Acromioclavicular (AC) Joint Repair
What Is AC Joint Repair and When Is It Used?
The acromioclavicular joint is where the outer end of the clavicle meets the acromion at the top of the shoulder. The AC capsule and ligaments control horizontal movement, while the coracoclavicular ligaments—the conoid and trapezoid—help suspend the shoulder girdle from the clavicle and control vertical displacement. A direct fall onto the shoulder can disrupt these structures and create a visible or painful separation.
AC joint repair or reconstruction aims to restore alignment and stability when the injury cannot meet the person's functional needs with non-surgical care. The term repair is often used broadly, but an acute injury may be stabilised while its own ligaments heal, whereas a chronic separation may need ligament reconstruction with graft tissue. The AC joint injury guide explains grades, symptoms and first-line treatment.
Who Is a Candidate and Who May Not Need Surgery?
Low-grade injuries are generally treated with temporary support, pain control and progressive rehabilitation. A grade III injury requires an individual decision because many people regain useful function without surgery, while others continue to have pain, scapular fatigue, instability or difficulty with heavy overhead work. The X-ray grade is therefore considered alongside symptoms, occupation, sport, examination and response to treatment.
Surgery is more commonly considered for displacement patterns that are unstable in more than one plane, open injuries, skin at risk, persistent symptomatic chronic separation or high functional demand that remains limited after appropriate non-surgical care. Active infection, uncontrolled health problems and inability to follow protection and rehabilitation may delay elective surgery. A cosmetic bump alone does not automatically require correction.
Preparing for AC Joint Surgery
Assessment begins with the injury mechanism, tenderness, deformity, shoulder-blade movement and stability in both vertical and horizontal directions. X-rays compare alignment and help identify fractures; additional views or CT may be needed when the bone injury is unclear. A clavicle fracture can resemble or accompany an AC separation and changes the surgical plan.
Tell the surgical and anaesthetic teams about medicines, blood thinners, allergies, previous clots and anaesthetic problems. Smoking and nicotine can interfere with tissue and bone healing, so stopping is encouraged. Follow individual fasting and medication instructions, arrange transport home and prepare clothing and essential items that can be managed with one arm.
- Discuss whether the injury is acute or chronic and whether fixation, ligament reconstruction or both are planned.
- Plan help with dressing, washing, meals and transport during the protected phase.
- Clarify work restrictions before surgery, especially for lifting, driving and overhead tasks.
How Is AC Joint Repair Performed?
The surgeon first reduces the clavicle and scapula into the planned relationship. Strong sutures, cortical buttons or other fixation constructs may be passed between the clavicle and coracoid to maintain coracoclavicular alignment while healing occurs. A hook plate is another option for selected acute patterns, but implant irritation and possible planned removal are considered. The AC capsule and deltotrapezial fascia are assessed and repaired when required because horizontal stability cannot be restored by vertical fixation alone.
Some procedures are arthroscopic-assisted, allowing the underside of the coracoid and the shoulder joint to be visualised through small portals; others use an open or combined approach for safe reduction and soft-tissue repair. Shoulder arthroscopy is a method of access, not a guarantee of a particular result. Technique is selected according to injury age, displacement, tissue quality, associated injury and surgeon planning.
Acute Repair, Chronic Reconstruction and Graft Options
In an acute injury, reduction and stable fixation may protect the torn native ligaments while they heal. When separation has been present for longer, the damaged ligaments may no longer have reliable healing potential in their original position. Reconstruction then uses a tendon graft to reproduce the conoid and trapezoid restraint, often combined with AC capsule repair.
A graft may come from the patient's own tendon or screened donor tissue. Tunnel number, graft route and fixation vary, and no single construct is best for every pattern. Bone size, tissue quality, previous surgery and the risk of fracture around tunnels are considered when choosing a method.
Anaesthesia and Procedure Time
AC joint surgery is commonly performed under general anaesthesia, sometimes with a regional nerve block for early pain control. The anaesthetist tailors the approach to the patient's health and the planned operation. A nerve block can temporarily make the arm feel heavy or numb, so sling and skin-protection instructions must be followed until sensation returns.
