Acromioclavicular Joint Chronic Dislocation Repair (Weaver-Dunn Procedure)

1. Introduction

The acromioclavicular (AC) joint, located at the top of the shoulder, plays a vital role in upper limb mobility and stability. It connects the clavicle (collarbone) to the acromion (part of the scapula or shoulder blade). Injuries to this joint, especially dislocations, are common among athletes and individuals who sustain falls or direct shoulder trauma. While acute AC joint dislocations can often be managed conservatively, chronic dislocations—especially those that do not heal or result in persistent instability—require surgical intervention. One of the widely accepted surgical treatments for chronic AC joint dislocations is the Weaver-Dunn procedure.

2. What is the Weaver-Dunn Procedure?

The Weaver-Dunn procedure is a ligament reconstruction technique aimed at restoring stability to the AC joint in cases of chronic dislocation. The technique involves resecting a portion of the distal clavicle and transferring the coracoacromial (CA) ligament to the clavicle to mimic the function of the original coracoclavicular (CC) ligaments. This surgical procedure is typically indicated when non-surgical management has failed, and there is persistent pain or dysfunction in the shoulder joint.

Indications

The Weaver-Dunn procedure is generally considered for patients with the following conditions:

• Chronic AC joint dislocations (Grade III–VI) according to the Rockwood classification.
• Failure of conservative treatments such as rest, physical therapy, and bracing.
• Persistent shoulder pain and functional limitation.
• Cosmetic deformity causing psychological or aesthetic concerns.
• Professional or recreational athletes needing full shoulder function.

Procedure Details

The surgical steps of the Weaver-Dunn procedure include:

Pre-operative Preparation

• Imaging: X-rays, MRI, or CT scans to assess joint alignment and ligament damage.
• Anesthesia: General or regional anesthesia is administered.

Surgical Steps

1. Incision and Exposure: A small incision is made over the AC joint to expose the distal clavicle and coracoacromial ligament.
2. Distal Clavicle Resection: A section (typically 1–2 cm) of the distal clavicle is removed to prevent bone-on-bone contact and relieve pain.
3. Ligament Transfer:
   • The coracoacromial ligament is detached from the acromion.
   • It is then sutured and fixed to the distal end of the clavicle, simulating the role of the coracoclavicular ligament.
4. Fixation:
   • Various fixation methods may be used, such as screws, suture anchors, or graft augmentation (using synthetic or biological grafts).
5. Closure: The soft tissue and skin are closed in layers.

Optional Enhancements

Some surgeons prefer to use biologic grafts or synthetic materials to augment the CA ligament transfer and improve long-term joint stability.

Effectiveness

The Weaver-Dunn procedure has shown positive outcomes in most patients, particularly in terms of:

• Pain relief
• Improved shoulder stability
• Restoration of shoulder function
• Enhanced cosmetic appearance

Studies have reported a success rate of over 85%, especially when augmented with grafts or internal fixation. Athletes and physically active individuals typically return to their previous activity levels within 6–9 months.

Risks and Side Effects

Like all surgical procedures, the Weaver-Dunn operation carries potential risks and complications, such as:

• Infection
• Persistent instability
• Failure of ligament transfer
• Clavicle fracture
• Hardware irritation or failure
• Loss of shoulder range of motion
• Neurovascular injury (rare)

The risk of complications can be minimized with proper surgical technique and adherence to post-operative protocols.

Recovery and Aftercare

Immediate Post-operative Period (0–2 Weeks)

• Shoulder immobilization with a sling.
• Pain management using medications.
• Wound care and infection prevention.

Early Rehabilitation (2–6 Weeks)

• Gradual initiation of passive range-of-motion exercises.
• Avoidance of lifting or overhead activities.

Intermediate Phase (6–12 Weeks)

• Active range-of-motion and strengthening exercises.
• Physical therapy to restore function.

Late Phase (3–6 Months)

• Sport-specific or work-related training.
• Return to full activity is generally permitted after 6 months, depending on recovery.

Cost and Availability

The Weaver-Dunn procedure is widely available in countries with advanced orthopedic or sports medicine services. The cost can vary based on:

• Hospital type (private vs public)
• Use of grafts or advanced implants
• Surgeon experience
• Duration of hospital stay
• Insurance coverage

Many countries offer it as part of their orthopedic surgery packages, often bundled with physiotherapy and diagnostics.

Patient Experiences

Most patients who undergo the Weaver-Dunn procedure report:

• Satisfactory pain relief
• Improved shoulder strength
• Enhanced quality of life

Athletes often return to competitive sports, and manual workers regain their ability to lift and perform overhead tasks. A small percentage may require revision surgery due to persistent instability or pain. Patient satisfaction tends to be higher when the procedure is performed by an experienced shoulder surgeon and is followed by structured rehabilitation.

Cost in Various Countries

Note: Prices may vary significantly depending on the hospital, implant type, and post-operative care.

Frequently Asked Questions (FAQ)

Q1. How long does the surgery take?

Typically, the procedure takes 60–90 minutes, depending on the complexity and surgical technique.

Q2. Is the surgery performed arthroscopically or open?

The traditional Weaver-Dunn is an open procedure, though arthroscopically assisted versions exist for less invasive recovery.

Q3. What is the success rate?

The procedure has a success rate of 85–90%, especially with proper rehab and graft augmentation.

Q4. Will I regain full shoulder function?

Most patients regain excellent shoulder mobility and strength, especially if they follow rehabilitation protocols diligently.

Q5. Is the Weaver-Dunn procedure permanent?

Yes, it is intended to be a permanent solution. However, in rare cases of reinjury or graft failure, revision surgery may be needed.

Q6. Can the procedure be done on both shoulders?

Yes, but typically not at the same time. If both shoulders are affected, they are usually operated on sequentially.

The Weaver-Dunn procedure is a tried and trusted surgical solution to chronic AC joint dislocations that provides long-standing stability and symptomatic relief. Patient outcomes continue to improve due to improvements in surgical methods as well as care post-surgery.

Although the procedure has some risks involved, the advantage of regained function and less discomfort makes it an acceptable choice for those who are unsuccessful with conservative methods. Patients must select highly qualified orthopedic surgeons and adhere to an intensive rehabilitation regimen to achieve optimal outcomes.