What is Acromioclavicular Joint Stabilisation?
Acromioclavicular (AC) joint stabilisation is a surgical procedure to restore stability and functionality to the acromioclavicular joint following injury, typically a dislocation or severe sprain. The AC joint is where the collarbone (clavicle) meets the highest point of the shoulder blade (acromion). The procedure often involves repositioning the displaced joint and reinforcing it with grafts or surgical hardware to prevent future dislocations.
Who is Suitable for AC Joint Stabilisation Surgery
Candidates for AC joint stabilisation typically include:
- Patients who have experienced a severe AC joint dislocation or sprain that has not improved with non-surgical treatments such as physical therapy and non-steroidal anti-inflammatory drugs (NSAIDs).
- Athletes or professionals whose activities involve substantial use of the shoulder and who need to regain full functionality quickly.
- Individuals who experience significant shoulder pain, weakness, or instability following an AC joint injury.
Benefits of AC Joint Stabilisation Surgery
Benefits of AC joint stabilisation can include:
- Restored Stability: The procedure aims to restore stability to the AC joint, reducing the risk of future dislocations.
- Pain Relief:
Many patients report significantly decreased pain following the surgery.
- Improved Functionality:
Stabilisation can enhance shoulder strength and mobility, allowing patients to return to normal activities, including sports or physically demanding work.
- High Success Rate:
When coupled with a comprehensive rehabilitation program, the procedure generally has a high success rate.
Types of AC Joint Stabilisation Surgery
The specific surgical techniques used can vary depending on the severity of the AC joint injury and the surgeon's preference. Here are some common types of AC joint stabilisation surgeries:
- Open Reduction and Internal Fixation (ORIF):
This procedure involves an incision over the AC joint and realigning the displaced bones (clavicle and acromion). The surgeon may use various fixation devices such as screws, plates, or wires to hold the joint correctly while it heals.
- Weaver-Dunn Procedure: The Weaver-Dunn procedure involves an incision over the AC joint and removing a portion of the distal clavicle. The coracoacromial ligament is detached and then reattached to the clavicle for stability.
- Coracoclavicular (CC) Ligament Reconstruction:
This surgery involves using a graft (autograft or allograft) to reconstruct the damaged CC ligaments and restore stability to the AC joint.
- Arthroscopic AC Joint Stabilization:
In arthroscopic AC joint stabilisation, the surgeon uses a tiny camera (arthroscope) and specialised instruments to visualise and repair the injured structures. The techniques used during arthroscopic procedures include ligament repair, reconstruction, or suture-based techniques.
- Synthetic Ligament Reconstruction:
In some cases, synthetic ligaments or grafts made of artificial materials are used to reconstruct the damaged ligaments and stabilise the AC joint. These synthetic ligaments provide support and stability while allowing for the healing process to occur.
Alternative Options to AC Joint Stabilisation Surgery
Before considering AC joint stabilisation surgery, it is common to explore non-surgical treatment options. These alternatives aim to alleviate symptoms and improve joint stability without surgery. Here are some alternative options to consider:
- Rest and Activity Modification
- Physical Therapy
- Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen
Surgical intervention may be considered if conservative measures do not provide adequate relief or the joint instability persists.
What to do Before an AC Joint Stabilisation Surgery?
Before undergoing AC joint stabilisation surgery, it is important to follow certain steps:
- Schedule an appointment with an orthopaedic surgeon specialising in shoulder and AC joint injuries. They will evaluate your condition, review your medical history, and conduct a physical examination.
- The surgeon may order imaging tests such as X-rays, MRI, or CT scans to assess the extent of the AC joint injury and identify any associated structural abnormalities.
- A preoperative evaluation will be conducted to ensure that you are in good overall health and ready for surgery. This may involve blood tests, ECG, and discussing any medications or supplements you take.
- Follow any preoperative instructions provided by your surgeon, which may include fasting guidelines, medication adjustments, and cessation of certain medications like blood thinners.
