability while allowing physiological rotation. [10] (10.1016/j.arthro.2019.01.038)
[L4] The AC-DC measurement and use of the Alexander view provides the clinician with a more realistic appreciation of true AC joint displacement, especially in defining watershed cases (ie, IIIA/IIB/IV) and may better inform the decision-making process regarding management options and recommendations. [12] (10.1016/j.jse.2019.12.014)
[L4] Additional research is needed to determine the main cause of pain and compare clinical outcomes of intra-articular versus extra-articular injections. [13] (10.5397/cise.2023.00311)
[L4] Recurrence of the initial dislocation appears to be related to onset of degenerative ACJ arthropathy. [14] (10.1016/j.otsr.2017.11.001)
[L4] This suggests that Type V AC dislocations may be given a trial of conservative therapy. [15] (10.1177/2325967115s00017)
[L1] Injuries to the SC joint are uncommon, and recognition and classification are critical to proper management to minimize long-term sequelae. [16] (10.1177/0363546513498990)
[L4] Conservative and surgical treatments are both effective in acromioclavicular joint osteoarthritis management. [17] (10.1007/s00167-020-06377-8)
[L3] Risk factors for subsequent DCE included tenderness to palpation at the AC joint, female sex, and surgery on the dominant side, with subsequent DCE performed in 40% of cases with a combination of these 3 factors. [18] (10.1177/2325967119844295)
[L1] Preventive arthroscopic DCR is not recommended in patients with radiological but asymptomatic ACJ arthritis. [19] (10.1177/0363546514547254)
[L1] The arthroscopic approach offers a unique advantage in diagnosing and treating occult intra-articular pathology. [20] (10.1016/j.jse.2006.10.006)
[L4] The authors recommend this procedure for the treatment of chronic complete AC dislocations. [21] (10.1016/j.injury.2010.09.023)
[L4] AC injections offer a 1-year success rate of 47%. [22] (10.5397/cise.2023.00031)
[L4] Osteoarthritis is associated with poorer final clinical outcomes, and an unhealed or re-torn cuff increases the risk of osteoarthritis. [23] (10.1016/j.otsr.2017.03.007)
[L1] Evaluating the integrity of the capsuloligamentous structures stabilizing the AC joint is reproducible and gives additional information on the severity of the injury, which might also influence the treatment decision. [24] (10.1016/j.jse.2020.10.026)
[L4] Treatment of ACD by synthetic ligament reconstruction gave satisfactory results, notably in terms of recovery of strength, but evolution is not risk-free with onset of significant early osteolysis. [25] (10.1016/j.otsr.2010.06.004)
[L5] Although each technique was able to restore different elements of the joint kinematics, none of the strategies completely restored the shoulder girdle to its preinjured state. [26] (10.1177/03635465221095231)
[L5] The kinematic changes could be a potential source of pain and dysfunction in the shoulder with AC joint dislocation. [27] (10.1177/0363546512458571)
[L5] Scapular and clavicular kinematics were affected in AC separation models. [28] (10.1016/j.jse.2013.01.004)
[L5] The observed frequency of hook contact with surrounding subacromial structures in a static shoulder confirms that the position of the hook portion of the implant can predispose anatomic structures to the post-operative complications of subacromial impingement and bony erosion. [29] (10.1016/j.injury.2009.12.012)
[L4] Non-operative reduction and stabilization of high-grade AC joint separations seems to be a valuable treatment option. [33] (10.1007/s00402-020-03630-0)
[L5] Future research should focus on addressing horizontal and rotational instability, to restore native physiological and biomechanical properties of the AC joint. [35] (10.1186/s12891-022-05935-0)
[L1] Open and arthroscopic AC joint reconstruction techniques have no differences in loss of reduction, the complication rate, and the revision rate based on the available literature. [38] (10.1177/0363546518795147)
[L4] Outcomes after arthroscopic CC reconstruction for chronic, type V AC dislocations in an active-duty military patient population show sustained and statistically significant improvements in functional outcomes as well as high rates of return to sport and maintenance of active-duty military status at long-term follow-up. [39] (10.1016/j.arthro.2025.05.008)
[L1] Coracoclavicular reconstruction with augmentation of the acromioclavicular joint has been shown to provide improved horizontal stability in both biomechanical and clinical studies compared to isolated coracoclavicular reconstruction. [41] (10.1007/s00167-018-5152-7)
[L4] Patients with edema on MRI were more likely to present pain than patients without edema, and subchondral bone edema on histologic examination was more frequent in patients with pain. [43] (10.1016/j.jseint.2020.03.007)
[L5] Nonoperative treatment is helpful for most patients, although those with osteolysis may have to modify their activities. [44] (10.5435/00124635-199905000-00004)
[L3] The presented data suggest adding a fixation of the AC joint to minimize lateral tilting of the scapula and maintain a more anatomic reposition result over time. [45] (10.1007/s00402-021-03761-y)
[L4] The short-term follow-up of 15 recently operated patients reveals excellent radiologic and clinical results, with no subluxations or dislocations of the acromioclavicular joint noted. [48] (10.1016/j.arthro.2006.12.015)
[L4] At a minimum 5-year follow-up, patients with successful non-operative treatment for type III-V ACJ injuries achieved similar clinical outcomes compared to those who were converted to ACCR. [49] (10.1007/s00167-020-06159-2)
[L4] Surgery for AC dislocations is difficult with radiological results that must still be improved, as radiological failures were observed in 41% of cases. [50] (10.1016/j.otsr.2015.09.012)

