The type of surgery you will need to stabilize your acromio-clavicular joint will depend on how acute your injury is. If you injured your AC joint less than four weeks ago then you may be able to have an arthroscopic (keyhole) repair. For chronic cases, where reconstruction of the ligaments rather than repair is needed, an open operation is performed. Both types of surgery are carried out under general anaesthesia with a nerve block and you can normally go home the same day, or the morning after your operation.
X-ray of acute high grade AC joint dislocation
This is a keyhole operation. Three tiny holes allow access to the joint and a separate 2cm mini-open incision over is made over your collar bone to complete the fixation. Strong fibre-tapes are passed through a small drill hole in your collar bone and the coracoid process of your shoulder blade. The sutures are looped and tightened over small titanium buttons which pull the collarbone down to its correct position. This suture material holds your AC joint in place while the injured coraco-clavicular ligaments heal. The x-ray images below show the drill passing through the collar bone and coracoid and the completed repair. The surgical photographs show the main steps of the procedure. The last of these images shows the titanium washer securing the fibre-tape loops beneath the coracoid.
intra-operative x-rays of arthroscopic AC joint repair
An incision is made over the top of your shoulder (see image of healed scar below) to expose your lateral clavicle and coracoid process. The medial part of your deltoid muscle is elevated and flipped off the lateral clavicle to allow exposure of the coracoid. A wafer of bone is resected from the damaged end of your clavicle and debris is cleared to allow the clavicle to be returned to its correct position. Very strong specially-woven Polyester rope (LARS ligament: see image below) is looped beneath the bony coracoid process of your shoulder blade and fixed through two holes in your collarbone with small screws. The remaining nylon rope is used to strengthen further the reconstruction. Sometimes a second implant (Internal Brace - a fibre-tape held with two suture anchors) is used to augment front-to-back stability.
Photograph of patient 5 months after surgery. Note the scar and the normal shoulder contour. A photograph (From Corin website) of the LARS ligament used for the reonstruction of the coraco-clavicular ligaments
A pre-op and post-op image of a grade 5 AC separation reconstructed with LARS ligament.
You will normally go home the same day, or the morning after your operation. Please take your prescribed painkillers regularly for the first few days. You will need to wear your sling for four weeks after keyhole surgery, but must wear the sling for 6 weeks after open repair (to allow your deltoid muscle to heal) . You may take down any bulky padded dressings on day 3 after surgery, but keep the waterproof dressings on for 12 days. Showering is fine after four days following keyhole surgery, as long as your waterproof dressings are in place, If you’ve had open surgery, please keep your wound dry for 14 days. Sutures will need removal/trimming at 12-14 days after surgery. You will start strengthening at three months and progress to unrestricted use of the arm.
Patients vary in their symptoms after surgery, but in general you can expect to return to:
Office work after two to four weeks (desk duties only – no lifting and wearing a sling)
Light physical work after twelve weeks
Heavy labour or overhead sport will take 16-24 weeks
Driving - t is likely to be six weeks before you are ready for this.
Overall 90% of patients will feel their shoulder is much better after AC joint stabilisation, although for some it may take several months to maximise their benefit.
When will I be followed up?
You will be seen at two weeks after your operation and have an X-ray to confirm the reduction has been maintained. Thereafter your follow up will vary depending on your needs and your progress. Patients are typically ready for discharge by 6 months.
What can go wrong?
Shoulder surgery is generally safe, but specific risks of acromioclavicular joint repair/reconstructive surgery include:
Stiffness (10%) - this sometimes requires further surgery to restore movement, but usually settles with time
Recurrent instability of the AC joint
- A small step may sometimes become visible at the AC joint as the implant stretches, but this is rarely functionally significant and does not normally need revision surgery
- A very small percentage of people will develop recurrent AC joint instability and require revision surgery
Infection (1% risk). If this happens, you may need further surgery or antibiotics to clear the infection
Your coracoid process, lies close to nerves and vessels. There is a small (<1% risk) of bleeding or nerve damage
Coracoid/claivcle fracture or erosion - occasionally these bones, which are narrow, suffer erosion, and more rarely still, fracture during or after these operations.
