When Is Surgery Recommended?
Surgical reconstruction of the acromioclavicular (AC) joint is recommended for Grade IV, V, and VI injuries (which require reduction and stabilisation) and for symptomatic Grade III injuries in active patients, manual workers, or those with persistent pain and deformity after adequate conservative treatment.
Surgical Technique
AC joint reconstruction involves reducing the displaced clavicle to its normal position and stabilising it with a fixation device. The coracoclavicular ligaments (which provide vertical stability) are reconstructed using a tendon graft (commonly semitendinosus) or a synthetic augmentation device (such as a TightRope or DogBone system).
The procedure is most commonly performed through a small open incision over the shoulder, though arthroscopic-assisted techniques are available.
Recovery
The arm is protected in a sling for 4–6 weeks. Physiotherapy begins early with gentle pendulum exercises, progressing to active movement at 6 weeks. Strengthening commences at 2–3 months. Return to desk work is typically at 4–6 weeks; manual work at 3–4 months; contact sport at 4–6 months.
Outcomes
Most patients achieve satisfactory pain relief, restoration of shoulder contour, and return to pre-injury activities. Some degree of residual deformity may persist even after successful surgery, particularly in very high-grade injuries. Dr Yu will discuss realistic expectations with you during your consultation.