References

[1] Outcome of distal clavicle resection in patients with acromioclavicular joint osteoarthritis and full‐thickness rotator cuff tear. Knee Surgery, Sports Traumatology, Arthroscopy. 2014. DOI: 10.1007/s00167-014-3114-2

[2] Seven-year course of asymptomatic acromioclavicular osteoarthritis diagnosed by MRI. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2019.04.004

[3] Acromioclavicular joint arthritis is not an indication for routine distal clavicle excision in arthroscopic rotator cuff repair. Knee Surgery, Sports Traumatology, Arthroscopy. 2020. DOI: 10.1007/s00167-020-06098-y

[4] The Role of Arthroscopy in Revision of Failed Open Anterior Stabilization of the Shoulder. Arthroscopy. 2009. DOI: 10.1016/j.arthro.2009.04.073

[5] Factors Predicting the Outcome After Arthroscopically Assisted Stabilization of Acute High-Grade Acromioclavicular Joint Dislocations. The American Journal of Sports Medicine. 2019. DOI: 10.1177/0363546519862850

[6] Diagnostic value of a preoperative acromioclavicular injection for symptomatic acromioclavicular osteoarthritis: a retrospective study of cross-sectional midterm outcomes. Clinics in Shoulder and Elbow. 2024. DOI: 10.5397/cise.2023.00073

[7] Severe acromioclavicular joint osteoarthritis is associated with acromial stress fractures after reverse shoulder arthroplasty. JSES International. 2022. DOI: 10.1016/j.jseint.2021.11.008

[8] Degenerative Joint Disease of the Acromioclavicular Joint. The American Journal of Sports Medicine. 2013. DOI: 10.1177/0363546513485359

[9] Limited distal clavicle excision of acromioclavicular joint osteoarthritis. Orthopaedics & Traumatology: Surgery & Research. 2016. DOI: 10.1016/j.otsr.2016.01.008

[10] Editorial Commentary:

                Why We Have To Respect The Anatomy In Acromioclavicular Joint Surgery And Why Clinical Shoulder Scores Might Not Give Us The Information We Need!. *Arthroscopy*. 2019. DOI: 10.1016/j.arthro.2019.01.038

[11] Surgical treatment of acromioclavicular dislocation: A review of 39 patients. Injury. 1983. DOI: 10.1016/0020-1383(83)90092-x

[12] Improved identification of unstable acromioclavicular joint injuries in a clinical population using the acromial center line to dorsal clavicle radiographic measurement. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.12.014

[13] Isolated acromioclavicular osteoarthritis and steroid injection. Clinics in Shoulder and Elbow. 2023. DOI: 10.5397/cise.2023.00311

[14] Arthroscopically assisted reduction of acute acromioclavicular joint dislocation using a single double-button device: Medium-term clinical and radiological outcomes. Orthopaedics & Traumatology: Surgery & Research. 2018. DOI: 10.1016/j.otsr.2017.11.001

[15] Successful Conservative Therapy in Rockwood Type V Acromioclavicular Dislocations. Orthopaedic Journal of Sports Medicine. 2015. DOI: 10.1177/2325967115s00017

[16] Instability and Degenerative Arthritis of the Sternoclavicular Joint. The American Journal of Sports Medicine. 2013. DOI: 10.1177/0363546513498990

[17] No differences between conservative and surgical management of acromioclavicular joint osteoarthritis: a scoping review. Knee Surgery, Sports Traumatology, Arthroscopy. 2021. DOI: 10.1007/s00167-020-06377-8

[18] Preoperative Factors Associated With Subsequent Distal Clavicle Resection After Rotator Cuff Repair. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119844295