Making the right choice about the best treatment for you means getting the right information. During your consultation, please do feel free to ask Mr Granville-Chapman to explain anything that you do not fully understand, and for his advice about the pros and cons of any treatment.
Mr Granville-Chapman was very polite and his examination and explanation of my symptoms and expected treatment was thorough
I found Mr Granville-Chapman to be very knowledgeable and professional. He put me very much at ease and explained all the options that I have thoroughly. He also told me to look for further information on the condition and procedures that I needed on his website, which gave lots of information and detail. It was also easy to understand for those without a medical background. I would highly recommend his services to anyone that has shoulder problems and requires a solution.
I attended for a repair of my right bicep tendon. After a thorough examination, Mr Granville-Chapman arranged an operation to be undertaken within 2 days which was extremely quick; he explained his reasoning which was both thorough and reassuring, explaining both the options of undergoing surgery and deciding to undertake conservative management.On the day of the surgery Mr Granville-Chapman was again very reassuring as although this is minor surgery I was still somewhat apprehensive. He came to fully explain the procedure and afterI woke up was quick to check on how I was doing.Overall I am very happy with the careMr Granville-Chapman
I have been very pleased with my treatment so far. Mr Granville-Chapman combines brisk efficiency with a pleasant, sympathetic manner. My operation, however, is still to come ...
From the initial consultation, through surgery on a fractured wrist, and now post-operative follow up, it has been a very positive and reassuring experience with Mr Granville-Chapman. I would have no hesitation in recommending him to someone else.
A first class clinician. A skilled surgeon with an excellent bedside manner.
A very pleasant Consultant who knows exactly how to make pain go away.
Mr Granville - Chapman has an excellent bedside manner. He engaged with my 12 year old son at an appropriate level and took the time to ensure that he understood the procedure and answer all his questions. He is thoroughly professional and I would not hesitate to recommend him.
I have been very pleased with the attention I have received. Mr. Granville-Chapman has reassured me that my symptoms are normal. It is very easy to make appointments that suit me.
Mr Granville chapman I found be caring informative and professional I would recommend him to all if you have a problem don't hesitate to contact him you won't be disappointed.
I recently broke my right clavicle in a mountain bike accident and it was repaired by Mr Granville-Chapman by adding a plate on top of the bone. Having just finished the last post-op consultation, I can confirm that I have been very happy with the process all along. In particular, Jeremy took time to explain in detail why a plate was needed, what the procedure would entail, and also was very patient answering my questions comprehensively beforehand and after during the recovery phase. Would certainly trust this competent surgeon to fix any future fractures I might sustain.
Mr Granville-Chapman has looked after my 15 year old son brilliantly, explaining the surgery, recovery and best way forward, and Kate has been very supportive helping with logistics etc, thank you so much.
So far my experience with Mr Jeremy Granville-Chapman has been personal and informative with regard to the operation I will be having. I feel confident that my operation will be a success and for this reason I am very happy to have Mr Jeremy Granville-Chapman as my consultant.
Very knowledgeable and helpful. Takes the time to make sure you're getting the treatment you need.
Mr Jeremy Granville -Chapman is not only a highly skilled consultant but is able to put you straight away at ease .My appointments were arranged very swiftly which was great, when you are experiencing severe pain. I am very happy with my treatment so far . many thanks to everyone who was involved in my treatment.
Polite, helpful, professional. Makes an effort to ensure full understanding of issues and procedures to be done. Highly satisfied
Very pleasant. Clear, careful explanations & options/possibilities. I feel well informed, and happy that my concerns are being well addressed, with a plan of review of the symptoms.
Excellent advise with everything explained clearly and a successful treatment which has benefited be greatly.
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