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Updated: Mar 6, 2026

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Heterotopic Ossification After Acute Acromioclavicular Joint Dislocation-Effect on Radiographic and Clinical

Larissa Eckl1,2,3, Jonas Pawelke3, Philipp Vetter2

  • 1Sports Orthopedics Section, TUM Klinikum rechts der Isar, Munich, Germany.

Orthopaedic Journal of Sports Medicine
|March 5, 2026
PubMed
Summary

Heterotopic ossification (HO) after acromioclavicular (AC) joint dislocations is common but usually mild. Severity in the conoid ligament area (CLA) correlated with better outcomes, while trapezoid ligament area (TLA) severity correlated negatively.

Keywords:
acromioclavicular jointcomplicationinstabilitysuture button stabilization

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Area of Science:

  • Orthopedic Surgery
  • Sports Medicine
  • Traumatology

Background:

  • Heterotopic ossification (HO) is a frequent occurrence following treatments for acute acromioclavicular (AC) joint dislocations.
  • HO is often regarded as a complication, necessitating further investigation into its impact.

Purpose of the Study:

  • To compare the severity and configuration of HO after single-suture button (SSB) and double-suture button (DSB) stabilization versus nonoperative treatment for Rockwood (RW) type V injuries.
  • To investigate the association between HO extent, vertical stability, and clinical outcomes.

Main Methods:

  • A cohort study (Level of evidence, 3) included 85 patients with acute RW type V AC joint dislocations treated with SSB, DSB, or nonoperatively.
  • HO was assessed via anteroposterior stress radiographs in the conoid ligament area (CLA) and trapezoid ligament area (TLA), graded for severity and configuration.
  • Radiographic and clinical outcomes, including the Taft score (TF), were evaluated at a mean 44-month follow-up.

Main Results:

  • HO occurred in 71.3% (CLA) and 58.7% (TLA) of patients, with no significant group differences in incidence or severity.
  • HO was predominantly mild and clavicular across all treatment groups.
  • Severity of HO in the CLA positively correlated with higher TF scores (B = 0.902; P = .003), while TLA severity showed a negative correlation (B = -0.823; P = .034).

Conclusions:

  • HO after AC joint dislocation treatment is common but typically mild and does not significantly affect most radiographic or clinical parameters.
  • The term 'complication' for HO should be used cautiously, as its clinical impact appears limited.
  • HO severity in the CLA may be associated with better functional outcomes, contrasting with TLA HO severity.