The acromioclavicular (AC) joint plays a crucial role in shoulder stability and movement, connecting the acromion (part of the shoulder blade) to the clavicle (collarbone). When this joint is injured due to trauma or degenerative conditions, such as severe shoulder separations (grades III-V) or chronic instability, acromioclavicular joint reconstruction surgery becomes necessary to restore function and alleviate pain. This comprehensive guide explores the anatomy of the AC joint, indications for surgery, types of reconstruction techniques, preparation, surgical procedures, recovery, risks, and more.
Acromioclavicular joint defined
The AC joint is a small but important joint located at the top of the shoulder, where the acromion and clavicle meet. It is surrounded by ligaments and supported by muscles that provide stability and allow for a wide range of shoulder movements, including lifting, reaching, and rotating the arm. Injuries to the AC joint often result from direct trauma, falls onto the shoulder, or repetitive overhead activities, leading to ligament sprains, partial tears, or complete joint separations.
When is AC joint reconstruction needed?
AC joint reconstruction surgery is typically recommended for patients with severe AC joint injuries that do not respond adequately to non-surgical treatments. These injuries often include:
- Grade III to V AC joint separations, where the ligaments are partially or completely torn, causing significant joint instability.
- Chronic AC joint instability that affects daily activities and quality of life despite conservative management.
- Severe arthritis in the AC joint, causing debilitating pain and reduced shoulder function.
Non-surgical treatment options
Initially, non-surgical treatments such as rest, ice, anti-inflammatory medications, and physical therapy may be attempted to alleviate symptoms and improve joint function. However, in cases where these measures fail to provide sufficient relief or stabilize the joint, surgical intervention may be necessary to repair or reconstruct the damaged ligaments and restore joint stability.
Surgical techniques for AC joint reconstruction in Singapore
AC joint reconstruction can be performed using different surgical techniques, depending on the severity of the injury and the patient’s specific needs:
- Open AC joint reconstruction: In this approach, an incision is made over the AC joint to directly visualize and repair the damaged ligaments. The surgeon may use sutures, anchors, or synthetic grafts to reconstruct the ligaments and stabilize the joint.
- Arthroscopic AC joint reconstruction: Arthroscopic surgery involves smaller incisions and the use of a camera (arthroscope) to guide the surgical instruments. This minimally invasive technique allows for a more precise repair of the AC joint with less tissue trauma and typically results in quicker recovery times.
During the reconstruction procedure, the surgeon carefully evaluates the extent of ligament damage, removes any scar tissue or damaged cartilage, and reconstructs the AC joint using selected surgical materials that best fit the patient’s anatomy and functional needs.
Preparing for AC joint reconstruction surgery
Before undergoing AC joint reconstruction surgery in Singapore, patients undergo a thorough evaluation by an orthopedic surgeon. This evaluation includes a detailed medical history review, physical examination, and diagnostic imaging such as X-rays and MRI scans to assess the extent of AC joint damage and plan the surgical approach.
Patients are also provided with pre-operative instructions, which may include adjustments to current medications, fasting prior to surgery, and practical guidance on preparing for post-operative recovery.
What happens during the surgical procedure
The surgical team begins by positioning the patient appropriately and administering general anesthesia. Depending on the chosen technique (open or arthroscopic), the surgeon makes the necessary incisions to access the AC joint.
Once the joint is exposed, the surgeon carefully assesses the damage, removes any damaged tissue or bone fragments, and proceeds with the reconstruction process. This may involve repairing torn ligaments, augmenting the joint with graft material if necessary, and securing the joint with specialized screws or anchors to enhance stability.
After completing the reconstruction, the surgeon closes the incisions with sutures or surgical staples and applies a sterile dressing. Patients are closely monitored in the recovery area before being transferred to a hospital room or discharged home on the same day, depending on the complexity of the surgery and individual recovery progress.
The process of recovery
Recovery from AC joint reconstruction surgery in Singapore involves a structured rehabilitation program designed to promote healing, restore shoulder function, and prevent complications. Initially, patients may experience some discomfort, which is managed with pain medications as prescribed by the surgeon.
Physical therapy plays a crucial role in the recovery process, starting with gentle range-of-motion exercises and gradually progressing to strengthening exercises as the shoulder heals. The physical therapist guides patients through exercises that target shoulder mobility, muscle strength, and joint stability, with the goal of achieving full recovery and returning to normal activities over time.
Possible risks and complications
Like any surgical procedure, AC joint reconstruction carries certain risks and potential complications, including:
- Infection: Although rare, infections can occur following surgery and may require antibiotics or additional treatment.
- Nerve or blood vessel damage: There is a small risk of injury to nearby nerves or blood vessels during surgery, which can cause temporary or permanent sensory changes.
- Stiffness or reduced range of motion: Some patients may experience stiffness in the shoulder joint during the recovery phase, requiring ongoing physical therapy to improve flexibility.
- Failure of reconstruction: In rare cases, the reconstructed ligaments may not adequately stabilize the AC joint, necessitating revision surgery or alternative treatments.
Post-surgery instructions
While the procedure aims to restore shoulder function and alleviate pain, full recovery and return to high-impact activities may take several months. Patients are advised to follow their surgeon’s guidance regarding activity levels, gradually reintroducing physical activities and sports as the shoulder strengthens and heals.
To protect the reconstructed AC joint and prevent future injuries, you may need to make lifestyle modifications such as avoiding heavy lifting or repetitive overhead movements that could strain the shoulder joint. Maintaining a healthy weight, participating in regular exercise, and attending periodic follow-up appointments with the orthopedic surgeon are also essential for preserving long-term joint health and function.
Artisan Sports & Orthopaedic Clinic
290 Orchard Road
Paragon Medical Centre #07-12
Singapore 238859
Phone (65) 8909 8877
https://www.artisanorthopaedics.sg/