Elshahhat A, Almekoud M, Zaghloul A, El-Sherbini A. Subsidence following surgical stabilization of acromioclavicular joint injuries: Should we be concerned? World J Orthop 2026; 17(6): 117244 [DOI: 10.5312/wjo.v17.i6.117244]
Corresponding Author of This Article
Amr Elshahhat, MD, Department of Orthopedic Surgery, Mansoura University, Algomhoria Street, Mansoura 33516, Dakahlia, Egypt. amrelshahat@mans.edu.eg
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Orthopedics
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Elshahhat A, Almekoud M, Zaghloul A, El-Sherbini A. Subsidence following surgical stabilization of acromioclavicular joint injuries: Should we be concerned? World J Orthop 2026; 17(6): 117244 [DOI: 10.5312/wjo.v17.i6.117244]
World J Orthop. Jun 18, 2026; 17(6): 117244 Published online Jun 18, 2026. doi: 10.5312/wjo.v17.i6.117244
Subsidence following surgical stabilization of acromioclavicular joint injuries: Should we be concerned?
Amr Elshahhat, Mahmoud Almekoud, Ahmed Zaghloul, Amr El-Sherbini
Amr Elshahhat, Mahmoud Almekoud, Ahmed Zaghloul, Amr El-Sherbini, Department of Orthopedic Surgery, Mansoura University, Mansoura 33516, Dakahlia, Egypt
Author contributions: Elshahhat A designed the overall concept and outline of the manuscript; Elshahhat A, Almekoud M contributed to the writing and editing the manuscript; Zaghloul A, El-Sherbini A contributed to the illustrations and review of literature; all authors were responsible for critical revision, and final approval of the manuscript.
AI contribution statement: During manuscript preparation, AI-assisted techniques were only utilized for editorial support and minor language refining. No AI tool was utilized to independently create scientific material, analyze data, evaluate findings, plan the study, or make inferences. The authors were solely responsible for all concepts, literature synthesis, clinical interpretation, and final article edits. This manuscript did not contain any AI-generated figures or pictures.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Amr Elshahhat, MD, Department of Orthopedic Surgery, Mansoura University, Algomhoria Street, Mansoura 33516, Dakahlia, Egypt. amrelshahat@mans.edu.eg
Received: December 2, 2025 Revised: December 27, 2025 Accepted: February 28, 2026 Published online: June 18, 2026 Processing time: 197 Days and 10 Hours
Abstract
Subsidence, or loss of reduction, is a recognized concern following surgical stabilization of acromioclavicular joint injuries and remains a source of debate regarding its clinical importance and implications for revision. This minireview synthesizes the available evidence on the incidence of postoperative subsidence, the diverse radiological criteria used to define it, and its correlation with functional outcomes. Reported rates vary widely, from 15% to 80%, reflecting differences in fixation methods, surgical technique, and follow-up duration. Suspensory button systems and graft reconstructions are particularly prone to early loss of reduction, whereas hook plates tend to preserve initial alignment but are limited by implant-related complications such as subacromial erosion and the necessity for removal. Despite measurable subsidence, several studies demonstrate that global shoulder scores often remain satisfactory, although patients may experience persistent pain, cosmetic dissatisfaction, or functional impairment that can prompt revision surgery. Current evidence suggests that re-displacement alone should not be considered an indication for reoperation; revision is best reserved for symptomatic patients or those with device-related complications. Standardized definitions of subsidence and consistent use of acromioclavicular-specific patient-reported outcome measures are essential to determine its true clinical relevance and to refine surgical decision-making.
Core Tip: Loss of reduction after surgical management of acromioclavicular joint injuries remains common across all fixation methods, yet its clinical relevance varies widely and is often poorly correlated with radiographic findings. This narrative minireview synthesizes current evidence to clarify how loss of reduction should be defined, why it occurs, which surgical and technical factors place patients at higher risk, and when revision reconstruction is truly justified. The minireview emphasizes that radiographs alone should not dictate management; instead, postoperative decision-making must integrate vertical and horizontal stability, tunnel accuracy, construct integrity, and the patient’s clinical symptoms and functional demands.
