The Acromioclavicular joint, also referred to as the 'AC joint' is the point where the clavicle (the collarbone), and the acromion part of scapula (the shoulder blade) meet.
In the vast majority of cases it is a sudden, sharp injury that causes the AC joint to separate, such as a fall or a blow to the shoulder, and is often seen in sports such as rugby, football and hockey or where someone has fallen off a horse or bicycle. In fact, men under 30 years of age engaged in sport account for a disproportionate number of cases.
It is sometimes, but not always, accompanied by fractures to the bones themselves.
It is a completely different injury to a shoulder dislocation, where head of the humerus bone comes out of the socket.
AC joint separations are classified into six different types, which in very general terms indicate the degree of severity of the injury, although some do indicate very specific movements of the bones and ligaments. Type 3 and above injuries may need surgical treatment.
There are a range of surgical approaches to acromioclavicular joint reconstruction. The common approaches involve reconnecting the joint using a loop suture or sutures supported by buttons. Some techniques also use an artificial ligament (often referred to as LARS ligaments) or a tendon graft
(usually hamstring tendon).
Dr Sunil Reddy routinely uses multiple strands of strong 2 mm tape (Fibertape) and bone-buttons to repair acute injuries and uses a hamstring tendon graft from the thigh for chronic injuries.
Postoperative recovery and rehabilitation
Dr Reddy as well as the Physiotherapist will see you on day 1 following surgery and demonstrate exercises to be performed at home as well as advise on things to do and not to do.
It is important that you follow the advice and rehabilitation guidelines to give yourself the best chance of recovery and an optimal outcome.
- You would likely have a regional/nerve block for pain management apart from a general anaesthetic.
- You would usually stay in the hospital overnight.
- Please take regular pain medication as advised.
- Apply Ice packs 3-5 times, for 10 min each time for the first two weeks.
- You will need to wear the sling for 4 weeks, but remove it thrice daily for 15-20 minutes each time to perform exercises. Avoid active forward elevation for 4 weeks as this may affect the deltoid repair.
- Please remove the sling for a shower, resting your arm by the side. The dressings are waterproof.
- After 4 weeks – You can cease the use of sling. Progress with exercises as advised by your therapist.
- Strengthening exercises usually start after 10-12 weeks following surgery.
- Avoid lifting weights and push-pull movements for 3 months following surgery.
- Driving is permitted once you come out of the sling and have achieved good control of the arm and a pain-free status. This is usually by the 4-week postoperative period.
- Return to work or sport is individualised according to severity of injury and post-operative recovery. Contact sport is discouraged for up to 6 months following reconstruction.
- Please follow your therapist’s advice regarding exercises and follow the rehabilitation guidelines that you can view/download below.