AC Joint Reconstruction
What Is AC Joint Reconstruction?
AC joint reconstruction is a surgical procedure that restores stability to the acromioclavicular joint at the top of the shoulder after the supporting ligaments have been significantly torn — most often from a fall directly onto the point of the shoulder. Rather than simply repairing stretched-out ligament tissue, reconstruction typically uses a tendon graft to recreate these critical stabilizing ligaments.
When Is AC Joint Reconstruction Needed?
AC joint reconstruction is generally considered for:
- Higher-grade AC joint separations (Grade IV–VI), where the collarbone has shifted significantly out of its normal position
- Grade III separations in physically demanding patients who haven’t responded well to a course of nonsurgical treatment
- Chronic, painful AC joint instability that persists after an initial period of nonsurgical management
- Cases where the collarbone continues to visibly and symptomatically shift out of position during activity
Nonsurgical treatment is usually recommended for lower-grade AC joint separations (Grade I-III).
How Is AC Joint Reconstruction Performed?
The procedure can be performed using an open, arthroscopically-assisted, or fully arthroscopic technique, depending on the specific injury pattern and surgeon preference. A tendon graft — either from the patient (autograft) or a donor (allograft) — is used to recreate the coracoclavicular ligaments, which are the primary structures holding the collarbone in its normal position relative to the shoulder blade. The graft is threaded through small tunnels or around the base of the collarbone and shoulder blade, then secured with fixation devices, restoring the normal relationship between these two bones. In some cases, additional sutures or a temporary support device may be used to protect the reconstruction while the graft heals into place.
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Recovery After AC Joint Reconstruction
Recovery is centered on protecting the new ligament reconstruction while it matures and integrates:
- A sling is typically worn for several weeks to protect the reconstruction from excessive strain
- Lifting restrictions are especially important early on, since heavy lifting places direct stress on the reconstructed ligaments
- Physical therapy progresses gradually, beginning with gentle motion before advancing to strengthening
- Return to full activity, including overhead sports and heavy lifting, generally takes several months, allowing the graft adequate time to fully incorporate and mature
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Dr. Palsis specializes in the treatment of knee, shoulder, and sports injuries.