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Introduction: Acromioclavicular (AC) joint separation is a leading cause of shoulder injury among athletes. High grade injuries may require operative fixation, and comprehensive return to play guidelines have not yet been established. The purpose of this investigation is to summarize return to play criteria following operative management of AC joint separation.

Methods: A systematic review of the literature was performed to evaluate clinical evidence regarding return to play following operative management of isolated AC joint separation. Studies satisfying inclusion criteria were analyzed for return to play timeline and other factors used to guide return to play following surgery.

Results: Sixty-three studies with at least 1 explicitly stated return to play criterion were identified out of an initial database search of 1,253 published articles. Eight separate categories of return to play criteria were identified, the most common of which was time from surgery (95.2%). Return to play timelines ranged from 2 – 12 months, the most common timeline being 6 months (37.8%). Only 4 (6.3%) studies utilized conditional criteria to guide return to play, among which included range of motion, strength, clinical stability, radiographic stability, functional assessment, safety assessment, and hardware removal.

Discussion: Most published studies utilize only time-based return to play criteria, and only a small number of studies employ patient-centered conditional criteria. While this systematic review helps provide a foundation for developing a comprehensive return to play checklist, further investigation is needed to establish safe and effective guidelines that will enable athletes to safely return to sport and minimize the recurrence of injury.