Acromioclavicular joint (AC joint) injury repair

The acromioclavicular (AC) joint is a minor joint at the shoulder’s superior aspect, where the acromion (portion of the scapula or shoulder blade) joins the clavicle (collarbone). Although small, the AC joint is vital for shoulder motion and stability, particularly with overhead or cross-body motions.

AC joint injuries are relatively common, especially in contact sports players like rugby, football, and ice hockey, or those that fall on the shoulder. The injuries can be from mild sprains to full dislocations. Minor injury may be treated conservatively with rest and physical therapy, but more severe ones necessitate surgical fixation to reestablish joint function and pain relief.

What is acromioclavicular joint (AC joint) injury repair?

The treatment for AC joint injuries depends on the severity of the injury, usually classified from Type I (minor sprain) to Type VI (severe dislocation with associated injuries). Surgical repair is generally recommended for Type IV to Type VI injuries and sometimes for persistent pain in Type III cases.

Surgical options include:

• Open or arthroscopic repair

• Weaver-Dunn procedure

• Coracoclavicular ligament reconstruction

• Use of synthetic materials or tendon grafts

The aim of surgery is to realign the joint, reconstruct torn ligaments, and ensure long-term stability of the shoulder.

Indications of acromioclavicular joint (AC joint) repair

Surgical repair of the AC joint is typically indicated in the following scenarios:

• Complete AC joint dislocation (Types IV-VI)

• Persistent pain or dysfunction after conservative treatment in Type III injuries

• High physical demand patients (e.g., athletes or laborers)

• Cosmetic deformity that affects quality of life

• Associated fractures or injuries around the shoulder

Procedure Details

AC joint repair surgery can be performed using open or minimally invasive (arthroscopic) techniques. The surgeon’s approach depends on the injury’s severity, the patient’s anatomy, and the surgeon’s preference.

Preoperative Preparation
Patients typically undergo imaging studies, including X-rays, MRI, or CT scans, to assess the extent of the injury. General anesthesia is used, and the procedure typically takes 1-2 hours.

Surgical Techniques

1. Weaver-Dunn Procedure
   A traditional method that involves transferring the coracoacromial ligament to the clavicle to reconstruct the torn coracoclavicular ligaments.

2. Anatomic Coracoclavicular Ligament Reconstruction
   Uses tendon grafts (often from the hamstring or allograft) to mimic the natural ligaments. These grafts are passed around the coracoid and clavicle to restore alignment.

3. Fixation Devices
   Techniques using metal or synthetic implants, screws, or suture buttons (like TightRope or Dog Bone techniques) are employed to stabilize the clavicle to the coracoid process.

Postoperative Protocol
A sling is usually worn for 4-6 weeks. Gradual physical therapy follows to regain range of motion, followed by strengthening exercises. Full recovery can take 4-6 months.

Effectiveness of acromioclavicular joint (AC joint) injury repair

The outcomes of AC joint repair surgery are generally positive. Studies report:

• High rates of pain relief and return to previous activity levels

• Significant improvement in shoulder strength and stability

• Cosmetic improvement in deformity

• Low rates of recurrence or re-dislocation with modern techniques

Minimally invasive methods, like arthroscopic repair and modern fixation devices, have shown excellent outcomes with fewer complications, faster recovery, and less postoperative pain.

Risks and Side Effects

As with any surgical procedure, AC joint repair carries certain risks:

• Infection at the surgical site

• Hardware-related irritation or failure

• Graft failure or non-healing

• Re-dislocation or persistent instability

• Stiffness or reduced range of motion

• Nerve injury (rare)

• Need for revision surgery

Careful patient selection, precise surgical technique, and adherence to rehabilitation protocols reduce these risks substantially.

Recovery and Aftercare

Recovery following AC joint repair is a structured process:

• Weeks 1–6: Immobilization in a sling to protect the joint

• Weeks 6–12: Gentle range-of-motion exercises under supervision

• Months 3–4: Strengthening exercises and gradual return to daily activities

• Months 5–6: Return to sports or physically demanding activities, depending on recovery

Pain management typically includes NSAIDs and ice therapy. Patients are advised to avoid lifting heavy objects or overhead movements until fully recovered. Compliance with physical therapy is crucial for optimal outcomes.

Cost and Availability

AC joint repair is widely available in orthopedic centers and specialized sports medicine clinics around the world. The cost of the procedure depends on several factors:

• Country and healthcare system

• Type of hospital (private vs public)

• Surgical technique and implants used

• Surgeon’s expertise

• Length of hospital stay

• Postoperative physiotherapy

In general, the procedure is more affordable in Asian countries like India and Thailand, while costs in countries like the USA and Israel can be significantly higher due to hospital charges and insurance systems.

Patient Experiences

Patients who undergo AC joint repair typically report high levels of satisfaction, especially those with severe injuries. Common sentiments include:

• Relief from chronic pain and discomfort

• Improved shoulder mobility and function

• Enhanced quality of life

• Return to sports and work with confidence

However, some patients may experience prolonged stiffness or residual discomfort if rehabilitation is not followed diligently. A small percentage may require revision surgery due to hardware issues or persistent instability.

Testimonial examples:

• “After my AC joint surgery in Seoul, I was back on the tennis court within 5 months. The pain was gone, and I had full strength in my shoulder again.”

• “The procedure in India was professional and affordable. My rehab was slow but worth every step.”

Cost acromioclavicular joint (AC joint) injury repair in different countries

FAQ

Is surgery the only option for AC joint injuries?
No, mild to moderate injuries (Types I-III) often respond well to conservative treatment, including rest, ice, physiotherapy, and pain medications.

When is surgery most recommended?
Surgery is strongly considered for high-grade dislocations (Types IV-VI), failed conservative management in Type III injuries, or for patients with high functional demands.

How long does the surgery take?
The procedure typically takes 60 to 120 minutes depending on the technique used.

Will I need to remove the hardware later?
Some implants, especially metallic ones, may need removal if they cause irritation. However, many modern devices are bio-compatible and can be left in place.

Can I return to sports after surgery?
Yes, most patients return to their previous level of activity within 4 to 6 months post-surgery with proper rehabilitation.

Is the surgery painful?
Pain is usually well managed with medications and ice therapy. Long-term pain relief is one of the primary goals of the surgery.

Conclusion

Acromioclavicular (AC) joint injuries can significantly impact an individual’s quality of life, especially if left untreated in moderate to severe cases. Surgical repair offers an effective and often permanent solution to restore stability, function, and strength in the shoulder. With advancements in surgical techniques and implants, the outcomes of AC joint repair have improved dramatically.

For patients experiencing chronic shoulder pain or instability due to AC joint injuries, timely evaluation and discussion with an orthopedic surgeon are crucial. Whether you’re an athlete aiming to return to peak performance or someone simply seeking a pain-free lifestyle, AC joint repair may be a worthwhile step toward full recovery.