Acromio-clavicular Joint (ACJ) Reconstruction

Reconstruction of the Acromio-clavicular Joint (ACJ) is a surgical procedure primarily utilized to address high-grade injuries to the ACJ, aiming to restore the connection between the collarbone (clavicle) and the upper limb through the shoulder blade (scapula). This procedure is typically employed for both acute and chronic injuries, with various techniques employed based on the severity and nature of the injury. 

Indications for ACJ reconstruction include: 

  • Severe acute injuries classified as type IV, V, or VI  
  • Chronic injuries (type III) where conservative treatment fails to provide relief. 
  • Acute type III injuries in high functioning athletes, manual workers 

Benefits of ACJ reconstruction include: 

  • Pain relief. 
  • Restoration of shoulder stability. 
  • Improved joint function. 
  • Increased shoulder strength. 
  • Stability of the joint. 

Risks of surgery are uncommon with the vast majority of patients having a successful outcome. However, potential risks of surgery include: 

  1. Infection  
  1. Nerve injury  
  1. Bleeding  
  1. Frozen shoulder or shoulder stiffness  
  1. Failure of the operation  
  1. Irritation from the hardware used 
  1. Further operations 
  1. Slight elevation of the clavicle above its normal position due to stretching of the tissues/ artificial ligaments after surgery 

The procedure is typically performed under general anaesthesia, with the patient positioned in a semi beach chair position. The surgical approach varies depending on whether the injury is acute or chronic. Mr Gulihar prefers to use two methods of fixation for both acute and chronic injuries. In acute injuries, damaged ligaments are stabilized using strong sutures, metallic endobuttons and extremely strong fibretape. In chronic injuries, tendon grafts or artificial polyester ligaments are used to replace torn ligaments along with stabilisation using metallic endobuttons. The operation generally lasts between 30 to 90 minutes depending of the time from injury and the severity of the injury. 

After surgery, patients may experience pain, which can be managed with painkillers. Physical therapy is initiated early to prevent stiffness and maintain muscle strength. Patients are typically reviewed after two weeks for wound assessment and physiotherapy. The shoulder sling is removed after six weeks, allowing for a full range of movements. Strenuous activities may be gradually resumed after six weeks to three months, with complete recovery typically taking six months to one year.