Acromio-clavicular Joint Reconstruction: Patient Information

Why do I need this operation?

The acromioclavicular joint (ACJ) is the joint between the collar bone and part of the shoulder blade called the acromion. This joint can be disrupted (partially or fully dislocated) during a heavy fall onto the shoulder or a direct blow. The ligaments between the collar bone and clavicle are ruptured during this, making the collarbone unstable and painful.

The Operation

The aim of the operation is to stabilise the end of the collarbone in relation to the shoulder blade. This should make the ACJ pain-free and restore function to the shoulder and arm.

• If the operation is done within a few weeks of the injury, the ACJ may be stabilised with strong sutures and small metal buttons. This allows the native ligaments to heal.
• If the instability has been present for a long period, the ligament may need to be replaced by either an artificial ligament or one transferred from another part of the shoulder (a modified Weaver-Dunn procedure).
• The end of the clavicle is often removed to prevent further pain from arthritis in the joint.
• The operation may be keyhole or through a small incision over the shoulder and may be combined with another procedure if there is a co-existing problem (e.g. tendon or ligament injury).

Potential Complications

Even when an operation goes well, about 5% of patients do not improve. The chance of a complication is small (<5%), and a significant complication affecting the outcome is even smaller (<1%).

Common complications include:

• Ligament stretch or failure: The ligament may not keep the collarbone perfectly aligned with the acromion. Even if this happens, patients usually retain improved function and reduced pain, and rarely need further surgery.
• Palpable knots/metalwork: Implants may be felt under the skin once swelling has gone down. This can cause irritation, especially when carrying straps. If persistent, a minor procedure can remove the implant.
• Infection: Superficial wound infections are more common and treated with antibiotics. Deep infections are rare but would require hospital admission for a wash-out and IV antibiotics.
• Nerve injury: Rare, as the surgical field is away from major nerves. Temporary numbness or weakness may occur but usually resolves. A complete injury could lead to permanent disability (extremely rare).

Recovery After ACJ Reconstruction

• Hospital stay: Usually day case
• Arm immobilisation: Sling for 4 weeks
• Total recovery period: Up to 6 months
• Return to driving: 4–6 weeks
• Return to work: Desk job: 1–3 weeks | Manual job: ~3 months
• Return to sports: Non-contact after 3 months | Contact/overhead after 6 months

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