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.