09/12/2012 1 AC Joint Dislocations & Instability Is the ACJ Important? YES – for overhead athletes: Following ACJ Dislocations: 30% of overhead athletes had to reduce sport 9% had to change sport Climbers and patients performing strength training had to reduce their activities or give up sports Altered activities in overhead ball sports Rangger et al. Orthopade 2002 Jun; 31(6):587-90 Is the ACJ Important? YES – for high demand professions: Following ACJ Injuries: 164 US Naval Cadets Residual symptoms found at 6 month follow-up: 36% of Grade 1 48% of Grade 2 Major in 13% Minor in 35% 69% of Grade 3 Cox. Am J Sports Med, 1981
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09/12/2012
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AC Joint "Dislocations & Instability
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Is the ACJ Important? ! YES – for overhead athletes:
! Following ACJ Dislocations:
! 30% of overhead athletes had to reduce sport
! 9% had to change sport
! Climbers and patients performing strength training had to reduce their activities or give up sports
! Altered activities in overhead ball sports
Rangger et al. Orthopade 2002 Jun;31(6):587-90
Is the ACJ Important? ! YES – for high demand professions:
! Following ACJ Injuries:
! 164 US Naval Cadets ! Residual symptoms found at 6 month follow-up:
! 36% of Grade 1
! 48% of Grade 2 ! Major in 13%
! Minor in 35% ! 69% of Grade 3
Cox. Am J Sports Med, 1981
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Indications for Stabilisation ! Literature = Type 4, 5 & 6
Ceccarelli et al. 2008
! “From the literature evaluation, clinical results seem to be comparable between the operative and the conservative treatments, "but complications are more evident in the surgery group. "
! Since there is not a preponderance of positive papers showing the benefits of a surgical technique over conservative therapy, the nonoperative treatment is still considered a valid procedure in the grade III acromioclavicular separation.
! More prospective randomized studies using validated outcome measures are needed to identify the suitable operation techniques for the acute injuries.”
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What are we trying to achieve?
• “A pain free & stable shoulder "that has enough mobility, strength "& muscle control for a patient’s "desired level of activity & participation”
• “None of the reconstruction techniques analyzed in the present study were able to restore the normal mechanical function of the intact coracoclavicular ligament complex”
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ACJ Ligaments ! Two thirds of the superior stability