A-C JOINT STABILIZATION
The clavicle (collarbone) attaches to the shoulder (acromion process) at the acromio-clavicular (A-C) joint. The A-C joint is an important structure as it connects the collarbone strut to the shoulder complex, enabling stable, painless range of motion of the upper limb. The A-C joint is stabilized by multiple ligaments that surround the joint – the joint capsule. In addition, the A-C joint and far end of the collarbone are stabilized by the coraco-clavicular (C-C) ligaments. When one sustains a low-energy injury to the A-C joint, only the A-C ligaments are injured. However, when one sustains a serious injury to the A-C joint, the A-C ligaments (capsule) and C-C ligaments are torn completely. Dr. Keller usually recommends surgery for patients who sustain this type of injury.
The goal of A-C stabilization surgery is to restore the normal position of the clavicle in relation to the acromion process. During surgery, Dr. Keller makes an incision over the far end of the clavicle. After placing the collarbone in the right position, Dr. Keller drills one or two small holes in the collarbone. He places these holes where the intact C-C ligaments attached to the collarbone. Dr. Keller then threads an allograft – donor tendon tissue – or a synthetic graft through the hole(s) in the collarbone and around the coracoid (a bony projection in front of the shoulder). After wrapping the graft around the coracoid, Dr. Keller threads the tissue through the bone tunnels in the collarbone and compresses the tissue to the collarbone with screws (interference screws).
Following surgery, patients are given a sling for comfort. Dr. Keller recommends intermittent icing and gentle range of motion following surgery. Dr. Keller also recommends starting physical therapy approximately 2-4 weeks after surgery. Physical therapy focuses on reducing swelling in the shoulder, restoring full range of motion, and maintaining strength in the shoulder. Patients should expect to regain their full range of motion within 8-12 weeks of surgery. It takes approximately 12-16 weeks for the reconstruction to heal, and return to sport usually requires further rehabilitation.