The aim of this review is to address controversies
in the management of dislocations of the acromioclavicular joint. Current
evidence suggests that operative rather than non-operative treatment
of Rockwood grade III dislocations results in better cosmetic and
radiological results, similar functional outcomes and longer time
off work. Early surgery results in better functional and radiological
outcomes with a reduced risk of infection and loss of reduction compared
with delayed surgery. Surgical options include acromioclavicular fixation, coracoclavicular
fixation and coracoclavicular ligament reconstruction. Although
non-controlled studies report promising results for arthroscopic
coracoclavicular fixation, there are no comparative studies with
open techniques to draw conclusions about the best surgical approach.
Non-rigid coracoclavicular fixation with tendon graft or synthetic
materials, or rigid acromioclavicular fixation with a
Dislocation of the acromioclavicular joint is
a relatively common injury and a number of surgical interventions
have been described for its treatment. Recently, a synthetic ligament
device has become available and been successfully used, however,
like other non-native solutions, a compromise must be reached when
choosing non-anatomical locations for their placement. This cadaveric
study aimed to assess the effect of different clavicular anchorage points
for the Lockdown device on the reduction of acromioclavicular joint
dislocations, and suggest an optimal location. We also assessed
whether further stability is provided using a coracoacromial ligament
transfer (a modified Neviaser technique). The acromioclavicular
joint was exposed on seven fresh-frozen cadaveric shoulders. The
joint was reconstructed using the Lockdown implant using four different
clavicular anchorage points and reduction was measured. The coracoacromial
ligament was then transferred to the lateral end of the clavicle,
and the joint re-assessed. If the Lockdown ligament was secured
at the level of the conoid tubercle, the acromioclavicular joint
could be reduced anatomically in all cases. If placed medial or
2 cm lateral, the joint was irreducible. If the Lockdown was placed
1 cm lateral to the conoid tubercle, the joint could be reduced
with difficulty in four cases. Correct placement of the Lockdown
device is crucial to allow anatomical joint reduction. Even when the
Lockdown was placed over the conoid tubercle, anterior clavicle
displacement remained but this could be controlled using a coracoacromial
ligament transfer. Cite this article: