This document summarizes a study on AC joint separations and associated intra-articular shoulder pathology. The study reviewed 18 patients with AC separations requiring repair and found that 61% had some form of intra-articular pathology like SLAP tears, partial RCT tears, or full RCT tears. The conclusion is that AC separations have a high rate of concurrent intra-articular injuries, so MRI or arthroscopy before AC joint repair is recommended to identify any additional pathology.

1. AC Separations
Alan M. Hirahara, M.D., FRCS(C)
Board Certified in Orthopaedic Surgery & Orthopaedic Sports Medicine
Specializing in arthroscopic shoulder surgery
Medical Director Team Physician Consultant
Sacramento State Athletics Sacramento River Cats Oakland A’s
MiLB - AAA

2. Shoulder Separation

3. AC Separations Have a High
Incidence of Associated Intra-
Articular Pathology
Alan M Hirahara, MD, FRCSC

4. Study
• Retrospective study design
• 18 patients with an AC separation requiring repair
– 11/05 – 3/12
• Results
– 61% of patients had some form of intra-articular pathology
– 22% had no intra-articular pathology
– 17% were never investigated so were unknown

5. Distribution of Pathology
10
10
9
8
7
6
5
4
3
3
2
2
1 1 1
0
SLAP pRCT RCT Ant Instability Post Instability

6. Discussion
• Tischer & Imhoff, AJSM 37(1), 2009, 136-9.
– High incidence of associated injuries with type
III–V AC separations (77 patients in 5 yrs)
• 14% SLAP
• 4% RCT
• 5% fracture

7. Conclusion
• High association of intra-articular pathology
with AC separations
• MRA or diagnostic arthroscopy is
recommended prior to AC repair or
reconstruction to avoid

8. Screw Fixation

9. Hook Plate

10. CC Ligament Reconstruction

11. CC Ligament Reconstruction

12. CC Recon with Post-op Fracture

13. TightRope
• 4 mm hole
• Risk of coracoid fx

14. GraftRope
• 6 mm hole
• Risk of coracoid fx

15. Dog Bone
• 3 mm hole

16. Ultimate Load Comparison
350
300
250
200
(lbf)
150
100
50
0
Native Ligament AC TightRope Dog Bone (1 Tape) Dog Bone (2 Tapes)

17. Portal Placement
• Portals
– Posterior
– Anterior
– Anterolateral

18. Arthroscopic Dog Bone

19. Thank You!