Acromioclavicular (AC) joint separations are injuries to the ligaments at the joint where the clavicle (collarbone) attaches to the acromion (roof of the shoulder) of the scapula (shoulder blade). These ligaments attach the clavicle to the acromion and to the coracoid, another part of the scapula.
AC joint separations are graded one through six, from least to most severe. The goal of surgery is to restore the normal relationship of the clavicle to the acromion and repair or reconstruct the injured acromioclavicular and coracoclavicular ligaments.
What Is Acromioclavicular (AC) Joint Reconstruction/Repair?
AC joint reconstruction or repair is performed to restore the normal position of the clavicle relative to the acromion and repair the ligaments damaged by an AC joint separation.
Dr. Chudik reconstructs the ligaments between the coracoid and clavicle, called the coracoclavicular ligaments, and repairs the ligaments between the acromion and clavicle, called the acromioclavicular ligaments.
A tendon graft, usually a hamstring tendon from the knee, is used to replace the torn ligaments. The reconstruction is also reinforced with internal fixation using a small anchor in the bone and strong sutures to help maintain proper alignment while the repaired or reconstructed ligaments heal.
Who Is a Candidate?
Patients with high-grade four through six AC joint injuries and some grade three injuries may require early surgery.
Patients with continued symptoms after proper non-operative management of lower-grade one through three AC injuries may also be candidates for surgery.
Ongoing infection may need to be treated with surgery and antibiotics before AC joint reconstruction or repair can be performed.
How the Procedure Is Performed
AC joint reconstruction or repair is performed as outpatient surgery, allowing patients to go home the same day. General anesthesia with an interscalene block is used.
Dr. Chudik properly positions the clavicle relative to the acromion and reconstructs the coracoclavicular ligaments between the coracoid and clavicle. He also repairs the acromioclavicular ligaments between the acromion and clavicle.
A tendon graft, usually a hamstring tendon from the knee, is used to replace the torn ligaments. A small bone anchor and strong sutures reinforce the repair or reconstruction and help maintain proper alignment of the AC joint while the ligaments heal.
For chronic injuries greater than six weeks old, or when cartilage in the AC joint is damaged, surgery also includes removal of just under 1 cm of bone from the end of the clavicle to prevent the ends of the bones from rubbing together and causing pain.
Recovery and Rehabilitation
Following surgery:
- The shoulder is restricted in a sling for six weeks to protect the repair and allow it to heal.
- The sling is worn at all times except for bathing, dressing, and exercises, including while sleeping.
- Patients may feel more comfortable sleeping upright on a couch or recliner.
- The wound should remain clean and dry for 10 to 14 days following open surgery.
- Light showering may begin after 14 days, but the wound should not be submerged under water for three weeks.
- Driving may resume after six weeks and once the patient is out of the sling.
- Patients may return to school or sedentary work in less than one to two weeks as long as the sling is worn and use of the operative arm is limited.
- Physical therapy should begin two to three days after surgery and continue for four to six months.
- Strengthening must be delayed for nine to 12 weeks following surgery to allow the ligaments to heal properly.
The success of AC joint reconstruction is highly dependent on postoperative rehabilitation, making it important to follow and maintain the prescribed therapy schedule.
Return to activity depends on the type of activity, sport, and position, as well as whether the injured arm is dominant or non-dominant. At least four to six months is required after surgery before returning to sports or strenuous labor. Full shoulder motion and strength are necessary before returning to these activities.
Risks and Outcomes
Potential surgical risks and complications include:
- Infection
- Rare injury to nerves of the shoulder, arm, forearm, or hand, which may cause numbness, weakness, or paralysis
- Stretching of the reconstructed ligaments with loss of reduction, joint separation, and recurrence of the deformity
- Breakage of internal fixation devices
- Erosion or fracture of the clavicle
- Shoulder stiffness, which is uncommon
- Persistent pain with overhead activities
- Need for revision surgery
Why Dr. Chudik for Acromioclavicular (AC) Joint Reconstruction/Repair
Dr. Chudik restores the normal relationship of the clavicle to the acromion while repairing the acromioclavicular ligaments and reconstructing the coracoclavicular ligaments.
His repair uses a tendon graft along with internal fixation using a bone anchor and strong sutures to reinforce the reconstruction and help maintain proper AC joint alignment while the repaired tissues heal.