Editorial Commentary: Allograft Acromioclavicular Joint Reconstruction Provides Long-Term Benefit for High-Grade Injuries in the Active Population but May Not Be Necessary for All Patients.

Acromioclavicular (AC) joint separations are a challenging injury to treat given that some patients do very well with conservative treatment whereas debilitating symptoms develop in other patients (particularly those with high-demand activity requirements) and surgical intervention is required. Surgical treatment for AC joint separations has traditionally carried a high risk of complications, most notably loss of reduction and recurrent instability. The advancement of arthroscopic techniques has allowed for less-invasive options with good functional outcomes, although the risk of recurrent instability remains. Type V injuries have traditionally been an indication for surgery in most cases, but recent evidence has suggested equivalent outcomes between conservative and surgical treatment for these injuries. Although arthroscopic allograft AC joint reconstruction can provide excellent patient outcomes, the jury is still out on whether surgery is necessary for all type V AC joint injuries, and it is important to provide patients individualized counseling and treatment while adhering to the classic medical principle of "first, do no harm."