How are most acute acromioclavicular (AC) separations treated?

• 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)

Acute acromioclavicular separations are treated based on how severe the ligament injury and displacement are. Most injuries are mild to moderate (grades I–III) and heal well with nonoperative care—immobilization in a sling to protect the joint, pain control, and then a progressive rehab program to restore range of motion and strength. For more severe injuries (grades IV–VI), or when symptoms persist after initial nonoperative treatment, surgical stabilization is considered to restore normal joint alignment and prevent long-term dysfunction. The other options propose universal surgery, or rely on therapy or casting for all cases, which doesn’t fit how treatment is tailored to injury severity.