Overview
An AC joint separation tears the ligaments that hold the clavicle in its anatomic position over the acromion. Mild separations recover with rehab, but high-grade injuries — in which the clavicle rides far above the acromion and the deltopectoral fascia is disrupted — produce persistent deformity, weakness, and pain. Reconstructing the torn ligaments restores the clavicle to its anatomic position.
How the Procedure Works
We reduce the clavicle back to its anatomic position first — confirming the reduction fluoroscopically — then hold it there while we reconstruct the coracoclavicular ligaments. A tendon graft is looped around the coracoid base and passed through two drill holes in the clavicle that correspond to the conoid and trapezoid ligament footprints; reconstructing both limbs of the coracoclavicular complex is more stable than a single-tunnel technique. Suspensory fixation (a cortical button or similar device) holds the reduction while the graft incorporates. The AC joint capsule is repaired over the top. Over-reduction — pulling the clavicle below its anatomic level — is a recognized complication that affects shoulder mechanics, so we verify position carefully before final fixation.
When to Consider AC Joint Reconstruction
AC joint reconstruction is generally offered when symptoms, imaging, and a trial of non-operative care together point to surgery as the next step. The typical picture includes:
High-grade AC separation
Rockwood type IV, V, or VI injuries where the clavicle is grossly displaced.
Persistent pain after rehab
A high-grade separation with ongoing symptoms or functional deficit despite a course of conservative care.
Conditions This Treats
Physicians Who Perform AC Joint Reconstruction
Providers Who Surgically Assist with AC Joint Reconstruction
Risks & Why We Still Recommend It
Every operation carries risk. The reason we offer this procedure is that the condition, left untreated, causes persistent pain and a mechanically unstable shoulder girdle that fatigues with overhead work and fails athletes at the top of the motion. That is the trade we are managing — not eliminating risk, but choosing the smaller of two unfavorable trajectories.
The risks we discuss with patients before ac joint reconstruction include:
- bleeding and infection
- anesthesia risk
- stiffness
- loss of reduction with recurrent deformity
- clavicle or coracoid fracture through the tunnels or fixation
- hardware irritation
- graft failure
The indication to proceed is a high-grade AC joint separation that is symptomatic after a trial of non-operative care, or an acute severe injury in a patient whose demands require a stable AC joint. Patients who don't need this operation don't get it.
Further Reading
External patient-education references and related OSI pages for additional background: