Abstract The issue of managing type III acromioclavicular (AC) separa- tions remains controversial, and decisions about using opera- tive versus conservative man- agement have undergone many distinct changes over the years. To review current management preferences within the orthopedic community, we sent a mail-in sur- vey to all members of the American Orthopaedic Society for Sports Medicine (AOSSM) and approved Accreditation Council for Graduate Medical Education (ACGME) ortho- pedic program residency directors. Of the 664 respondents (577 AOSSM members, 87 directors), 81% (71/87 AOSSM members) to 86% (502/577 directors) continue to treat uncom- plicated type III AC separations conservatively. Providing a sling for comfort remains the preferred type of conservative management (AOSSM members, 91% [456/502]; directors, 89% [63/71]). For surgi- cal management, respondents rec- ommended resection of the distal clavicle slightly more often than not (AOSSM members, 57% [42/74]; directors, 59% [319/538]) and rigid stabilization of the AC joint during early postoperative rehabilitation (AOSSM members, 80% [444/555]; directors, 82% [61/74]). Finally, most recommended reconstructing either the coracoclavicular ligaments (69% [330/476] and 61% [33/54], respec- tively) or both the coracoclavicular ligaments and the AC ligaments (27% 130/476] and 33% [18/54]) when addressing this problem. Since the early 1990s, there has been little change in initial conserva- tive management of type III AC sep- arations. Furthermore, the surgical approach to reconstruction, when necessary, has also undergone rela- tively few changes, with the excep- tion of an increased preference for primary distal clavicle excision. A cromioclavicular (AC) injuries have been doc- umented as far back as 460 to 377 BC, when Hippocrates acknowledged the dif- ficulties and common misdiagnosis involving AC dislocation treatment. 1 Operative repair of AC dislocations was recorded beginning in 1861. 2 In 1974, Powers and Bach 3 described a complete AC dislocation as a rupture of the coracoclavicular ligaments, the AC ligaments, the joint capsule, and the fibers of the deltoid and trapezius aponeurosis. Powers and Bach used the injury classification of Tossy and colleagues 4 in a survey of orthopedic chairpersons. Of the respondents, only 9.5% preferred a nonoperative approach as treatment for this injury; of the 126 respondents preferring surgical treatment, 60% advocated fixation across the AC joint, and only 0.8% recommended immedi- ate excision of the distal clavicle. In 1992, choice of treatment meth- ods for AC injuries was the subject of another survey, by Cox. 5 Cox used the Rockwood and Green classifica- tion 6 to describe the AC dislocation. The type III AC dislocation involves a complete rupture of the AC liga- ments, the coracoclavicular ligaments, and the joint capsule. Cox received 187 responses from orthopedic pro- gram residency directors and 51 from orthopedic surgeons active in sports medicine and responsible for the care of collegiate and professional athletes. Results showed a dramatic reversal in treatment choices for type III AC inju- ries. Of the surveyed directors and sur- geons, 72.2% and 86.4%, respectively, advocated nonoperative treatment of the type III AC separation. Regarding nonoperative approaches, 28.1% of directors said they would use manual reduction and an AC immobilizer; the other 71.9% of directors advocated symptomatic treatment. Similarly, 33.3% of surgeons preferred manual reduction with an AC immobilizer; the other 66.7% chose symptomatic treat- ment. For required surgery, 27.7% of directors advocated fixation across the AC joint; the other 72.3% of directors preferred fixation across the coraco- clavicular space. Only 1 (3.6%) of 28 surgeons preferred fixation across the AC joint; the other 27 (96.4%) advo- cated fixation between the coracoid and the clavicle. Last, 21.8% of direc- tors and 33.9% of surgeons advocated primary excision of the distal clavicle for a type III AC dislocation. February 2007 89 ( aspects of trauma • an original study ) Type III Acromioclavicular Separation: Results of a Recent Survey on Its Management Carl W. Nissen, MD, and Abhishek Chatterjee, BA Dr. Nissen is Associate Professor of Sports Medicine, Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut. Mr. Chatterjee is Medical Student, University of Connecticut School of Medicine, Farmington, Connecticut. Requests for reprints: Carl W. Nissen, MD, Associate Professor, Connecticut Children’s Medical Center, 100 Simsbury Road, Suite 208, Avon, CT 06001 (tel, 860-674-0609; fax, 860-674-8111; e-mail, cnissen@ccmckids.org). Am J Orthop. 2007. 36(2):89 – 93. Copyright 2007 Quadrant HealthCom Inc.