ACJ reconstruction

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What is ACJ reconstruction?

Acromioclavicular joint (ACJ) reconstruction surgery may be offered to you if you have damaged your ACJ (where your collarbone joins your shoulder blade) as the result of a fall or collision. Surgery is normally only offered in the case of severe damage. For less serious damage, other less invasive techniques are recommended. ACJ reconstruction is a commonly performed procedure with good long-term results.

What does ACJ reconstruction surgery involve?

During an operation, your consultant will stabilise your damaged ACJ either by using sections of your own ligament taken from the front of your shoulder (the coracoacromial ligament) or by using an artificial ligament, which is looped around your clavicle (collarbone) and the coracoid process from the shoulder blade. This will pull your separated shoulder back into place, helping to stabilise the ACJ and reducing pain. In severe cases a temporary plate may also be required whilst the ligaments have a chance to heal. This may need to be removed as a second operation.

An ACJ ligament repair is carried out under general anaesthetic. The replacement ligament is inserted through an incision in the top and front of the shoulder and secured to the clavicle with a screw. The procedure will leave you with a scar of 5-7cm running along the top of your shoulder.

Afterwards, your arm will need to be supported in a sling for at least three weeks – otherwise the weight of your arm could pull the repair apart. If your surgeon uses your own ligament to repair the ACJ you will need to wear the sling for a minimum of four weeks.

Immediately after surgery you will be given an X-ray to check on the repair and shown a series of exercises to regain the movement and strength of your shoulder by the physiotherapist.

Why might I need ACJ reconstruction?

This type of surgery may be recommended if you experience a serious ACJ injury/dislocation. ACJ injuries can vary in severity from a mild strain to a complete ligament tear. It occurs when the acromion and clavicle are forced apart as the result of heavy impact or a fall, causing damage to the ligaments. This results in pain and instability in the shoulder. Replacing the damaged ligaments will reduce the pain and improve shoulder function.

How long does it take to recover?

For the first three to four weeks after surgery you must continue to wear your sling day and night, even whilst sleeping. A physiotherapist or nurse will show you how to manage the sling. You must not lie on the shoulder that has been operated on for the first few weeks after surgery. Ideally, you should sleep on your back or on the opposite side with pillows to support you and prevent you from rolling onto your operated shoulder.

You should avoid moving your arm any more than is directed by the physiotherapist. Gentle movements of your wrist, hand and elbow can help prevent stiffness but if you bend and straighten your elbow, ensure that it is supported to avoid putting strain onto the repaired ligament.

You will receive on-going rehabilitation from a physiotherapist during the first few weeks after surgery, with a follow-up appointment with your orthopaedic surgeon after six weeks. You should be able to return to normal activities six to twelve weeks after surgery. You should not drive while your arm is in a sling and you should avoid contact sports for at least six months.

What is the long-term impact of ACJ reconstruction surgery?

ACJ reconstruction is a common procedure that is generally safe and effective in improving the stability of the shoulder, relieving pain and restoring movement following severe ACJ injury. For more minor ACJ damage, less invasive techniques will be recommended, such as immobilisation and injections.