Subsidence following surgical stabilization of acromioclavicular joint injuries: Should we be concerned?

Subsidence, or loss of reduction, is a recognized concern following surgical stabilization of acromioclavicular joint injuries and remains a source of debate regarding its clinical importance and implications for revision. This minireview synthesizes the available evidence on the incidence of postoperative subsidence, the diverse radiological criteria used to define it, and its correlation with functional outcomes. Reported rates vary widely, from 15% to 80%, reflecting differences in fixation methods, surgical technique, and follow-up duration. Suspensory button systems and graft reconstructions are particularly prone to early loss of reduction, whereas hook plates tend to preserve initial alignment but are limited by implant-related complications such as subacromial erosion and the necessity for removal. Despite measurable subsidence, several studies demonstrate that global shoulder scores often remain satisfactory, although patients may experience persistent pain, cosmetic dissatisfaction, or functional impairment that can prompt revision surgery. Current evidence suggests that re-displacement alone should not be considered an indication for reoperation; revision is best reserved for symptomatic patients or those with device-related complications. Standardized definitions of subsidence and consistent use of acromioclavicular-specific patient-reported outcome measures are essential to determine its true clinical relevance and to refine surgical decision-making.