The shoulder complex contains three major joints: the acromioclavicular (AC) joint, the glenohumeral joint, and the sternoclavicular joint. The AC joint is the connecting point of the acromion (highest portion of the shoulder) and the clavicle (collarbone) and is the most frequently injured of the three shoulder girdle joints. The AC joint capsule and its supporting ligaments can be pulled away from their respective attachment points causing the acromion to be separated from the clavicle. AC joint injuries vary in severity, ranging from mild stretching of the ligaments to a complete detachment of the ligaments in severe separations. While athletes have the highest likelihood of experiencing an AC joint injury, particularly those involved in aggressive contact sports such as football or wrestling, non-athletic individuals can also experience an AC joint injury from a blunt force trauma to the shoulder.
There are six grades of acromioclavicular (AC) joint injuries that are assigned based on the severity of damage to the AC joint capsule and surrounding ligaments. Grades 1-3 are mild injuries that cause varying degrees of joint displacement from the ligaments being stretched. These milder AC joint injuries often benefit from conservative therapies alone. Grades 4-6, however, occur when the AC joint capsule is completely disrupted and the connecting ligaments are completely severed from their attachment sites. These severe AC joint injuries typically require surgical intervention to realign the clavicle with the acromion. Realigning the clavicle is accomplished by suturing the AC joint capsule back to the correct anatomical position. Dr. Frank McCormick, orthopedic shoulder doctor, treats patients in Orlando, Palm Beach County, and surrounding Florida communities, who have experienced an AC joint injury and are in need of surgical reconstruction.
Dr. McCormick prefers the minimally invasive arthroscopic procedure for acromioclavicular (AC) joint reconstruction. When the patient is stabilized under anesthesia and in the correct position, a number of small incisions are made surrounding the AC joint. A small camera (arthroscope) is introduced and the images of the muscles, tendons, and ligaments of the AC joint are transmitted to a monitor for Dr. McCormick to review. A steroid solution is continuously circulated throughout the duration of the procedure to enhance the visualization of these shoulder structures. Specialized surgical instruments are then inserted to remove any damaged tissues or anatomical abnormalities noted with the arthroscope.
AC joint reconstruction often involves integrating a tendon graft from donor tissue (allograft). The tendon grafts are attached to the anterior (front) portion of the shoulder and fastened to the clavicle with special surgical anchors that are secured within the bone. Medical-grade sutures are also integrated through screws to protect the tendon grafts during the healing process as well as provide additional strength to the newly repaired ligaments. When the clavicle is realigned with the acromion and all the necessary revisions are complete, the arthroscope and surgical instruments are withdrawn from the AC joint and the incisions are closed with sutures or steri-strips.
The severity and complexity of the acromioclavicular (AC) joint injury often determine the recovery period following AC joint reconstruction. Most patients in Orlando, Palm Beach County, and the surrounding Florida communities can expect a return to normal daily and athletic activities in approximately 3 to 4 months. The immobilization of the AC joint with a sling or other device can be expected immediately following surgery. Any post-operative symptoms can be managed with rest, ice, and non-steroidal anti-inflammatory medications (NSAIDs). The key to a successful recovery following AC joint reconstruction is adhering to and completing a physical rehabilitation program. While this physical therapy program will be tailored to address the patient’s specific needs, it will generally focus on re-establishing shoulder strength and range of motion.
For more information on shoulder labrum and SLAP tear repairs, or to discuss your shoulder labrum treatment options, please contact the office of Frank McCormick, MD, orthopedic shoulder doctor serving Orlando, Kissimmee, Palm Beach County, Florida, and the surrounding areas.
