AC Joint Repair

What is an AC (acromioclavicular) joint injury?

The acromioclavicular (AC) joint is one of three joints located within the shoulder and is the most frequently injured shoulder joint. The AC joint is formed from the connection between the clavicle (collarbone) and the acromion, the highest portion of the scapula (shoulder blade). An AC joint injury occurs when the acromion becomes separated from the clavicle. These injuries are graded according to the severity of the injury. They can range from a mild separation, where the connecting ligaments are simply stretched, to a complete rupture of the ligaments from their attachment sites. Blunt force trauma directly to the shoulder often results in more severe injuries. Aggressive contact sports, such as wrestling or football, or a motor vehicle collision can cause a complete rupture of the AC joint capsule.  Dr. Benedict Nwachukwu, orthopedic shoulder doctor, treats patients in Manhattan, New York City, and the surrounding New York boroughs who have suffered an AC joint injury and are in need of a surgical repair.

What is the treatment for an AC joint separation?

The severity of injury to the AC joint capsule and surrounding ligaments is the criteria for grading AC joint injuries:

• Grades 1-3 AC joint separation are classified as stretching of the ligaments or mild sprains with minimal joint displacement. These minor injuries can often be treated with conservative measures alone. A combination of joint immobilization, rest, ice, and non-steroidal anti-inflammatory medications (NSAIDs) can provide pain and inflammation management during the healing process.
• Grades 4-6 AC joint separation are classified as the complete disruption of the AC joint capsule and typically are more severe injuries. If an injury falls into this classification, or if conservative therapy is unsuccessful, surgical intervention to realign the clavicle with the acromion may be required. This is accomplished by securing the AC joint capsule back to its original anatomical position.

How is an AC joint repair performed?

Surgical repair of the acromioclavicular joint is typically performed as an outpatient procedure that does not require an overnight hospital stay. Prior to the procedure, the patient is placed under general anesthesia. Once stabilized, Dr. Nwachukwu will make a number of small incisions surrounding the AC joint. A small camera (arthroscope) is inserted through one of the portals to analyze the bones, ligaments, and tendons of the AC joint. A sterile solution is continuously circulated throughout the joint as well to enhance the visualization of these structures. The images from the arthroscope are transmitted to a screen for Dr. Nwachukwu to methodically examine the conditions to be addressed. Specialized surgical instruments are then introduced to excise and remove the damaged tissue fragments. The healthy ligament portions that remain are fastened back into the original anatomical position.

To realign the clavicle with the acromion, a tissue graft from a donor (allograft) is fastened to the anterior (front) portion of the shoulder and anchored to the clavicle. The donor tissue graft and repaired ligaments are fastened with special surgical anchors that are secured within the bone. Medical sutures can be positioned through the screws to protect the tissue grafts in the healing process as well as strengthen the repaired ligaments. When the necessary revisions are complete, the arthroscope and surgical instruments are removed, and the incisions are closed with steri-strips or sutures.

What is the recovery period like after AC joint repair?

The recovery period following an acromioclavicular joint repair depends on the severity and complexity of the AC joint injury. Most patients can expect a full recovery with a return to normal daily activities in approximately 3 to 4 months. A patient’s willingness to comply with the post-operative care instructions provided by Dr. Nwachukwu can largely affect the recovery process. In general, patients in New York can expect immediate immobilization of the AC joint following surgery. This sling may be worn for up to 6 weeks to properly heal the AC joint. A combination of rest, ice, and non-steroidal anti-inflammatory medications (NSAIDs) are encouraged for pain and inflammation management. The key to a successful recovery is active participation and completion of the physical rehabilitation program set forth by Dr. Nwachukwu. This physical therapy program will be focused on re-establishing shoulder strength and improving range of motion.