How are most acute AC separations managed in practice?

• A. Nonoperative management with sling for Grades I-III; surgery for higher-grade injuries (IV-VI) or persistent symptoms
• B. Immediate surgery for all
• C. Physical therapy only
• D. Casting for all

Answer: (A)

In acute AC separations, treatment is guided by how severely the ligaments are torn and how much the clavicle is displaced. For most injuries that are mild to moderate (grades I–III), nonoperative management with a sling provides comfortable immobilization while the ligaments heal, followed by structured rehabilitation to restore range of motion and strength. This approach works well because the damage is often limited to the AC ligaments, with the coracoclavicular (CC) ligaments intact or only minimally involved, allowing functional recovery without the risks of surgery.

Surgery is reserved for more severe injuries (grades IV–VI) where there is marked displacement and substantial disruption of both the AC and CC ligaments, as well as for cases with persistent symptoms or instability after an initial trial of nonoperative care. In these high-grade injuries, operative stabilization aims to anatomically reconstruct the ligaments and restore AC/CC stability, which improves pain, function, and the ability to return to high-demand activities.

So, the best approach in practice is nonoperative for less severe injuries (with a sling) and surgical intervention for higher-grade injuries or when symptoms persist despite nonoperative treatment.