Acute acromioclavicular separations. A 20-year study.

One hundred and twenty-two acromioclavicular separations treated surgically at the Campbell Clinic from 1956 to 1976 have been studied. On group of 44 patients who had primary excision of the distal clavicle with repair of ligaments was compared with another group of 78 patients who had primary repair of the ligaments only. Of the original 122 patients (average age, 27 years; range, 12 to 64 years), 112 were male and 10 were female. Eighty-six of the 122 patients were reevaluated (average follow-up, 4.4 years; range, 1 to 16 years). No difference in the two groups was apparent in range of motion or in muscle power/weakness, as tested by resistive examination. There was no correlation between presence or amount of degenerative changes in the acromioclavicular joint and the patient's symptomatology. Of the group who had excision of the distal end of the clavicle, only 4.5% had degenerative joint disease as compared with 24.3% of the other group. Repair of the coracoclavicular and acromioclavicular ligaments, with a beveled excision of the distal 1 cm of clavicle, has been a successful and reliable method for treating Type III (complete disruption of acromioclavicular and coracoclavicular ligaments and tears of deltoid and trapezius muscle attachments from the clavicle) and some Type II (complete disruption of capsule and acromioclavicular ligaments) injuries.