Subsidence following surgical stabilization of acromioclavicular joint injuries: Should we be concerned?

Figure 1 Rockwood and Green classification for acromioclavicular joint injuries. Schematic representation of the six injury grades based on ligamentous disruption and clavicular displacement.

Figure 2  Radiographic and anatomical measurements. A: Coracoclavicular interval measurements used to assess acromioclavicular joint (ACJ) reduction. Coracoclavicular distance (CCD) of the contralateral normal side (A) and the injured side (B) are demonstrated; CCD difference is calculated as (B minus A), and CCD ratio as (B divided by A); B: Assessment of clavicular tunnel positioning following ACJ reconstruction. The clavicular tunnel ratio is obtained by dividing the distance from the lateral clavicular border to the center of each bone tunnel by the total clavicular length; C: ACJ subluxation ratio. The ratio is determined as (D/A) × 100%, where D is the perpendicular distance from the inferior clavicle to the inferior acromial tangent line, and A is the perpendicular height of the acromion at its midline; D: Measurement of ACJ widening. Widening is calculated as the mean of the superior and inferior clavicle-to-acromion distances (A and B), compared with corresponding measurements on the contralateral shoulder. DCTP: Distance from the lateral clavicular border to the center of each bone tunnel.

Figure 3 Clinical decision algorithm for evaluating and managing postoperative loss of reduction after acromioclavicular joint stabilization. A stepwise flowchart guiding assessment of symptoms, radiographic thresholds, and indications for revision. ROM: Range of motion.