Acromioclavicular Separation Repair

The general strategy of repairing acute separations involves surgical reduction (realigning) of the acromioclavicular joint followed by placement of a device to hold the joint in the correct position while the injured ligaments heal in their anatomical position. The device that is placed is either removed in a second procedure or retained in the shoulder. While some chronic injuries require replacement (called reconstruction) of the ligaments with supplementation of tissue (“graft”), this may not be required in the acute setting. Graft augmentation has recently been shown to improve functional outcomes and maintenance of joint alignment even with acute acromioclavicular separations, however(3).

The first and commonly utilized technique for repair of these injuries involves arthroscopically-assisted coracoclavicular fixation (with or without graft augmentation). This technique utilizes strong suture tensioned between two titanium buttons, one on the clavicle and one on the coracoid process, to hold the acromioclavicular joint back in position. This technique is performed arthroscopically through tiny portals and a small inch-long incision at the clavicle. In this approach, a graft can be added in more severe injury patterns to enhance fixation and to improve joint alignment at long term follow up(3).

An alternative technique, and the one historically studied in the traditional literature(1) uses a rigid and secure plate, called the “hook” secondary to the portion of the implant deployed underneath the acromion. This device mechanically holds the collarbone down in the correct position during healing but uses a metal implant in the subacromial space and therefore needs to be removed. Because of the requirement for a second procedure and the slight delay of functional recovery with this approach(1), this procedure may be less favored currently than in the past.

Surgery for acromioclavicular separation repair is performed as an outpatient, where the patient leaves the facility the same day. A numbing block is administered followed by a light general anesthetic for the procedure which takes approximately one hour to perform. Showering and hygiene is permitted after a few days when bandages are removed and a sling is worn for six weeks, during which time simple activities are permitted with the hand and elbow. Once the sling is discontinued, activities of daily living are resumed, and stretches and strengthening exercises are incorporated. Between 10 and 12 weeks is the time point recommended for removal of a retained implant if required, such as the hook plate, followed by resumption of activities as tolerated including overhead and heavy use.

Complications from repair of acromioclavicular separations are similar as those with any surgical procedure, and although rare, include infection, injury to surrounding structures, failure of the repair, need for revision surgery. With appropriate surgical indications and technique, you can expect success of the repair and resumption of full preinjury activities without restrictions.