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A Novel Non-Operative Protocol for the Acute Management of In-Season Acromioclavicular Separations

      Introduction

      Acromioclavicular (AC) joint separations are a common injury in contact athletes. Historically, treatment of these acute injuries have focused on rest, sling immobilization, anti-inflammatory medication, and a gradual return to sporting activities. We have developed a novel treatment protocol utilizing a corticosteroid injection and a static scapular retraction and stabilization brace to anatomically reduce the AC joint and safely and quickly return these athletes to the playing arena.

      Methods

      Data was prospectively collected and retrospectively reviewed on the in-season management of all football acromioclavicular separations at an NCAA division I university. Inclusion criteria were all consecutive in-season AC separations sustained during football activities that requiring medical attention. Exclusion criteria include fractures, glenohumeral dislocations, rotator cuff tears, nerve injuries, other concomitant shoulder injuries, and injuries sustained during the last game of the season. The end points measured were number of games missed and time to full return to play.

      Results

      During seven football seasons (2008-2014), 56 acromioclavicular separations occurred. Fifty-two are included in the current study. Full return to play averaged 5.7 days (range 0-31 days), and athletes missed 0.25 games (range 0-3 games). Quarterbacks missed the most time. After an AC separation to the throwing shoulder, the quarterback missed a mean 26 days (range 22-31 days) and 3 games. After an AC separation to the non-throwing shoulder, the quarterback missed a mean 7.3 days (range 4-9 days) and 0.6 games (range 0-1 games).

      Conclusion

      This study describes a specific non-operative protocol for in-season management of AC injuries. The unique aspect of this protocol is the use of a static, 3-point brace to rotate and reduce the entire forequarter back to the clavicle, utilizing fracture reduction principals. This anatomically reduces the AC joint, alleviates pressure on the rotator cuff, and allows athletes to safely and quickly return to play.