Acromioclavicular and sternoclavicular joint injuries in contact sports: a narrative review of conservative and surgical treatments.

Background and Objective: Acromioclavicular (AC) joint sprain and sternoclavicular (SC) joint injuries commonly occur in contact athletes due to the direct-blow mechanism of injury. Despite the high prevalence in this patient population, a small degree of literature on AC and SC joint injuries specifically pertain to contact athletes. The goal of this narrative review is to analyze the literature pertaining to AC and SC joint injuries in both contact athletes and the general population and to provide treatment recommendations specifically for the contact athlete. Methods: A review of PubMed and MEDLINE was completed to identify articles reporting on the surgical and nonoperative treatment of AC and SC joint injuries in athletes. In this initial screen, the authors excluded general reviews, case reports, duplicate studies between databases and publications in languages other than English. The quality of included studies was assessed using the Methodological Index for Nonrandomized Studies (MINORS). The authors then conducted a search for studies comparing non-operative to operative treatment of AC and SC joint injuries, in addition to studies comparing between operative technique. Key Content and Findings: Non-operative management of AC and SC joint injuries offer an acceptable return-to-play timeline. Despite persistent pathologic radiographic appearance in certain cases of non-operative management, clinical outcomes are generally equivalent between athletes treated non-operatively as compared to operatively. In cases of a failed course of nonoperative treatment, surgical management can achieve high return-to-sport rates, though is generally associated with longer recovery intervals. Despite mechanism of injury, rate of successful return to previous level does not appear to correlate with degree of contact in a sport, but instead with overhead demand of the sport. Conclusions: Contact athletes with AC and SC joint injuries should be trialed with a course of nonoperative management, even in higher grade injuries, with some exceptions. Athletes should be appropriately counseled, with particular attention paid to positions requiring increased overhead demand. When surgery is required, non-rigid anatomic fixation allows for a high rate of return to sport with less complications compared to rigid fixation.