AC Joint Separation

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Would like to dispel some myths. As an Orthopaedic surgeon, I see these injuries not uncommonly. When reading the below keep in mind there are very few Absolutes in surgery.

Also a great (and free) reference for all Orthopaedic injuries and conditions that would be very useful to our community here is a website and mobile app called Orthobullets. It’s at Orthobullets.com.

Here we go . . .

  1. Type 3 injuries are the most controversial. There are 6 types (7 really as there are type IIIA and IIIB). All are dependent on degree and direction of displacement.

  2. The displacement is indicative of injury to the main stabilizing ligaments called the CoracoClavicular ligaments. Ligamentous healing is predicated in reduction of the displacement to allow the ligaments to heal, thus . . .

  3. Plates are a completely reasonable and evidence based modality of treatment - when surgery is required this is THE treatment in most cases. HOWEVER

  4. Not all plates are the same. You can do a hook plate but yes it requires a second surgery to remove which is something I try to avoid at all times. You can also do a clavicle plate with the combination of a biologic (usually an allograft -cadaver- tendon) or non-biologic ( strong sutures in a tension construct to bring the clavicle back down and let the ligaments heal) augmentation.

  5. When to recommend surgery is the trick. Typically people with Type 3 injuries - in my hands- that are high demand or high level athletes are CANDIDATES for surgery. I think everyone reading this is probably a CANDIDATE for surgery. Couch potatoes are not.

Type I and II are non surgical in hopefully everyone’s hands. Types IV (posterior displacement thru your trapezius muscle) and types V and VI (>100% displacement and inferior displacement -very rare-respectively) are surgical in most people.

  1. Recovery. Limitations do exist and this is typically for multiple months based on individual patient progress. 6 weeks of passive range of motion to allow ligament healing is pretty standard and then you up the activity from there. That does not mean that on the first day of the seventh week you are magically healed. It’s a spectrum. You’ll hear a varying degree of restrictions and recommendations on this as there’s not much consensus from one provider to the next.

I hope that helps dispel some confusion. Please look it all up on Orthobullets as that is actually a peer reviewed site for further info.

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