The acromioclavicular joint is the small joint at the top of the shoulder where the collarbone meets the shoulder blade.

Strong tissues around this joint normally keep the collarbone in its correct position.

A fall directly onto the shoulder can tear these tissues. The collarbone may then move out of its normal position. This is commonly called an AC joint injury or shoulder separation.

Most AC joint injuries do not require surgery. However, some injuries cause ongoing pain or instability and may benefit from AC joint reconstruction.

When is AC joint reconstruction needed?

Most AC joint injuries can initially be treated with a sling, rest, exercises and a gradual return to activity.

Surgery may be considered when:

• The collarbone remains significantly out of position

• The shoulder continues to feel unstable

• Pain continues despite appropriate treatment

• The injury interferes with work, exercise or sports

• The shoulder is regularly used for heavy physical activity

• An older injury continues to cause pain or instability

The decision depends on the severity of the injury, the patient's symptoms, daily activities and expectations.

What is AC joint reconstruction?

AC joint reconstruction is an operation to restore the normal connection between the collarbone and shoulder bladeafter the tissues holding them together have been badly damaged.

During the operation, the collarbone is brought back towards its normal position. Strong stitches or other strong supporting material are then used to hold the bones together while the damaged tissues heal.

In some patients, a strong strip of tissue may also be used to provide additional support.

The aim is to create a stable shoulder while allowing normal shoulder movement.

What happens during the operation?

The operation is performed through a cut at the top of the shoulder.

The collarbone is brought back towards its normal position. The damaged tissues are then repaired or strengthened using strong stitches and supporting material.

The collarbone is held securely while the tissues heal.

The exact method depends on how badly the joint has been damaged and whether the injury is recent or old.

What are the benefits?

When the operation is appropriate, it can:

• Improve shoulder stability

• Reduce pain

• Bring the collarbone closer to its normal position

• Improve shoulder function

• Help patients return to work and exercise

• Help patients return to sports

• Improve confidence when using the shoulder for demanding activities

The aim is not simply to make the shoulder look better on an X-ray. The main goal is to provide a stable, comfortable and useful shoulder.

What is recovery like?

The shoulder needs time to heal after reconstruction.

The arm is usually protected in a sling during the early part of recovery. Shoulder movement is then increased gradually, followed by strengthening exercises.

Recovery usually includes:

• Controlling pain and swelling

• Protecting the shoulder during the early healing period

• Gradually improving shoulder movement

• Strengthening the shoulder

• Gradually returning to normal activities

• Later returning to heavy work and sports

Your surgeon will provide a rehabilitation plan based on the type of injury and operation.

When can I return to sports?

Return to sports is gradual.

Light daily activities usually return before heavy lifting, contact sports and activities that place greater stress on the shoulder.

Before returning to demanding sports, the shoulder should have regained good movement, strength and stability.

The time required varies depending on the injury, operation and type of sport.

What are the risks?

AC joint reconstruction is a commonly performed operation, and serious complications are uncommon.

Possible problems include:

• Infection

• Bleeding or blood clots

• Shoulder stiffness

• Continued pain

• Continued or repeated instability

• The collarbone moving out of position again

• Problems with the material used to hold the shoulder in place

• Discomfort from screws or other devices, when used

• The need for another operation

Following the recommended rehabilitation programme is important for allowing the repaired tissues to heal properly.

Frequently Asked Questions

Does every AC joint injury need surgery?

No. Most AC joint injuries can be treated without surgery. An operation is considered when the injury causes significant or ongoing pain, instability or difficulty with work and activities.

Will the operation make my shoulder normal again?

The aim is to restore a stable and comfortable shoulder and improve its function. Many patients experience significant improvement, although the final result can vary from person to person.

How long does recovery take?

Recovery takes several months because the tissues need time to heal. Normal daily activities usually return before heavy lifting and sports.

Can I return to sports after the operation?

Many patients can return to sports after appropriate healing and rehabilitation. The return should be gradual, particularly for contact sports and activities involving heavy lifting.

Will my collarbone look completely normal after surgery?

The position of the collarbone can improve significantly, but a small difference in appearance may remain in some patients. The more important goal is to restore a stable, comfortable and functional shoulder.