Acromioclavicular joint repair

Acromioclavicular Joint Repair: Restoring Shoulder Function and Stability

The acromioclavicular joint (AC joint) plays a vital role in the shoulder’s stability and function. It is a small but significant joint located at the top of the shoulder, where the collarbone (clavicle) meets the shoulder blade (scapula). Injuries to the AC joint can result from various causes, including sports injuries, accidents, or degenerative conditions. 

When damage occurs, acromioclavicular joint repair becomes a critical treatment option to restore shoulder stability and alleviate pain. In this article, we will explore the anatomy of the AC joint, common injuries, the surgical repair process, and the expected outcomes.

Understanding the Acromioclavicular Joint

The AC joint is a synovial joint that connects the clavicle to the acromion process of the scapula. This joint is surrounded by ligaments and held together by a capsule, providing stability while allowing for limited motion. It plays a crucial role in shoulder movement and function. Particularly, in activities that involve raising the arm or carrying heavy loads.

Common Acromioclavicular Joint Injuries

Injuries to the AC joint can occur due to various factors, such as direct trauma, repetitive stress, or degenerative changes over time. Some common AC joint injuries include:

Acromioclavicular Joint Sprain: This injury usually occurs in sports such as football or cycling. The determination of it’s characterisation is by the stretching or tearing of the ligaments surrounding the AC joint.

Acromioclavicular Joint Dislocation: In severe cases, the ligaments holding the AC joint together can be completely torn. This leads to a dislocation where the clavicle moves out of its normal position relative to the acromion.

Arthritis of the AC Joint: Over time, wear and tear can lead to osteoarthritis in the AC joint, resulting in pain, stiffness, and limited range of motion.

diagram of acromioclavicular joint

Indications for Acromioclavicular Joint Repair

AC joint repair surgery is a major possibility and potential option when conservative treatments, such as rest, physical therapy, and anti-inflammatory medications, fail. This is when they fail to provide adequate relief or when there is severe joint instability. The decision to undergo surgery depends on factors such as the patient’s age, activity level, and the extent of the injury.

The Surgical Procedure

AC joint repair typically happens using one of several surgical techniques, depending on the specific injury and the surgeon’s preference. Here’s an overview of the common surgical methods:

Open Reduction and Internal Fixation (ORIF): This procedure involves making an incision over the AC joint, realigning the displaced bones, and using hardware such as screws or a plate to secure the joint in its proper position. ORIF is commonly used for severe dislocations.

Arthroscopic Surgery: In some cases, minimally invasive arthroscopic surgery may be an option. Small incisions are made, and a tiny camera (arthroscope) is used to visualize and repair the joint. Arthroscopic techniques are often preferred for less severe injuries.

Tightrope Technique: This innovative technique involves passing a strong suture through the clavicle and acromion, holding them together like a “tightrope” to stabilize the joint. It provides a less invasive option with favorable outcomes.

Recovery and Rehabilitation

The recovery process after AC joint repair varies depending on the surgical technique used and the extent of the injury. However, some general guidelines apply:

Immobilization: After surgery, the typical immobilisation of the shoulder takes place with a sling or brace for a period ranging from a few weeks to several months, depending on the surgical approach and the patient’s progress.

Physical Therapy: Physical therapy is a crucial part of the recovery process. It helps restore range of motion, strengthen the shoulder muscles, and improve joint stability. As the shoulder heals, the gradual introduction of rehabilitation exercises occurs.

Return to Activity: The timeline for returning to regular activities or sports varies but is often several months. The surgeon and physical therapist will guide the patient through a gradual return to full function.

Expected Outcomes

AC joint repair surgery aims to alleviate pain, restore joint stability, and improve shoulder function. The outcomes are generally positive, with most patients experiencing a significant reduction in pain and an improvement in shoulder strength and range of motion.

However, it’s important to note that the success of AC joint repair depends on several factors, including the severity of the injury, the surgical technique used, and the patient’s commitment to post-operative rehabilitation.

shoulder pain - Acromioclavicular joint repair

Possible Complications

As with any surgical procedure, AC joint repair carries potential risks and complications, although they are relatively rare. Some of these include:

Infection: The surgical site may become infected, requiring antibiotics and additional treatment.

Hardware Issues: Hardware used in the procedure may loosen or cause irritation, necessitating removal or revision surgery.

Nerve or Vascular Injury: Damage to nearby nerves or blood vessels is a rare but serious complication.

Stiffness or Limited Range of Motion: Some patients may experience residual stiffness or limited range of motion in the shoulder.

As a result,

Acromioclavicular joint repair is a valuable surgical intervention for individuals suffering from AC joint injuries. It offers the potential for significant pain relief and improved shoulder function. Making the decision to undergo surgery should be in consultation with a healthcare provider, it has a proven track record of success. It helps in restoring the AC joint’s stability and enabling patients to return to their normal activities with confidence. As with any medical treatment, it’s crucial for patients to fully understand the procedure. Thus, this includes follow post-operative rehabilitation guidelines, and active participation in their recovery to achieve the best possible outcomes.

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