Acromioclavicular (AC) Repair/Reconstruction
Why AC Repair/Reconstruction
The patient is positioned in a sitting position on the operating room table and the arm is placed in an arm holder. A 1-2 inch incision is made over the top of the shoulder with 3 smaller incisions for the scope and arthroscopic instruments. The coracoid (small extension of the shoulder blade where the coracoclavicular ligaments attach) is exposed and a guide is positioned under the coracoid and on top of the clavicle (collar bone). A small cannulated drill is inserted through the guide from the clavicle down through the coracoid while viewing with the scope. A wire is inserted through the cannulated drill after the guide is removed. The wire is then used to shuttle strong sutures attached to a metal button, that is shaped like a dog bone, up through the small tunnel created in the coracoid and clavicle. A button is then attached to the sutures on top of the clavicle and the sutures are tensioned while the clavicle is reduced back to its normal position. If the AC sprain is more chronic (i.e. more than 3 weeks old) then an allograft (cadaver) tendon is used to reinforce the repair. This is shuttled around the collarbone and coracoid to reinforce the repair to reconstruct the ligaments that were torn. The wound is closed in multiple layers with absorbable sutures and sterile dressings are applied. The arm is placed into a sling. The surgery is performed under general anesthesia with a nerve block.
- This surgery is usually outpatient, which means the patient will be able to go home the same day.
- Surgery typically lasts 1-1.5 hours
- Patients will be fit for a sling at a preoperative appointment and this sling will be placed on the patient prior to waking up from anesthesia
- The sling is to be worn at all times until the nerve block has worn off. At that point, the arm should be removed from the sling at least three times a day for elbow, wrist, and finger motion.
Why AC Repair/Reconstruction
- Improve the position of the clavicle (collar bone) relative to the acromion reducing the deformity caused by the displaced clavicle.
- Decrease pain caused by the displaced end of the clavicle pushing on the overlying skin and muscle.
- Restore shoulder range of motion and function
- Return to work, sport, and activities with confidence
- Acute or chronic AC separation that is grade 5 or higher.
- Grade 3 separation in athletes/laborers that participate in repetitive overhead activities.
- Grade 3 sprain in patients with persistent pain after conservative treatment.
Patients are usually placed in a sling for 4 weeks postop. The sling may be removed for elbow, wrist, and finger movement by the first day after surgery. Physical therapy (PT) will start 2-3 weeks after surgery. Physical therapists follow a prescribed protocol outlined by Dr. Faulkner to regain range of motion and strength. Physical therapy and home exercises are a critical part of a patient’s outcomes and quality of life after surgery. Patients should expect to continue to improve with range of motion and strength up to 6 months after surgery, with most of the gains occurring within the first few months. Patients should plan on being seen in clinic about every 6 weeks until 5-6 months after surgery for close monitoring and to ensure any questions are answered. Radiographs will be taken at 2 weeks, 6 weeks, and 3 months from surgery to ensure the clavicle stays in the appropriate position and to monitor for any fractures. Most patients are cleared for full activity 5-6 months after surgery.
4 weeks. The sling should be removed at least 3x/day for elbow, wrist, and finger range of motion exercises as will be instructed. You should do pendulum exercises 3x/day as well.
No. Driving with a sling is considered driving impaired and could be subject to a citation.
Yes. You are also usually unaware of their arm movements at night. The sling helps to ensure that the arm stays in a good position for healing.
Physical therapy typically starts 2-3 weeks after surgery.
2 days after surgery. Once you remove the bandages, you will see 3 sticky white strips covering the wounds. These are called steri-strips and should be left in place until your first postoperative appointment.
The ice machine should be used for about 30 minutes at least 3 times a day until your first postop. You may ice more frequently if desired.
An anesthetic injection performed by the anesthesiologist to turn off pain signals that go to a targeted region.
This will be discussed at your preop appointment. If a narcotic is prescribed, the risks and side effects will be reviewed with you. We encourage you to try and discontinue these by your first postop appointment. Depending on your health history, it is encouraged to take anti-inflammatories and Tylenol instead of the narcotics.
The most common risk after this surgery is failure of the fixation used to stabilize the position of the distal clavicle. This causes recurrent deformity, but it almost never as severe as it was prior to the surgery. Other less common risks include infection, bleeding, arthritis, fracture of the coracoid or clavicle, stiffness, and nerve injury.