Several techniques exist. Hook plate: a specially shaped plate is hooked under the acromion with screws in the clavicle, reducing the joint while ligaments heal. The plate is removed at three to four months. Ligament reconstruction: a tendon graft or synthetic ligament is used to reconstruct the coracoclavicular ligaments, with or without a tight-rope device (suture button). Acute repair of the native ligaments may be performed within two to three weeks of injury. The operation takes one to one and a half hours.
Surgery is recommended for high-grade AC joint dislocations (types IV, V, VI) and selected type III injuries in young, active patients or manual workers with persistent symptoms after a trial of non-operative treatment.
Sling, analgesia, and physiotherapy. Many type III injuries do well without surgery. A trial of three to six months of non-operative management is often recommended before considering surgery for type III.
X-rays including stress views. Assessment of the degree of displacement. Timing depends on the technique — hook plate or acute repair within two to three weeks; reconstruction can be performed later.
Restoration of AC joint stability, improvement in overhead strength and function, and correction of the cosmetic deformity. Most patients return to full activity including sport and manual work.
Shoulder stiffnessCommon
Temporary. Physiotherapy important.
Hook plate irritationExpected
The hook causes subacromial impingement. The plate must be removed at three to four months.
ScarExpected
Visible scar over the top of the shoulder.
Acromial erosion or fractureUncommon
The hook can erode the acromion bone. Risk reduced by timely plate removal.
Recurrent instabilityUncommon
The ligaments may fail or stretch after plate removal or graft reconstruction. Risk approximately 10%.
Coracoid fractureRare
With tight-rope devices.
Distal clavicle osteolysisUncommon
Bone resorption at the end of the clavicle.
InfectionUncommon
Wound infection.
General anaesthesia with nerve block. Beach-chair position.
Sling for four to six weeks. Gentle exercises from one to two weeks. Active overhead movement from six weeks. Strengthening from eight to twelve weeks. If hook plate used, removal at three to four months (a short general anaesthetic). Return to sport at four to six months.
X-rays at two weeks, six weeks, and three months. Hook plate removal at three to four months.
Do all AC joint injuries need surgery?
No. Most type I and II injuries and many type III injuries heal well with a sling and physiotherapy. Surgery is reserved for high-grade injuries or type III injuries that remain symptomatic.
Will the bump on my shoulder go away?
Surgery aims to reduce the AC joint. Some residual prominence may remain but is usually much improved compared to the injury.