Case-based Approach to the Management of AC Joint Injuries – An International Perspective (2021 Annual Meeting)-Case-based Approach to the Management of AC Joint Injuries

Case-based Approach to the Management of AC Joint Injuries - An International Perspective-Provencher

Video Transcription

Video Summary

The discussion centers on managing acromioclavicular (AC) joint injuries, particularly complications after surgical reconstruction, emphasizing patient selection and technique evolution. The speaker advocates a combined coracoclavicular (CC) and AC joint reconstruction with minimal distal clavicle resection, preserving the clavicle as a crucial structural strut. Loss of reduction, fractures (especially coracoid), and tunnel malposition in the clavicle and coracoid are common complications. Maintaining anatomic tunnel placement and considering sex-based anatomical differences improve outcomes. Horizontal instability is critical, especially in overhead athletes and throwers, for whom early surgery (within two weeks) may be advised to restore function and prevent scapular dyskinesis. Combined CC and AC reconstructions using allograft hamstring tendons and knotless constructs have shown improved fixation and return to sport rates. The open mini-incision approach allows critical deltotrapezial fascia repair, which remains challenging arthroscopically. Managing patient expectations about residual vertical deformity but improved horizontal stability is essential for satisfactory clinical outcomes.

Asset Caption

Dr. Matthew Provencher

Keywords

acromioclavicular joint injuries

surgical reconstruction complications

coracoclavicular and AC joint reconstruction

anatomic tunnel placement

horizontal instability in athletes

allograft hamstring tendon fixation