A schema of treatment of the three types of acromioclavicular injuries, based
[See table in the PDF file]
on pathological change in each, is presented. Type-I injuries are those with direct trauma to the acromioclavicular joint without significant ligamentous tears or intability. Type-II injuries are those with acromioclavicular ligamentous injury and instability but without disruption of the coracoclavicular ligaments. Type-III injuries are those with complete clavicular instability and disruption of both sets of ligaments.
Type-I injuries are treated expectantly when seen early, and when seen late, with acromioclavicular arthritis, they are treated by resection arthroplasty. Expectant treatment is advocated for early Type-II injuries while late symptomatic Type-II separations are treated by resection arthroplasty of the acromioclavicular joint.
Those patients with acute and chronic Type-III injuries are treated surgically by a new operation which combines resection arthroplasty of the acromioclavicular joint with fixation of the clavicle in an anatomical position by suture of the acromial end of the shortened coraco-acromial ligaments into the medullary canal of the clavicle. The results in both acute and chronic cases, fifteen in number, have been quite good.
From the Division of Orthopedic Surgery, University of New Mexico School of Medicine, Albuquerque, and the Division of Orthopedic Surgery, University of Utah College of Medicine, Salt Lake City