AC Joint Reconstruction (Shoulder Separation) Surgery Overview

A procedure aimed at addressing acromioclavicular (AC) joint injuries, commonly known as shoulder separations. This condition typically occurs when the clavicle separates from the acromion, often due to trauma from sports or falls. Surgical intervention may be recommended when conservative treatments, such as rest, ice, and physical therapy, fail to alleviate pain or restore function. During the surgery, the surgeon repositions the separated bones and stabilises the joint using sutures, screws, or plates, aiming to restore shoulder strength and mobility. Post-surgery rehabilitation is crucial for achieving optimal recovery and facilitating a return to daily activities and sports.

a 3D illustration of a shoulder AC joint being repaired with anchors and sutures

Step-by-Step Breakdown of AC Joint Reconstruction Surgery

  1. Preoperative Evaluation

    • Comprehensive assessment of the patient’s medical history.

      Conduct physical examinations and imaging studies (X-rays or MRI) to determine the severity of the shoulder separation (AC joint injury).

      Discuss the need for surgery and appropriate consent forms are signed.

  2. Anesthesia Administration

    • The patient is typically given general anaesthesia, but regional anaesthesia may also be an option depending on the case.

  3. Surgical Positioning

    • The patient is positioned on the operating table, usually in a semi-reclined position, to provide optimal access to the shoulder.

  4. Surgical Approach

    • An incision is made over the top of the shoulder, above the acromioclavicular (AC) joint.

  5. Exposure of the Joint

    • The layers of tissue, including skin, subcutaneous tissue, and fascia, are carefully dissected to expose the AC joint.

  6. Identification of Injury

    • The surgeon identifies the damaged ligaments and assesses the degree of separation.

  7. Reconstruction

    • Repair of the torn ligaments.

    • Techniques may include:

      • Anchoring the ligament back to the clavicle.

      • Using sutures or anchors to secure the ligaments in their proper position.

      • Some cases may require the use of grafts from other tissues if significant repair is necessary.

  8. Reduction of the Joint

    • The clavicle is carefully repositioned to align with the acromion and restore normal anatomy.

  9. Stabilisation

    • Temporary fixation devices (e.g., pins or screws) may be used to maintain the proper position during the healing process.

  10. Closure

    • The layers of tissue are carefully closed:

      • Sutures or staples are used for the deeper layers.

      • The skin is sutured or closed with adhesive strips.

  11. Postoperative Care

    • The patient is moved to a recovery area to monitor vital signs as they wake from anaesthesia.

    • Pain management strategies are discussed.

    • Instructions regarding arm immobilisation in a sling, and follow-up appointments are provided.

  12. Rehabilitation

    • A rehabilitation plan is established, typically starting with passive range of motion exercises followed by progressive strengthening as healing allows.

  13. Follow-Up Evaluations

    • Regular follow-up appointments to monitor healing and recovery progress, adjusting the rehabilitation protocol as needed.

This straightforward outline covers the fundamental steps in AC joint reconstruction surgery. Each case may require specific adjustments based on individual circumstances.