This narrative review by Cote and Mazzocca presents a criterion-based rehabilitation framework for all grades of acromioclavicular joint separation. It covers nonoperative management for grades I-III and postoperative rehabilitation after anatomic coracoclavicular reconstruction (ACCR) for grades IV-VI. Progression is driven by biology and patient response, not fixed time points.
When a patient with a grade III AC separation sits in your clinic, the default answer is not surgery. Over 80% of AOSSM members and orthopedic residency directors choose conservative management first, and systematic reviews show comparable outcomes between operative and nonoperative treatment with higher complication rates in the surgical group.
Prescribe a formal 6-12 week rehabilitation trial focused on scapular stabilization. If your patient shows meaningful improvement by 6 weeks, continue rehab through 12 weeks and return to activity. If there is little to no response by 6 weeks, that is your trigger to offer ACCR.
For grades IV, V, and VI, go straight to ACCR. Post-ACCR, keep the patient in a Lerman platform brace for 6-8 weeks and hold all isotonic strengthening until 12 weeks — this is not arbitrary caution, it reflects the point at which tendon-to-bone tunnel healing shifts from pull-out failure to midsubstance failure in the biological literature.
The SICK scapula classification (scapular malposition, inferior medial winging, coracoid tenderness, dyskinesis) is the relevant assessment tool here. 70% of chronic grade III patients have dyskinesis, and those patients score worse on every functional outcome measure.
This narrative review by Cote and Mazzocca presents a criterion-based rehabilitation framework for all grades of acromioclavicular joint separation. It covers nonoperative management for grades I-III and postoperative rehabilitation after anatomic coracoclavicular reconstruction (ACCR) for grades IV-VI. Progression is driven by biology and patient response, not fixed time points.
When a patient with a grade III AC separation sits in your clinic, the default answer is not surgery. Over 80% of AOSSM members and orthopedic residency directors choose conservative management first, and systematic reviews show comparable outcomes between operative and nonoperative treatment with higher complication rates in the surgical group.
Prescribe a formal 6-12 week rehabilitation trial focused on scapular stabilization. If your patient shows meaningful improvement by 6 weeks, continue rehab through 12 weeks and return to activity. If there is little to no response by 6 weeks, that is your trigger to offer ACCR.
For grades IV, V, and VI, go straight to ACCR. Post-ACCR, keep the patient in a Lerman platform brace for 6-8 weeks and hold all isotonic strengthening until 12 weeks — this is not arbitrary caution, it reflects the point at which tendon-to-bone tunnel healing shifts from pull-out failure to midsubstance failure in the biological literature.
The SICK scapula classification (scapular malposition, inferior medial winging, coracoid tenderness, dyskinesis) is the relevant assessment tool here. 70% of chronic grade III patients have dyskinesis, and those patients score worse on every functional outcome measure.