AC Joint Reconstruction
What is it?
AC joint reconstruction is a surgical procedure used to stabilize the AC joint in patients who have sustained a significant AC separation. An AC joint separation is a common injury which is typically sustained from a traumatic fall onto the shoulder. It is common in cyclists, football players, and other contact athletes but can happen to anyone who falls hard directly onto their shoulder. Injuries can involve the AC joint ligaments only. More severe injuries also tear the ligaments between the corocoid and the clavicle (CC ligaments). Tearing of these ligaments results in greater displacement of the AC joint. Many patients can manage their injury non-operatively, however, in some patients with significantly displaced AC joints, surgery can be warranted.
Can it be treated without surgery?
Many AC separations can be treated without surgery. The decision to pursue surgery is dependant on many factors such as the amount of displacement of the AC joint, patient age, patient activity level, and the chronicity of the injury. Non-operative management involves a progressive rehabilitation program focused on strengthening the supporting muscles of the shoulder and shoulder blade. Many patients, including high level athletes, can have sucessful management of their injury without surgery long as their AC joint is not severely displaced.
What are the risks?
The surgery itself is generally very safe. There is very little blood loss and very low risk of infection. There are the general risks of anesthesia, however, usually just a light anesthetic needs to be used because most patient elect to have their arms numbed with a nerve block during the surgery. The biggest risk of the surgery is that the AC joint destabilizes again after surgery. Usually this happens to a much smaller degree than the original injury and the shoulder is still better than prior to surgery, however, the cosmetic deformity and some residual shoulder dysfunction can persist.
How do I know if I have an AC separation?
Patients with and AC separation have pain localized to the top of their shoulder. There can be a prominant bump over the AC joint. Some patients experience pain and clicking within the shoulder with overhead motion. Separating the AC joint usually takes a relatively significant fall onto the shoulder, so most patients know exactly when it was injured.
Examination and x-rays are typically all that is needed to diagnose an AC separation. An MRI may be ordered in some in order to detect any associated injuries to the shoulder.
How is the surgery performed?
The type of surgery performed depends on the chronicity of the tear, and how easily the separation can be reduced. In acute injuries (<4 weeks) with AC joints that can be reduced, the procedure can be performed arthroscopically without a "reconstruction" of the ligaments. Recently torn ligaments can "scar" together recreating a functional ligament.
In more chronic injuries (>4 weeks), Our approach is to preform a reconstruction of the ligaments. This involves use of a cadaver tendon, or sometimes one of your own tendons, to recreate the torn ligaments and stabilize the AC joint. Sometimes the end of the collar bone is also trimmed back some to prevent the development of arthritis between this bone and the end of the acromion.
What is the recovery like?
The surgery itself is typically done as an outpatient so you will be discharged to home the same day. You will remain in a sling at all times for several weeks after surgery (Up to 8 weeks) except while performing gentle range of motion exercises. After 8 weeks, you can discontinue sling use and start to work on shoulder strengthening. After 12 weeks you will no longer have specific restrictions on your shoulder although the rehabilitation will continue to work on functional strengthening. Higher level activities can be attempted 4-6 months after surgery.