5. AC Ligaments
Superior AC Lig = 56% Posterior Translation
Posterior AC Lig = 25% Posterior Translation
Klimkiewikcz
Superior AC Lig = Rotational Stability
Branch et al.
Urist, JBJSA. 1946 5
7. AC Ligaments
Attaches over 2.6cm of clavicle in men, 2.3cm in
women
Renfree & Wright
6
8. AC Ligaments
Attaches over 2.6cm of clavicle in men, 2.3cm in
women
Renfree & Wright
(1.5cm - Hearnden 2012)
6
9. AC Ligaments
Attaches over 2.6cm of clavicle in men, 2.3cm in
women
Renfree & Wright
(1.5cm - Hearnden 2012)
No difference if superior or inferior AC lig. cut
(horizontal, vertical & rotatory)
Branch et al. AJSM 1996
6
10. AC Ligaments
Attaches over 2.6cm of clavicle in men, 2.3cm in
women
Renfree & Wright
(1.5cm - Hearnden 2012)
No difference if superior or inferior AC lig. cut
(horizontal, vertical & rotatory)
Branch et al. AJSM 1996
Superior & Posterior not capable of stabilising
clavicle - 32% incr. of posterior translation after
Ant & Inf capsular resection
Corteen & Teitge
6
16. Failed ACJ Excision (Strauss et al. 2010)
Common Causes Less Common Causes
Instability Distal Clavicle Fracture
Under Resection Suprascapular neuropathy
Over Resection Other Cause
- Neck pain, SLAP, etc.
Stiffness (29%)
Bony regrowth
Untreated Concomitant
Pathology
Infection
12
17. Failed ACJ Excision (Strauss et al. 2010)
Common Causes Less Common Causes
Instability Distal Clavicle Fracture
Under Resection Suprascapular neuropathy
Over Resection Other Cause
- Neck pain, SLAP, etc.
Stiffness (29%)
Bony regrowth
Untreated Concomitant
Pathology
Infection
12
18. Failed ACJ Excision (Strauss et al. 2010)
Common Causes Less Common Causes
Instability Distal Clavicle Fracture
Under Resection Suprascapular neuropathy
Over Resection Other Cause
- Neck pain, SLAP, etc.
Stiffness (29%)
Bony regrowth
Untreated Concomitant
Pathology
Infection
12
21. Clavicle Excision
11mm excision should not violate the
Trapezoid ligament in 98%
Renfree & Wright
14
22. Clavicle Excision
11mm excision should not violate the
Trapezoid ligament in 98%
Renfree & Wright
>10mm excision detaches 10% of the
Trapezoid ligament
Boehm et al. Acta Orth Scand. 2003
14
23. Clavicle Excision
11mm excision should not violate the
Trapezoid ligament in 98%
Renfree & Wright
>10mm excision detaches 10% of the
Trapezoid ligament
Boehm et al. Acta Orth Scand. 2003
High incidence of post-op pain if >10mm
resected
Eskola et al. JBJS 1996
14
24. Clavicle Excision
Only 5mm of the distal clavicle needs to be
resected to ensure that no bone-to-bone
contact occurs in rotation
Corteen & Teitge
Edwards et al. Arthroscopy 2007
15
25. Recommended:
Resect 5mm on clavicle side & acromial
side
Corteen & Teitge
16
26. Also:
Post-op pain correlates with Translation,
but not amount of bone resected
Blazar et al. CORR. 1998
No difference if superior or inferior AC lig.
cut (horizontal, vertical & rotatory instability)
Branch et al. AJSM 1996
17
The acromioclavicular joint has dual innervation from both the suprascapular nerve and the lateral pectoral nerve. Reprinted from the article “Injuries to the Acromioclavicular Joint” by DeLee, Drez, and Miller in the book Delee & Drez’s Orthopaedic Sports Medicine: Principles and Practice, p. 916, Copyright 2003, with permission from Elsevier.\n\n