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ACJ Grade III How I treat it

ACJ Grade III How I treat it. Mr Lee Van Rensburg GEASS Munich October 2011. Allman – Grade III. JBJS B Vol 49-A, NO. 4, JUNE 1967. Rockwood. Rockwood et al; The Shoulder. 1998: p. 483-553.). Rockwood. AC ligaments disrupted ACJ dislocated CC ligaments disrupted

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ACJ Grade III How I treat it

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  1. ACJ Grade IIIHow I treat it Mr Lee Van Rensburg GEASS Munich October 2011

  2. Allman – Grade III JBJS B Vol 49-A, NO. 4, JUNE 1967

  3. Rockwood Rockwood et al; The Shoulder. 1998: p. 483-553.)

  4. Rockwood • AC ligaments disrupted • ACJ dislocated • CC ligaments disrupted • CC interspace > than normal shoulder • (25-100% more than the normal shoulder) • Deltoid and trapezius muscles usually detached from the distal end of the clavicle • Delto trapezial fascia intact • Type V • CC 100% to 300% more than normal Rockwood et al; The Shoulder. 2004: p. 533

  5. Non Operative

  6. Non operative • Relative rest • Sling comfort • ROM • Nothing heavier than cup of tea 6/52 • No contact sport 3/12 • F/U 6/52 • Salvage • Modified Weaver Dunn • 4 strands 1 PDS

  7. Allman – Grade III JBJS B Vol 49-A, NO. 4, JUNE 1967

  8. 2011 2011 J Shoulder Elbow Surg (2011) 20, S70-S82

  9. Sling 3 to 4 weeks • ROM exercises followed by progressive strengthening • Rehabilitation protocols should be followed diligently • inadequate rehabilitation can be a source of persistent pain and instability of the ACJ • Return to sports once • Full, painless range of motion • May require 3 months J Shoulder Elbow Surg (2011) 20, S70-S82

  10. Favourable outcome in 80% of patients at 1 and 5 years • Functional deficits are minimal, • Strength similar to that of the contralateral shoulder • 1 report of 17% loss of bench press strength • Persistent ACJ tenderness, instability, shoulder stiffness, and cosmetic deformity may require surgery J Shoulder Elbow Surg (2011) 20, S70-S82

  11. Chronic acromioclavicular separation: the medium term results of coracoclavicular ligament reconstruction using braided polyester prosthetic ligament. • Chronic acromioclavicular disruption • Eleven men • Average age of 39 • Follow up 55 months • 10 patients achieved a good/ excellent result • 1 patient had fracture of the base of the coracoid after heavy lifting in the early postoperative period which resulted in a poor outcome. • 2 patients needed an additional operation • Excision of the lateral end of the clavicle and removal of screw • ASD Injury. 2007 Nov;38(11):1247-53

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