What would be the most effective

management of an
acromioclavicular joint (AC)
injury in collegiate lacrosse?

Allison Funk
 BACKGROUND
• AC joint injuries were the most common of all
shoulder injuries in collegiate lacrosse (50%).1
• AC joint injuries are characterized according to
severity; Type I-VI.2
 Grade I and II are ligamentous strains, partial tearing of the supporting
ligaments, and minimal displacement of the distal clavicle.2
 Grade III through VI are complete disruption of both the AC joint and
capsule and the coracoclavicular (CC) ligaments.2
• Two treatment options:3
 Nonoperative
 Operative
• Limited data available regarding injury type and
consequences that follow in lacrosse.4
 CLINICAL FINDINGS

• Type I and II lesions recommend for conservative

treatment.3
 Return within 1 week (44%) or 2 weeks (24.4%)1
• Type III dislocation treatment is uncertain.3
• Grade IV, V, and VI operative treatment is the
accepted method.3
• NCAA have rules to regulate proper equipment
for all players except the goalkeeper
 Must wear shoulder and arm pads
 CLINICAL APPLICATION

• Shoulder is the most mobile joint in the human

body.5
• Treat AC joint injuries case-by-case
 An athlete with type IV-VI, should undergo surgery to be
have a better possibility to return to their preinjury
intensity level of participation in lacrosse.2
 Conservation treatment can hinder the ability to
compete at the preinjury level if chosen to not proceed
with AC joint reconstruction due to existing shoulder
dysfunction.2
 CLINICAL APPLICATION
CONTINUED
• Pros and cons to each management
technique:
 Patients who undergo the nonoperative option are
typically returning to play after 6 to 12 weeks.2
 Surgical management cases take longer to recover
due to the postoperative immobilization period
followed by rehabilitation
• Do what is best for the athlete!
 IMPLICATION FOR CLINICAL
PRACTICE
• Educate those on proper equipment fitting
 Coaches, parents, players, equipment staff, and
medical staff.
• Can be applied to all levels of lacrosse
• Overall, overhead contact and collision
sports that tend to wear shoulder and/or
arm pads
 FUTURE RESEARCH

• Design more supportive shoulder and arm

pads
• Definite treatment option for type III
dislocations
QUESTIONS?
 REFERENCES

1. Gardner E, Chan W, Sutton K, Blaine T. Shoulder injuries in men’s

collegiate lacrosse, 2004-2009. AM J Sports Med. 2016;
44(10):2675-2681.
2. Petri M, Warth R, Greenspoon J, et al. Clinical results after
conservative management for grade III acromioclavicular joint
injuries: Does eventual surgery affect overall outcomes?
Arthroscopy. 2016; 32(5):1-7.
3. Beitzel K, Cote M, Apostolakos J, et al. Current concepts in the
treatment of acromioclavicular joint dislocations. Arthroscopy. 2013;
29(2):387-397.
4. Webb M, Davis Caroline, Westacott Daniel, et al. Injuries in elite
men’s lacrosse: An observational study during the 2010 world
championships. Orthop J Sports Med. 2014; 2(7):1-7.
 REFERENCES

5. Van Lancker H, Martineau P. The diagnosis and treatment of

shoulder injuries in contact and collision athletes. Orthop Trauma.
2012; 26(1):1-11.