Procedure time varies with acute versus chronic injury, arthroscopic or open access, graft preparation and associated treatment. Many patients can leave on the day of surgery, while medical needs or a complex reconstruction may require longer observation. Discharge depends on stable vital signs, controlled symptoms and a safe home plan rather than a fixed duration.
The First Days After AC Joint Repair
The arm is usually supported in a sling to reduce load across the repair. Early priorities are wound care, swelling and pain control, hand and elbow movement, and safe posture. Keep dressings dry as instructed, use a wrapped cold pack rather than applying ice directly to skin, and take prescribed medicines only at the stated dose.
Shoulder movement limits depend on the fixation and soft-tissue work. Lifting, pushing, pulling and using the arm to rise from a chair can overload the construct even when pain is modest. Another patient's sling duration or exercise list should not replace the protocol for the actual repair.
AC Joint Repair Rehabilitation Timeline
Rehabilitation balances protection of ligament healing with prevention of unnecessary stiffness. Progress is based on wound healing, pain, movement, imaging when indicated and the shoulder's response after exercise. Strengthening begins only when the repair can tolerate increasing load.
- Protection: use the sling as directed, maintain hand and elbow movement and avoid load across the repair.
- Controlled motion: introduce permitted passive and assisted shoulder movement without forcing elevation or cross-body reach.
- Active control: restore comfortable active motion and coordinate the shoulder blade with the arm.
- Strength: progress cuff, deltoid, shoulder-blade and trunk loading after adequate healing.
- Function: rebuild lifting, overhead endurance, contact preparation and sport-specific control in stages.
Returning to Work, Driving and Sport
Return to desk work may be possible before duties involving carrying, climbing, overhead reaching or manual handling. The plan must account for sling use, pain medicine, commuting and the ability to protect the repair. Driving should wait until the sling is no longer required for protection and the person can control the vehicle and respond in an emergency.
Running and lower-body conditioning may resume before upper-limb contact, throwing or heavy lifting, provided the shoulder is protected. Return to sport depends on healing, full useful motion, strength, shoulder-blade control and confidence during sport-specific tasks. A fixed three- or four-month promise cannot account for reconstruction type or the demands of collision sport.
Risks and Possible Complications
Potential complications include infection, bleeding, stiffness, persistent pain, numbness, anaesthetic problems and a blood clot. Procedure-specific concerns include loss of reduction, fixation irritation or migration, fracture of the clavicle or coracoid, graft stretching or failure, and ongoing horizontal or vertical instability. The prominence over the joint may not become perfectly symmetrical even when function improves.
A failed construct does not automatically require another operation; symptoms, deformity, imaging and functional limitation are reassessed together. Persistent painful instability, fracture or fixation problems may lead to consideration of revision AC joint repair.
Factors That Influence Results and Alternatives to Surgery
Results are influenced by injury grade and chronicity, stability in both planes, reduction quality, tissue and bone quality, smoking, associated injury and adherence to protection and rehabilitation. High-energy trauma and previous surgery can make treatment more complex. No fixation or graft can guarantee healing, a perfectly flat shoulder contour or return to the previous sporting level.
Non-surgical care includes temporary sling use, pain management, early safe movement and progressive strengthening of the shoulder girdle. It remains appropriate for most low-grade injuries and many grade III injuries when function improves. Delayed reconstruction can still be discussed if persistent pain, fatigue or instability continues after an adequate programme.
When Should You Contact a Doctor?
After surgery, contact the clinical team for increasing redness or wound drainage, fever, uncontrolled pain, new deformity or a sudden change after a fall. New hand weakness or numbness, a cold or pale hand, chest pain, shortness of breath or painful calf swelling requires urgent medical assessment. Do not wait for routine follow-up when these signs occur.
For an overview of related shoulder conditions and procedures, visit the Shoulder page. To discuss whether repair or continued non-surgical care fits your injury and activity goals, use the Contact page to request an individual assessment.