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AC Joint Stabilisation

Introduction

Acute Dislocations are those presenting <2-3 weeks after injury. This is the ideal time for those requiring surgery.

Surgery is recommended for:

  • Type 3 dislocations in certain populations.
    • Overhead work labourers.
    • Elite athletes.
    • Those where the prominence is a cosmetic concern.
  • All Type 4-6 dislocations.

The aim of surgery is to restore the normal relationship between the clavicle and the acromion, to allow the ligaments to repair in normal position and in some cases to directly repair/augment the ligaments.

There are numerous methods of surgically treating Acute AC Joint dislocations.

My Preferred method is minimally invasive stabilisation with a Tightrope device.

 

AC Joint Repair / Stabilisation

This minimally invasive surgery is under general anaesthesia and can be performed as day only / one-night stay in hospital.

An approx. 3-4 cm incision is made over the clavicle. Bone tunnels approximately 3mm diameter are made in the clavicle bone and the coracoid bone.

Four strands of a synthetic ultra-strong suture are passed through these tunnels and secured through two small titanium buttons either side. This allows the important coracoclavicular ligament to heal in normal position. In addition, the capsule of the AC joint and ligament are repaired.

An x-ray is taken during the operation to ensure the bones are back in normal alignment and button are placed correctly.

The skin is closed with dissolvable sutures and the arm is placed in a sling post operatively.

Recovery

  • Day surgery / overnight stay procedure.
  • Start sedentary activities below shoulder level straight away (e.g. dressing, eating, showering).
  • Drive at 6 weeks.
  • Discard sling after 6 weeks.
  • Overhead movement can start at 6 weeks
  • Contact sports commence at approx. 3 months.

Results

  • Patient satisfaction in this surgery is >85-90%.
  • Majority of patients get their full movement and strength back between 3-6 months post-surgery.

Risks and complications

These include:

  • Recurrence of instability / dislocation 5-15%.
  • Fracture of Clavicle / Coracoid <10%.
  • Stiffness.
  • Late Arthritis of AC Joint.
  • Infection.
  • Nerve Injury.

Chronic AC joint dislocation surgery / AC joint reconstruction

Chronic injuries are those presenting >4-6 weeks after dislocation. In these patients, the ligament has a reduced capacity to heal, so the surgical treatment is slightly more complex and involves a number of processes:

  • Primary / Standard stabilisation e.g. such as a tightrope device / plate.
  • Additional (biological) fixation to augment the repair.
  • Transfer of ligament to the clavicle (Weaver Dunn Procedure) and / or Addition of a tendon graft.
  • Excision of outer 5mm Clavicle.

This surgery is carried out under general anaesthesia. It requires 1-night stay in hospital.

This surgery is more painful and more complex than for Acute Injuries.

Recovery

  • Overnight stay procedure.
  • Start sedentary activities below shoulder level straight away (e.g.: dressing, eating, showering).
  • Drive at 6 weeks.
  • Discard sling after 6 weeks.
  • Overhead movement can start at 6 weeks.
  • Contact sports commence at approx. 3 months.

Risks and complications

These include:

  • Fracture of Clavicle / Coracoid.
  • Stiffness.
  • Late Arthritis of AC Joint.
  • Infection.
  • Nerve Injury.