[19] Is Arthroscopic Distal Clavicle Resection Necessary for Patients With Radiological Acromioclavicular Joint Arthritis and Rotator Cuff Tears?. The American Journal of Sports Medicine. 2014. DOI: 10.1177/0363546514547254

[20] Arthroscopic versus open distal clavicle excision: Comparative results at six months and one year from a randomized, prospective clinical trial. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.10.006

[21] Surgical treatment of chronic acromioclavicular dislocation: Comparison between two surgical procedures for anatomic reconstruction. Injury. 2010. DOI: 10.1016/j.injury.2010.09.023

[22] Mid- to long-term success rate and functional outcomes of acromioclavicular injections in patients with acromioclavicular osteoarthritis. Clinics in Shoulder and Elbow. 2023. DOI: 10.5397/cise.2023.00031

[23] Osteoarthritis after rotator cuff repair: A 10-year follow-up study. Orthopaedics & Traumatology: Surgery & Research. 2017. DOI: 10.1016/j.otsr.2017.03.007

[24] The ligamentous injury pattern in acute acromioclavicular dislocations and its impact on clinical and radiographic parameters. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2020.10.026

[25] Acute grade III and IV acromioclavicular dislocations: Outcomes and pitfalls of reconstruction procedures using a synthetic ligament. Orthopaedics & Traumatology: Surgery & Research. 2010. DOI: 10.1016/j.otsr.2010.06.004

[26] Differences between Coracoclavicular, Acromioclavicular, or Combined Reconstruction Techniques on the Kinematics of the Shoulder Girdle. The American Journal of Sports Medicine. 2022. DOI: 10.1177/03635465221095231

[27] The Function of the Acromioclavicular and Coracoclavicular Ligaments in Shoulder Motion. The American Journal of Sports Medicine. 2012. DOI: 10.1177/0363546512458571

[28] Acromioclavicular joint ligamentous system contributing to clavicular strut function: a cadaveric study. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2013.01.004

[29] Subacromial morphometric assessment of the clavicle hook plate. Injury. 2010. DOI: 10.1016/j.injury.2009.12.012

[33] Can an acute high-grade acromioclavicular joint separation be reduced and stabilized without surgery? A surgeon’s experience. Archives of Orthopaedic and Trauma Surgery. 2020. DOI: 10.1007/s00402-020-03630-0

[35] Current concepts in acromioclavicular joint (AC) instability – a proposed treatment algorithm for acute and chronic AC-joint surgery. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05935-0

[38] Current Concepts in the Operative Management of Acromioclavicular Dislocations: A Systematic Review and Meta-analysis of Operative Techniques. The American Journal of Sports Medicine. 2018. DOI: 10.1177/0363546518795147

[39] Arthroscopic Coracoclavicular Ligament Reconstruction With Double‐Bundle Soft Tissue Allograft for Chronic Type V Acromioclavicular Dislocations Shows Excellent Patient Outcomes and Return to Duty and Sport at Minimum 10‐Year Follow‐Up. Arthroscopy. 2025. DOI: 10.1016/j.arthro.2025.05.008

[41] Acromioclavicular joint augmentation at the time of coracoclavicular ligament reconstruction fails to improve functional outcomes despite significantly improved horizontal stability. Knee Surgery, Sports Traumatology, Arthroscopy. 2018. DOI: 10.1007/s00167-018-5152-7

[43] Histologic and magnetic resonance image evaluation in acromioclavicular joint osteoarthritis. JSES International. 2020. DOI: 10.1016/j.jseint.2020.03.007

[44] Painful Conditions of the Acromioclavicular Joint. Journal of the American Academy of Orthopaedic Surgeons. 1999. DOI: 10.5435/00124635-199905000-00004

[45] Additional acromioclavicular cerclage limits lateral tilt of the scapula in patients with arthroscopically assisted coracoclavicular ligament reconstruction. Archives of Orthopaedic and Trauma Surgery. 2021. DOI: 10.1007/s00402-021-03761-y

[48] Minimally Invasive Coracoclavicular Ligament Augmentation With a Flip Button/Polydioxanone Repair for Treatment of Total Acromioclavicular Joint Dislocation. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2006.12.015

[49] Conversion to anatomic coracoclavicular ligament reconstruction (ACCR) shows similar clinical outcomes compared to successful non‐operative treatment in chronic primary type III to V acromioclavicular joint injuries. Knee Surgery, Sports Traumatology, Arthroscopy. 2020. DOI: 10.1007/s00167-020-06159-2

[50] Complication rates and types of failure after arthroscopic acute acromioclavicular dislocation fixation. Prospective multicenter study of 116 cases. Orthopaedics & Traumatology: Surgery & Research. 2015. DOI: 10.1016/j.otsr.2015.09.012