AC Joint Stabilization

Overview

AC joint stabilization is a surgical procedure to repair damaged ligaments of the acromioclavicular (AC) joint, which connects the acromion (part of the shoulder blade) to the clavicle (collarbone). The procedure uses ligament reconstruction with graft and heavy suture to restore stability to the AC joint.

While the vast majority of AC joint injuries can be managed non-operatively, surgery may be necessary for high-grade separations that fail conservative treatment or cause persistent symptoms affecting quality of life and function.

When Is Surgery Needed?

AC joint stabilization may be recommended for:

• High-grade AC joint separations (Type IV, V, VI) that have failed conservative treatment
• Persistent pain and functional limitations after adequate trial of non-operative care
• Significant cosmetic deformity that is bothersome to the patient
• Overhead athletes or laborers with high functional demands
• Chronic AC joint instability affecting daily activities or sports performance

Evidence-Based Approach

Important: Studies in active military cadets have demonstrated that 70% of them with high-grade AC joint injuries can resume active military duty without surgery.

Furthermore, studies have demonstrated that there is no difference in the acute or delayed management of these injuries, so most patients should have a trial of non-operative treatment initially. Surgery is reserved for those who do not improve with conservative care.

The Surgical Procedure

AC joint stabilization reconstructs the damaged ligaments to restore normal joint alignment and stability.

Surgical Technique

The procedure involves several key steps:

• Incision over the AC joint
• Removal of any damaged tissue or scar tissue
• Preparation of the clavicle and acromion for graft placement
• Placement of graft material to reconstruct the damaged ligaments
• Heavy suture augmentation to provide additional stability
• Fixation techniques to hold the reconstruction in place while it heals
• Reduction of the AC joint to restore normal alignment

Graft Options

Several graft options are available, including allograft (cadaver tissue) or autograft (patient's own tissue). Dr. Kirsch will discuss the best option for your specific situation. Modern techniques also incorporate high-strength suture tape systems that provide excellent stability while allowing biological healing.

Recovery Timeline

Recovery from AC joint stabilization requires careful protection of the reconstruction while gradually restoring motion and strength.

Early Recovery (Weeks 1-6)

Protection of the AC joint reconstruction is critical.

• Arm in sling for protection (typically 4-6 weeks)
• Can move hand, wrist, and elbow immediately
• No lifting or pulling with the operative arm
• Avoid cross-body movements that stress the AC joint
• Pain management with multimodal approach
• Ice therapy to reduce swelling

Intermediate Recovery (Weeks 6-12)

Gradually begin range of motion exercises. Physical therapy focuses on restoring shoulder mobility while protecting the AC joint reconstruction. Avoid overhead activities and heavy lifting during this phase.

Late Recovery (3-6 Months)

Progressive strengthening begins around 12 weeks. Gradual return to overhead activities and sports. Most patients experience significant improvement in pain and stability during this phase. By 4-5 months, most can return to non-contact activities.

Full Recovery (6-9 Months)

Return to full activities including contact sports typically occurs around 6-9 months. Most patients achieve excellent stability and can return to their desired activity level. The reconstruction continues to mature and strengthen over the first year.

What to Expect

Pain Relief

Most patients experience significant pain relief after AC joint stabilization, particularly with overhead activities and cross-body movements that previously caused discomfort.

Stability and Appearance

The procedure restores stability to the AC joint and improves the cosmetic appearance by reducing the prominent bump at the top of the shoulder. Most patients are very satisfied with both the functional and cosmetic outcomes.

Return to Activities

Athletes can typically return to their sport within 6-9 months. The procedure has shown excellent outcomes for overhead athletes and laborers, allowing most to return to their previous level of activity with improved comfort and function.