Acromioclavicular (AC) Separation Reconstruction
I separated my shoulder a long time ago. Should I consider surgery?
Patients with chronic shoulder separations have a history of an injury in the past (greater than six weeks to years ago) resulting in a “bump” at the shoulder that can cause pain, weakness, and shoulder blade dysfunction (called dyskinesia). Chronic shoulder separations are treated differently than acute separations because the injured ligaments lose their capacity to heal(1). Due to this impaired biologic healing capacity in chronic cases, tissue/biologic augmentation in addition to mechanical stabilization is frequently required(2). If you have an old acromioclavicular separation and are still having symptoms, it may be time to consider surgery to reconstruct the injured ligaments to improve function and pain in your shoulder.
Surgery for a chronic acromioclavicular separation generally requires a tissue with strong tensile properties to recreate the torn and irreparably injured ligaments. This tissue, called a “graft” is generally taken from a cadaveric source (called allograft), is strong and durable, and such a reconstruction has in large part supplanted more antiquated procedures for this condition and is considered the gold standard(3). These reconstructions are considered anatomic, where the tendon graft is placed at the same position as the injured ligaments, creating the most robust biomechanical environment for function, resulting in excellent long term outcomes(4).
While infrequent, cases of infection, pain, and loss of alignment of the joint in patients undergoing acromioclavicular joint reconstruction can occur(4). These complications can be minimized by meticulous surgical and soft tissue handling techniques, use of a sling after the procedure, and ensuring the acromioclavicular joint is anatomically restored to the proper position at the time of surgery. Other surgical pearls in this operation include limiting the size of bone tunnels to prevent risk of clavicle fracture and strongly securing the initial reconstruction(5). If you have a history of a prior injury to your shoulder and acromioclavicular joint, and are concerned about ongoing problems, we recommend you make an appointment with shoulder surgeon Dr. Obermeyer for a complete evaluation to discuss risks and benefits of surgical reconstruction in your particular case.
References
- Weinstein DM, McCann PD, McIlveen SJ, Flatow EL, Bigliani LU. Surgical treatment of complete acromioclavicular dislocations. Am J Sports Med. 1995 May-Jun;23(3):324-31. doi: 10.1177/036354659502300313. PMID: 7661261.
- Borbas P, Churchill J, Ek ET. Surgical management of chronic high-grade acromioclavicular joint dislocations: a systematic review. J Shoulder Elbow Surg. 2019 Oct;28(10):2031-2038. doi: 10.1016/j.jse.2019.03.005. Epub 2019 Jul 23. PMID: 31350107.
- Tauber M, Gordon K, Koller H, Fox M, Resch H. Semitendinosus tendon graft versus a modified Weaver-Dunn procedure for acromioclavicular joint reconstruction in chronic cases: a prospective comparative study. Am J Sports Med. 2009 Jan;37(1):181-90. doi: 10.1177/0363546508323255. Epub 2008 Sep 25. PMID: 18818433.
- Carofino BC, Mazzocca AD. The anatomic coracoclavicular ligament reconstruction: surgical technique and indications. J Shoulder Elbow Surg. 2010 Mar;19(2 Suppl):37-46. doi: 10.1016/j.jse.2010.01.004. PMID: 20188267.
At a Glance
Dr. Thomas Obermeyer
- 15+ years of training and experience treating complex shoulder and sports medicine conditions
- Expert subspecialized and board-certified orthopedic care
- Award-winning outstanding patient satisfaction scores
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