What is Acromioclavicular (AC) Joint Reconstruction?
Acromioclavicular (AC) joint reconstruction is a surgical procedure used to repair or stabilize the AC joint, which is located at the top of the shoulder where the collarbone (clavicle) meets the shoulder blade (scapula). This joint is crucial for shoulder movement and stability, but it can be damaged through injury, trauma, or repetitive stress.
An AC joint injury may involve a sprain, dislocation, or tear of the ligaments that connect the clavicle and the acromion (a bony projection on the scapula). In cases where conservative treatments (e.g., rest, physical therapy) do not relieve symptoms, or in cases of severe injury, AC joint reconstruction may be necessary to restore function and alleviate pain.
Why is AC Joint Reconstruction Needed?
AC joint reconstruction is typically recommended for the following conditions:
- AC Joint Separation or Dislocation: This occurs when the ligaments connecting the clavicle and the acromion are torn, often due to a fall, direct blow, or trauma (such as a car accident or contact sports injury).
- Chronic AC Joint Pain: Long-term pain from previous injuries or arthritis in the AC joint may be unresponsive to nonsurgical treatments like physical therapy, anti-inflammatory medications, or injections.
- Ligament Rupture: When the ligaments that stabilize the AC joint are severely damaged or completely ruptured, the joint becomes unstable.
- Severe AC Joint Degeneration or Osteoarthritis: Over time, the AC joint can wear down, causing pain and limiting shoulder function. If conservative treatments fail, surgery may be needed.
How is AC Joint Reconstruction Performed?
AC joint reconstruction can be performed using open surgery or arthroscopy (minimally invasive surgery). The exact technique used will depend on the type and severity of the injury, as well as the surgeon’s preference.
The Procedure:
- Anesthesia: The procedure is usually performed under general anesthesia, though regional anesthesia may be used in some cases to numb the shoulder and arm.
- Incision: A small incision is made over the AC joint, or multiple small incisions are made if using arthroscopic surgery.
- Ligament Reconstruction: The surgeon removes any damaged or degenerated tissue and reconstructs the ligaments that stabilize the joint, often using tissue from a tendon (usually from the patient’s own body) or synthetic materials. Sometimes, a graft (such as a tendon or ligament from another part of the body or from a donor) is used to reconstruct the AC joint ligaments.
- Repositioning the Clavicle: If the collarbone (clavicle) has been displaced or dislocated, the surgeon may reposition it to restore the natural alignment of the joint.
- Fixation: The reconstructed ligaments are fixed in place using screws, plates, or other devices to secure the joint and allow the tissues to heal.
- Closure: After the reconstruction, the incisions are closed with sutures, and the shoulder is bandaged.
The surgery typically takes about 1 to 2 hours, depending on the complexity of the case.
Post-Surgery Care and Recovery:
After the surgery, you will be moved to a recovery room for observation as the anesthesia wears off. The recovery process typically includes:
Immediate Post-Surgery (First Few Days):
- Pain Management: You may experience pain, swelling, and discomfort around the shoulder, which can be managed with prescribed pain medications, ice packs, and rest.
- Sling or Immobilizer: You will likely be required to wear a sling or shoulder immobilizer to keep the joint stable and prevent movement during the healing process.
- Physical Therapy: Your surgeon will provide instructions regarding physical therapy. Rehabilitation begins early in the recovery phase to ensure that you regain range of motion and prevent stiffness.
Rehabilitation Phases:
- Phase 1 (0-6 weeks): The focus is on pain management, reducing swelling, and protecting the repair site. During this phase, you will wear a sling to keep the shoulder stable. Limited movement may be permitted under the supervision of a physical therapist.
- Phase 2 (6-12 weeks): Gradual return to range-of-motion exercises to restore movement. Light strengthening exercises may begin as the joint heals, but heavy lifting or overhead activities should be avoided.
- Phase 3 (3-6 months): More advanced strengthening exercises to rebuild muscle strength and improve shoulder function. The goal is to regain full motion and strength while avoiding stress on the healing ligaments.
- Phase 4 (6-12 months): Most patients are cleared to return to regular activities after full rehabilitation, although high-impact activities or sports may require additional time for recovery.
Potential Risks and Complications:
While AC joint reconstruction is generally safe, it carries some risks, including:
- Infection: As with any surgery, there is a small risk of infection at the incision site or inside the joint.
- Nerve or Blood Vessel Injury: The shoulder contains important nerves and blood vessels that may be injured during surgery, though this is rare.
- Joint Stiffness: Some patients may experience limited range of motion or stiffness, especially if rehabilitation exercises are not followed correctly.
- Recurrent Dislocation or Instability: Although the goal of the surgery is to restore stability, in some cases, the AC joint may remain unstable or re-dislocate after the repair.
- Failure of the Reconstruction: In rare cases, the ligaments may fail to heal properly, or the reconstruction may not provide adequate support, requiring additional surgery.
- Blood Clots: There is a small risk of developing blood clots, especially after surgery.
Benefits of AC Joint Reconstruction:
- Pain Relief: One of the primary benefits of AC joint reconstruction is relief from chronic pain caused by joint degeneration, dislocation, or instability.
- Restored Shoulder Function: By stabilizing the AC joint and repairing any damaged tissues, the surgery can help restore shoulder strength and mobility, improving the ability to perform daily activities and participate in sports.
- Improved Quality of Life: Most patients experience significant improvements in the quality of their shoulder function and a reduction in discomfort after recovery.
- Prevention of Further Damage: The procedure can prevent further deterioration of the joint, which might lead to arthritis or more severe joint instability.
Long-Term Outlook:
Recovery from AC joint reconstruction typically takes 6 to 12 months, depending on the severity of the injury and the individual’s healing process. Most patients are able to return to normal activities, including sports, after full recovery. However, patients who undergo reconstruction for severe degeneration or joint arthritis may experience some limitations in function, and activities that place excessive strain on the shoulder may need to be modified.
It’s important to follow the rehabilitation plan carefully to ensure the best possible outcome. Adherence to physical therapy and post-surgery guidelines is crucial for regaining strength, mobility, and stability in the shoulder.
When to Contact Your Surgeon:
You should contact your surgeon if you experience:
- Signs of infection, such as fever, increased redness, or drainage at the incision site
- Persistent or worsening pain despite taking prescribed pain medications
- Difficulty moving the shoulder or arm
- New or unusual sensations such as numbness, tingling, or weakness in the arm
- Significant swelling, bruising, or a feeling that the shoulder is unstable
Conclusion:
Acromioclavicular (AC) joint reconstruction is an effective surgical procedure for treating severe AC joint injuries, degenerative conditions, and chronic instability that do not improve with nonsurgical treatments. The procedure helps restore stability to the shoulder, alleviate pain, and improve overall shoulder function, allowing you to return to daily activities and sports. While recovery takes time, the outcomes are generally positive for patients who follow the post-surgery rehabilitation plan.
If you are experiencing AC joint pain or instability, consult with your orthopedic surgeon to discuss whether AC joint reconstruction is the right treatment for you