Practical management of grade III acromioclavicular separations

Acromioclavicular joint (AC) injuries are common in the young athletic population. There is general agreement that grade I and grade 11 separations are best managed nonoperatively, whereas grades IV to VI warrant surgical stabilization. In contrast, considerable controversy exists surrounding the best method of treatment for grade III AC separations. The trend in recent literature is toward the initial nonoperative management of these injuries. However, consideration of other factors such as type of sport, timing of injury relative to athletic season, or the throwing demands in an injured dominant arm may play a role in the decision to treat grade III injuries operatively or nonoperatively. We offer a protocol algorithm for treating grade III AC separations for managing this controversial injury.