- Sometimes, your surgeon may recommend prehabilitation, which involves specific exercises and physical therapy to optimise joint function and strengthen the surrounding muscles before surgery.
- Engage in open communication with your surgeon to understand the potential risks, benefits, and expected outcomes of the AC joint stabilisation surgery. This will allow you to decide about proceeding with the surgery.
AC Joint Stabilisation Surgery
Here is a general overview of what typically happens during the procedure:
- Anaesthesia:
You will be given anaesthesia to ensure you are comfortable and pain-free during the surgery. The type of anaesthesia used can vary, and you should discuss this with your surgeon before the procedure.
- Incision:
The surgeon will make an incision over the AC joint area, typically on the top or front of the shoulder. The length and placement of the incision may vary depending on the surgical technique employed.
- Exposure: The surgeon will carefully separate the skin and underlying tissues to gain access to the AC joint and surrounding structures. This may involve dissecting through layers of muscle, tendon, and ligaments.
- Joint Preparation:
The surgeon will assess the extent of the injury and prepare the joint for stabilisation. This may involve removing damaged or degenerative tissues, reshaping the clavicle or acromion, or repairing torn ligaments.
- Stabilisation:
The chosen stabilisation technique will be performed. This can include various methods such as suturing the ligaments, using grafts or synthetic ligaments, or employing fixation devices like screws, plates, or wires to hold the joint in the correct position.
- Closure: Once the stabilisation is complete, the surgeon will close the incision using sutures or staples. Sterile dressings and a bandage will be applied to protect the surgical site.
What to Expect After an AC Joint Stabilisation Surgery?
After AC joint stabilisation surgery, you will be moved to a recovery room and monitored closely as you wake up from anaesthesia. The medical team will assess your vital signs and manage your pain.
You are likely to be discharged on the same day.
You will be given pain medications to help manage any postoperative pain. Follow your surgeon's instructions regarding pain medication use, and report any excessive pain or unexpected side effects.
AC Joint Stabilisation Surgery Recovery Plan
Here are some general aspects of the recovery process:
- Immobilisation: You will likely be required to wear a sling or brace to immobilise the shoulder joint and protect it during the initial healing phase. The duration of immobilisation will depend on the surgical technique and your surgeon's recommendations.
- Pain Management: Your surgeon will prescribe pain medications to manage post-operative pain. Follow the prescribed medication schedule and inform your surgeon if you experience excessive pain or have concerns about pain management.
- Physical Therapy:
Rehabilitation and physiotherapy play a crucial role in recovery. Your surgeon will provide guidelines on when to begin therapy. Physiotherapy typically focuses on restoring range of motion, strengthening the shoulder muscles, and gradually returning to normal activities. Adhere to your therapist's instructions and attend therapy sessions as scheduled.
- Gradual Return to Activities:
Your surgeon will guide you on when to gradually resume daily activities and return to sports or other physical activities. It is important to follow the recommended progression to avoid re-injury and allow adequate healing.
- Follow-up Appointments:
Regular appointments with your surgeon and physiotherapist will be scheduled to monitor your progress and make necessary adjustments to your recovery plan. These appointments are important for assessing the healing of the joint and ensuring a successful recovery.
AC Joint Stabilisation Surgery Prognosis
The prognosis following AC joint stabilisation is generally good, with many patients returning to their pre-injury activity levels. While some patients may continue to experience mild discomfort or changes in shoulder contour, most report significant improvements in pain and function.
AC Joint Stabilisation Risks
While complications are relatively rare, risks can include infection, nerve damage, implant failure, or the need for additional surgery. There is also a small risk of persistent pain or stiffness in the shoulder.
What if AC Joint Stabilisation is Delayed?
Delaying surgery can result in prolonged discomfort and decreased shoulder function. In some cases, chronic instability of the AC joint may lead to arthritis. Therefore, timely surgical intervention is often recommended for severe AC joint injuries.