What is AC Joint Reconstruction?
Acromioclavicular (AC) joint reconstruction is the surgical treatment often required for patients diagnosed with an AC joint separations and dislocations. Most often, AC joint injuries are caused by a traumatic fall on the tip of the shoulder. Symptoms of an AC joint injury include immediate pain and swelling, as well as decreased shoulder range of motion, function, and strength. The pain is caused from tearing the AC joint ligaments and supporting tissues. AC joint reconstruction surgery is the recommended treatment to repair a high grade AC joint injury. The surgery is typically done arthroscopically with the goal of restoring normal alignment to the AC joint, thus eliminating pain, and restoring normal function to the shoulder complex. Dr. Cunningham is a shoulder surgeon at Vail Summit Orthopaedics and Neurosurgery. He is an expert at diagnosing and treating AC joint injuries for patients in Vail, Aspen, Summit County, and Denver, CO.
When is Arthroscopic AC Joint Reconstruction Needed?
Low grade AC joint separations (Types 1 & 2) are treated non-surgically with rest, ice, the short term use of a shoulder sling, and gentle physical therapy to help restore range of motion and strength. Occasionally, an AC joint injection is used to decrease inflammation in the AC joint. For high grade AC joint injuries (Types 4,5 &6 and some Type 3 injuries), arthroscopic AC joint reconstruction surgery is needed. Otherwise, patients will experience chronic shoulder pain, weakness, as well as having an obvious bump and deformity over their AC joint.
Patients undergoing arthroscopic AC joint reconstruction for Ac joint separations typically report a high level of satisfaction post-operatively. The AC joint is reduced or aligned back to its normal position so that the torn ligaments can heal properly. After healing from surgery, patients are able to return to all their normal activities, including overhead sports and strenuous work.
What are the Different Shoulder Separation Surgery Techniques?
Typically, AC joint reconstruction surgery is done arthroscopically. The end of the clavicle is brought back down into its normal alignment within the AC joint and held in this position with strong suture material secured with two small, metal fixation devices. Often, a donor tendon or allograft is utilized to augment and support the torn ligaments so that they heal thicker and stronger than before the injury.
Certain types of AC joint injuries are treated through an open approach with the use of a special stainless steel plate called a “hook plate.” The hook plate is used to reduce, align and hold the joint back into its normal anatomic position so that the ligaments can heal normally. Depending on the nature of the injury and whether there was any pre-existing arthritis in the AC joint, a “Mumford” procedure may be performed. With a Mumford procedure, 8-10mm of bone is removed from the end of the clavicle so that there is no bone on bone contact that could continue to cause worsening arthritis in the AC joint and pain.
After surgery, most patients will experience excellent results and can expect to regain full shoulder range of motion, full strength, no pain, and a return to all activities.
How is AC Joint Reconstruction Performed?
Arthroscopic or open AC joint reconstruction is performed in an outpatient setting with patients going home the same day. Prior to surgery, a nurse will place an IV and administer some medications. A skilled anesthesiologist will typically perform a nerve block using ultrasound guidance, thus numbing all the nerves to your shoulder and upper extremity, so that when you awaken from surgery, you will have minimal pain. The patient is then brought into the operating room, transferred to the OR table, and drifted off to sleep with a light general anesthetic. The patient is positioned and the shoulder area is cleaned with a strong antimicrobial scrub solution. Sterile drapes are then used to drape out the steriley prepped shoulder.
An arthroscopic, which is about the size of a pencil, is introduced into the shoulder joint, and all the structures in the shoulder are inspected. If there is any other damage to the shoulder beyond the AC joint injury, this damage is also repaired. A small incision is then made over the top of the AC joint. A special guide is used to make a small drill hole down through the end of the clavicle and through a bone underneath the clavicle called the coracoid. Strong suture material is then threaded through this small drill hole and secured to the end of the clavicle and to the underside of the coracoid with two small metal fixation devices. A donor tendon is then placed alongside the torn ligaments and secured in place, as this donor tendon helps reinforce and strengthen the torn ligaments. Depending on the injury and whether arthritis is present, a Mumford procedure may be performed.
The entire surgical procedure is completed in 1 hour, although there is some additional setup and take down time in the operating room, so a patient may be in the OR for close to 2 hours. Following the surgical repair, the incisions are then closed with bioabsorbable suture material and then small tapes or steri-strips are applied to help hold the incisions together. A sling is then applied. The patient is awoken from surgery and brought to the recovery room. Most patients are on their way home after 2 hours in the recovery room when we confirm that one’s pain is controlled, and when patients are awake and alert, and when they can eat, drink, and urinate.
What is the Recovery After AC Joint Reconstruction?
As with most arthroscopic surgery, the initial recovery is relatively fast compared to open surgery. The rehabilitation of the surgical reconstruction itself will require a recovery period commensurate to the type, and extent of the procedure. Generally, recovery includes:
- Keeping the initial dressing in place and dry for 3 days. One can shower with a waterproof dressing over the wound site or take a bath with the shoulder kept dry in the first 3 days. After 3 days, all the dressings can be removed and discarded, the steri strips are left in place, and one can take a regular shower but not submerge the shoulder under water for 2 weeks from the date of surgery.
- Use of the sling for up to 8 weeks with prescribed limitations on shoulder mobility
- Immediately start elbow, wrist and hand exercises
- Come to our office for a wound check at 7 – 14 days from surgery
- Starting physical therapy if directed
- No Lifting for up to 8 weeks
- Restoring full shoulder range of motion by week 12 from surgery
- Low impact waist height tasks (keyboard, writing) during the first 12 weeks, then slow increased demand
- Shoulder and periscapular muscle strengthening at 10-12 weeks from surgery.
The majority of patients report return to their preferred activities and lifestyle choices. Dr. Cunningham is a shoulder surgeon at Vail Summit Orthopaedics. He is an expert at diagnosing and treating AC joint injuries for patients in Vail, Aspen, and Denver, CO.