Nonoperative Treatment of Low-grade AC Joint Injuries in Pediatric Athletes.

BACKGROUND

Pediatric acromioclavicular (AC) joint injuries are rarely reported, and data on return-to-sport rates (RTS) in this population are limited. This study aims to characterize management strategies and return-to-sport outcomes following AC joint injuries in pediatric athletes, addressing a gap in the current literature.

METHODS

Patients under 18 years of age who sustained an AC joint injury between March 1, 2014, and March 1, 2024, were identified using databases from a large tertiary referral hospital and a large children's hospital. Extracted data included patient demographics, injury patterns, management approaches, and RTS status.

RESULTS

A total of 108 patients (110 shoulders) were included (74% male; mean age, 12.77±2.13 ​​​​​y; range 8 to 17 years). Low-grade injuries accounted for 95% of cases, and all injuries were managed nonoperatively. Sling immobilization was used in 40%, physical therapy (PT) in 29%, rest in 17%, and a combination of sling and PT in 15%. The most common mechanisms were football (29, 26%), motor vehicle collisions (11, 10%), and soccer (10, 9%). At least 48% (52) of patients had documented return-to-sport dates, with the median RTS time being 21 days (IQR 14 to 49.45​​​​​ d). Concomitant injury was associated with a longer RTS time (HR 0.33, 95% CI 0.16-0.69, P =0.003).

CONCLUSIONS

In this cohort of pediatric athletes, AC joint injuries were predominantly low-grade and managed nonoperatively. Of the patients with documented follow-up and RTS, the median RTS time was 3 weeks. These findings reinforce the favorable prognosis of nonoperative treatment for low-grade injuries in this population. Given the rarity of pediatric AC joint injuries and the limited published data, reporting these outcomes is essential to guide evidence-based management in pediatric sports medicine.

LEVEL OF EVIDENCE: IV: retrospective cohort study.