The type of surgery you will need to stabilize your acromio-clavicular joint will depend on how acute your injury is. If you injured your AC joint less than four weeks ago then you may be able to have an arthroscopic (keyhole) repair. For chronic cases, where reconstruction of the ligaments rather than repair is needed, an open operation is performed. Both types of surgery are carried out under general anaesthesia with a nerve block and you can normally go home the same day, or the morning after your operation.
This is a keyhole operation. Three tiny holes allow access to the joint and a separate 2cm mini-open incision over is made over your collar bone to complete the fixation. Strong fibre-tapes are passed through a small drill hole in your collar bone and the coracoid process of your shoulder blade. The sutures are looped and tightened over small titanium buttons which pull the collarbone down to its correct position. This suture material holds your AC joint in place while the injured coraco-clavicular ligaments heal. The x-ray images below show the drill passing through the collar bone and coracoid and the completed repair. The surgical photographs show the main steps of the procedure. The last of these images shows the titanium washer securing the fibre-tape loops beneath the coracoid.
An incision is made over the top of your shoulder (see image of healed scar below) to expose your lateral clavicle and coracoid process. The medial part of your deltoid muscle is elevated and flipped off the lateral clavicle to allow exposure of the coracoid. A wafer of bone is resected from the damaged end of your clavicle and debris is cleared to allow the clavicle to be returned to its correct position. Very strong specially-woven Polyester rope (LARS ligament: see image below) is looped beneath the bony coracoid process of your shoulder blade and fixed through two holes in your collarbone with small screws. The remaining nylon rope is used to strengthen further the reconstruction. Sometimes a second implant (Internal Brace – a fibre-tape held with two suture anchors) is used to augment front-to-back stability.
You will normally go home the same day, or the morning after your operation. Please take your prescribed painkillers regularly for the first few days. You will need to wear your sling for four weeks after keyhole surgery, but must wear the sling for 6 weeks after open repair (to allow your deltoid muscle to heal) . You may take down any bulky padded dressings on day 3 after surgery, but keep the waterproof dressings on for 12 days. Showering is fine after four days following keyhole surgery, as long as your waterproof dressings are in place, If you’ve had open surgery, please keep your wound dry for 14 days. Sutures will need removal/trimming at 12-14 days after surgery. You will start strengthening at three months and progress to unrestricted use of the arm.
Patients vary in their symptoms after surgery, but in general you can expect to return to:
Overall 90% of patients will feel their shoulder is much better after AC joint stabilisation, although for some it may take several months to maximise their benefit.
You will be seen at two weeks after your operation and have an X-ray to confirm the reduction has been maintained. Thereafter your follow up will vary depending on your needs and your progress. Patients are typically ready for discharge by 6 months.
Shoulder surgery is generally safe, but specific risks of acromioclavicular joint repair/reconstructive surgery include:
Making the right choice about the best treatment for you means getting the right information. During your consultation, please do feel free to visit Kamala Devi Hospital to explain anything that you do not fully understand.
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