AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-Open AC

Open AC_CC Reconstruction-Xinning Li, M.D.

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This document outlines the management of chronic acromioclavicular (AC) joint dislocation, specifically focusing on Type V injuries per the Rockwood classification, characterized by 100%-300% coracoclavicular (CC) distance increase and disruption of AC and CC ligaments as well as the deltotrapezial fascia.<br /><br />Type V AC dislocations account for about 20% of all AC joint injuries and predominantly affect males aged 20-40 years. Associated lesions such as SLAP tears, rotator cuff tears, and biceps pathology are common, with MRI often used for diagnosis.<br /><br />Non-operative management over six months shows mixed outcomes; approximately 23% achieve normal functional scores (DASH or ASES), and all manual laborers in one study were able to return to work, though some remain unsatisfied.<br /><br />Surgical options vary from anatomical and non-anatomical techniques, including Tightrope suture systems, ligament reconstruction, and open reduction internal fixation (ORIF) with plates or screws. The preferred open CC reconstruction uses a semitendinosus tendon graft (allograft for primary cases, autograft for revisions), reinforced by tape sutures.<br /><br />Key surgical pearls include drilling two tunnels (conoid 4.5 cm and trapezoid 3 cm from distal clavicle), fixation with 5.5 x 8 mm PEEK screws, crossing the graft, and optionally excising 5-7 mm of the distal clavicle. Arthroscopic evaluation may be performed first to address intra-articular pathology, with the patient positioned in a beach chair.<br /><br />Postoperative care involves sling immobilization for six weeks, early elbow and wrist range of motion, progressive physical therapy from four weeks onward, strengthening by 10-12 weeks, and return to heavy labor or sports at six months. Open revision surgery is reserved for failed reconstructions.<br /><br />Overall, this approach aims to restore stability and function in chronic high-grade AC joint separations.

Keywords

chronic acromioclavicular joint dislocation

Type V AC dislocation

Rockwood classification

coracoclavicular distance

AC and CC ligament disruption

non-operative management

surgical reconstruction

semitendinosus tendon graft

postoperative rehabilitation

arthroscopic evaluation