Overview
An AC joint separation is a tear of the ligaments that hold your collarbone (the clavicle) tied down to the bony shelf at the top of your shoulder blade (the acromion). Mild separations heal with rehab. The high-grade injuries are different — the collarbone visibly rides far above the shoulder, and the soft tissue holding everything together has come apart. Those leave a bump, persistent weakness, and pain that doesn't settle. AC joint reconstruction rebuilds the torn ligaments and pulls the collarbone back into its proper position.
How the Procedure Works
Your surgeon starts by pulling the collarbone back down into its proper position and confirming the position with a live X-ray (fluoroscopy). Then comes the reconstruction itself. A tendon graft is looped around a small bony hook on the front of the shoulder blade (the coracoid) and passed through two drill holes in the collarbone — at the exact spots where the original ligaments used to attach. Rebuilding both limbs of that ligament complex is more stable than a single-attachment approach. A small button device holds the position while the graft heals into the bone. The capsule of the AC joint itself is repaired over the top. There's a known risk of pulling the collarbone too far down (over-reduction) — your surgeon checks position carefully before locking everything in.
When to Consider AC Joint Reconstruction
AC joint reconstruction comes into play when your symptoms, imaging, and the result of a real trial of non-operative care all point to surgery as the next step. The typical patient profile:
High-grade AC separation
Rockwood type IV, V, or VI injuries where the clavicle is grossly displaced.
Persistent pain after rehab
A high-grade separation with ongoing symptoms or functional deficit despite a course of conservative care.
Conditions This Treats
Physicians Who Perform AC Joint Reconstruction
Providers Who Surgically Assist with AC Joint Reconstruction
Risks & Why We Still Recommend It
Every operation carries risk. The reason we offer this procedure is that the alternative — leaving a high-grade separation alone — is its own bad trajectory: a permanently bumpy, weak shoulder that fatigues with overhead work and fails athletes at the top of their motion. We aren't eliminating risk; we're choosing the smaller of two unfavorable paths.
The risks we discuss with you before AC joint reconstruction include:
- bleeding and infection
- anesthesia risk
- stiffness
- loss of reduction with recurrent deformity
- clavicle or coracoid fracture through the tunnels or fixation
- hardware irritation
- graft failure
The indication to proceed is a high-grade AC joint separation that's still symptomatic after a real trial of non-operative care, or an acute severe injury in a patient whose work or sport demands a stable shoulder girdle. Patients who don't need this operation don't get it.
Further Reading
External patient-education references and related OSI pages for additional background: