AC Joint Surgery: Procedures, When It's Needed, and Recovery

What is the name of the surgery for AC joint?

Surgical interventions for acromioclavicular (AC) joint injuries do not have a single, universal name but rather encompass various procedures tailored to the specific type and severity of the injury, often involving reconstruction or stabilization techniques of the ligaments supporting the joint.

Understanding AC Joint Injuries

The acromioclavicular (AC) joint is located at the top of the shoulder, where the collarbone (clavicle) meets the highest part of the shoulder blade (acromion). It is stabilized by two sets of ligaments: the acromioclavicular (AC) ligaments, which connect the clavicle directly to the acromion, and the stronger coracoclavicular (CC) ligaments (conoid and trapezoid), which connect the clavicle to the coracoid process of the scapula.

Injuries to the AC joint, commonly known as AC joint separations or sprains, result from direct trauma to the shoulder, such as a fall onto the tip of the shoulder or a direct blow. These injuries are classified using the Rockwood classification system, which categorizes them into six types based on the degree of ligamentous tearing and displacement of the clavicle relative to the acromion:

• Type I: AC ligament sprain, no significant tearing or displacement.
• Type II: AC ligament tear, CC ligaments sprained but intact; mild superior displacement of the clavicle.
• Type III: Complete tears of both AC and CC ligaments; significant superior displacement of the clavicle.
• Type IV: Type III injury with posterior displacement of the clavicle into or through the trapezius muscle.
• Type V: Type III injury with marked superior displacement of the clavicle, often through the deltoid and trapezius fascia.
• Type VI: Inferior displacement of the clavicle, rare.

When is Surgery Considered for AC Joint Injuries?

While Type I and II AC joint injuries are typically managed non-surgically with rest, ice, and rehabilitation, surgical intervention is often considered for higher-grade separations (Type III and above), especially in active individuals or athletes, or when conservative treatment fails to restore stability and function. The decision for surgery depends on several factors:

• Severity of Injury: High-grade separations (Type III-VI) with significant clavicular displacement.
• Patient Activity Level and Occupation: Athletes or individuals requiring overhead arm use may benefit more from surgical stabilization.
• Chronic Instability or Pain: Persistent symptoms despite appropriate non-surgical management.
• Cosmetic Deformity: Though usually secondary, significant deformity can be a factor for some patients.

Common Surgical Procedures for AC Joint Injuries

There isn't one single "name" for AC joint surgery, as various techniques are employed depending on the specific injury pattern, surgeon preference, and patient factors. The goal of these procedures is generally to stabilize the clavicle relative to the acromion and coracoid process, restoring the integrity of the AC and/or CC ligaments.

Here are the most common surgical approaches and techniques:

• Coracoclavicular (CC) Ligament Reconstruction/Repair:

  • This is the most common category of procedures for Type III and higher separations. The CC ligaments are crucial for vertical stability of the AC joint.
  • Direct Repair: In very acute cases, the torn ends of the CC ligaments may be directly repaired, though this is less common due to the often frayed nature of the tears.
  • Reconstruction with Suture Button Devices: Modern techniques often involve using strong sutures passed around the coracoid process and through drill holes in the clavicle, secured with buttons on both sides. Examples include the TightRope™ (Arthrex) or LockDown™ (Smith & Nephew) systems. These provide immediate stability while allowing for biological healing.
  • Reconstruction with Allograft/Autograft: For more chronic or severe cases, a tendon graft (either from the patient, e.g., hamstring, or from a donor) may be used to reconstruct the torn CC ligaments, recreating the natural ligamentous complex. This is often combined with suture button fixation.
  • Weaver-Dunn Procedure (Modified): This classic procedure involves transferring the coracoacromial ligament (a different ligament in the shoulder) from the acromion to the distal clavicle to reconstruct the superior AC ligament. It is often augmented with CC ligament reconstruction techniques or internal fixation.

• Distal Clavicle Excision (DCE) or Mumford Procedure:

  • This procedure involves surgically removing a small portion (typically 5-10mm) of the end of the clavicle.
  • It is primarily indicated for chronic AC joint arthritis (osteoarthritis) or impingement, often after trauma, rather than acute ligamentous tears. It creates space between the clavicle and acromion to relieve pain and improve motion.
  • It can be performed as an open procedure or arthroscopically.

• AC Joint Stabilization with Internal Fixation:

  • Historically, pins, screws (e.g., Hagie pins), or plates were used to directly fix the AC joint. However, these methods often required a second surgery for hardware removal and carried risks of hardware failure or migration. They are less commonly used as primary fixation methods today but may be used in specific complex cases or as temporary stabilization.

Surgical Approach:

• Open Surgery: Involves a larger incision over the shoulder, allowing direct visualization of the joint and ligaments.
• Arthroscopic Surgery: Minimally invasive, using small incisions and a camera (arthroscope) to visualize the joint. Many modern CC ligament reconstructions can be performed arthroscopically or with arthroscopic assistance, leading to smaller scars and potentially faster initial recovery.

Goals of AC Joint Surgery

The primary goals of AC joint surgery are to:

• Restore Anatomical Alignment: Correct the displacement of the clavicle.
• Provide Stability: Reconstruct or repair the torn ligaments to prevent recurrent displacement.
• Reduce Pain: Alleviate chronic pain associated with instability or arthritis.
• Improve Function: Restore full range of motion and strength, allowing return to desired activities.

Recovery and Rehabilitation After AC Joint Surgery

Recovery from AC joint surgery typically involves an initial period of immobilization in a sling (4-6 weeks), followed by a progressive rehabilitation program. This program focuses on:

• Early Motion: Gentle passive and assisted range of motion exercises.
• Strengthening: Gradual strengthening of the shoulder and scapular muscles.
• Proprioception and Stability: Exercises to improve joint awareness and control.
• Return to Activity: Sport-specific or work-specific drills, typically allowing return to full activity between 4-6 months, depending on the procedure and individual progress.

Adherence to the prescribed rehabilitation protocol is critical for optimal surgical outcomes.

Potential Risks and Complications

As with any surgical procedure, AC joint surgery carries potential risks, including:

• Infection
• Bleeding
• Nerve or blood vessel damage
• Stiffness or limited range of motion
• Persistent pain or instability
• Hardware failure or prominence (if applicable)
• Re-injury or re-separation

Consulting a Specialist

If you suspect an AC joint injury or are experiencing chronic shoulder pain, it is crucial to consult with an orthopedic surgeon or sports medicine specialist. They can accurately diagnose the injury, discuss the various treatment options—both surgical and non-surgical—and recommend the most appropriate course of action based on your specific condition and lifestyle.