Acromioclavicular (AC) joint stabilisation

The stabilisation of a dislocated Acromioclavicler Joint (ACJ) can be undertaken in a number of different ways depending on the nature of the dislocation and the time that has passed since the initial injury.

In acute injuries, in which the injury occurred within 3-4 weeks of the date of the operation, stabilising the clavicle using a synthetic ligature or tape can be undertaken. If however there is a more significant injury or if there has been a delay in presentation, then for greater security, the Coracoclavicular (CC) ligaments reconstruction can be reinforced with an additional component to the operation. Although a synthetic ligature or tape is still used to stabilise the clavicle, this can be reinforced by undertaking a Weaver Dunn procedure at the same time. This entails the excision of a small amount of the outer end of the clavicle and the transfer of the Coracoacromial (CA) ligament to the excsison site. By adding this ‘biological graft’, a more robust reconstruction can be achieved, which will in turn hopefully lead to a more secure reconstruction and therefore better outcomes. In some circumstances, and especially in revision surgery, other graft options can also be used in the reconstruction instead of the Weaver Dunn transfer.

Information for patients / operative Information

Risks and complications

• Infection
• Bleeding
• Nerve injury
• Stiffness
• Recurrent or residual instability
• Failure

Before admission

• Please bring any X-rays or scans with you to the hospital. This will usually be on a CD disc. These will not be needed if it was Mr Falworth who organised the investigations.
• No food for 6 hours, or drink for 4 hours, prior to surgery.
• Please avoid smoking for 12 hours prior to surgery

In Hospital

• An AC joint stabilisation procedure is usually performed with a single overnight stay.
• An incision measuring approximately 10 cm is made over top of the shoulder. This is often referred to as a “Bra-strap” or “Sabre” incision. The wound will be closed with dissolving sutures and Steri-strips.
• Splash proof dressings will be applied but the wound should remain dry for 10 days.
• Prior to your discharge from hospital, a physiotherapist will demonstrate some simple exercises as part of your rehabilitation protocol. These exercises should be undertaken when you’re at home and will help your shoulder recover from the surgery before your outpatient physiotherapy commences.

What to Expect

• Swelling; immediately after any surgical procedure there can be quite a lot of swelling around the shoulder but this settles after approximately 24 hours. A Cryocuff or alternative cold therapy compress, can be helpful in minimising swelling and inflammation. The Cryocuff will usually be issued to you upon discharge
• Pain; an Interscalene Block is often used to reduce immediate post-operative pain. If any discomfort arises once the block has worn off, simple oral analgesics can be taken to manage this. These will be provided to you upon discharge.
• Bleeding; there may be some oozing through the bandages but this should settle soon after the operation.

Post-operative care

• Following the surgery you will need to wear a sling to support the shoulder for 4 -6 weeks. To prevent the development of undue shoulder stiffness, the belt that is attached to your sling can be removed 24 hours after your operation.
• The wound should be kept dry for 10 days.
• At ten days the dressing and paper Steristrips can be gently removed. If the wound is ‘dry’ then it is all right to wash the wound. If not, please consult Mr Falworth or your GP for further advice.
• The most important part of your post-operative care is to start an early exercise programme, which the ward physiotherapist will have commenced prior to discharge from hospital. This will be aimed at maintaining some shoulder movement whilst still protecting the reconstruction. Unprotected shoulder movement could threaten the surgical outcome, whilst overprotection will result in stiffness. Care is therefore needed.

Post-operative appointments

• You will be reviewed in clinic approximately 3 weeks following your surgery.

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