Which Rockwood AC joint separation grades are typically managed nonoperatively?

• A. I-II
• B. III-VI
• C. II and IV
• D. IV

Answer: (A)

Mild AC joint injuries heal well without surgery because the joint remains stable when the coracoclavicular ligaments are intact. In the lowest grades, the ligaments are sprained (Grade I) or partially torn with stable alignment (Grade II), so conservative care works best: brief sling immobilization, pain control, and a gradual return to range of motion and strengthening as symptoms allow. Once both the AC and the coracoclavicular ligaments are disrupted and the clavicle is more markedly displaced (Grade III) or beyond (Grades IV–VI), the joint loses stability and the typical approach shifts toward operative stabilization to restore anatomy and function. Therefore, the grades typically managed nonoperatively are Grade I and Grade II.