Acromioclavicular joint injuries: a review of pathoanatomy, assessment and current management approaches

Acromioclavicular joint (ACJ) injuries represent approximately 10% of all shoulder girdle injuries and their assessment and management can be clinically challenging. This may be for several reasons, including a lack of consensus concerning the reliability of the classification systems, contributing to suboptimal clinical outcomes. A paucity of literature regarding predictive factors for ACJ pathology may also be a factor. Controversy regarding conservative versus surgical management to provide optimal care also continues to be a factor in this clinical challenge, as similar results have been shown with both approaches. There is consensus that low-grade injuries can be treated with non-operative management, but some will go on to have long-term complications. However, the risks of surgical intervention may not out-weigh the benefits. In higher grade injuries there is further controversy over conservative versus surgical management. Improved classification systems and shared decision-making to individualize treatment plans are likely to improve patient outcomes. This review provides an overview of current assessment and management of ACJ injuries in adults.