AC and CC Joint Repair & Reconstruction

The AC joint is where the clavicle (collarbone) meets the acromion (a bony process on the scapula or shoulder blade). Injuries to this joint are classified based on their severity, from mild sprains to complete dislocations.

Low-grade sprains can often be treated successfully with nonsurgical treatments, including a short period of rest, medications for pain, immobilization, and physical therapy. Surgery is typically considered when conservative treatments fail to relieve pain or instability or in cases of high-grade injury or dislocation, where the ligaments are extensively damaged.

The choice of technique depends on the specific injury and the surgeon’s expertise. Common procedures include direct repair of the torn ligaments when the injury occurred recently, reconstruction using tendon or ligament grafts when the injury occurred in the past (either autografts from the patient or allografts from a donor), and fixation using screws or suture anchors.

The CC ligaments (the conoid and trapezoid ligaments) attach the clavicle and the coracoid process of the scapula and provide stability to this region of the shoulder. Injuries to these ligaments often occur alongside AC joint injuries, especially in higher-grade injuries.

As in AC joint injuries, surgery for the CC ligaments is indicated when the clavicle is significantly displaced upward, causing pain, reduced shoulder function, and the risk of chronic instability or arthritis. When surgery is necessary, both the AC joint and CC joint injuries will be addressed at that time.

Direct repair of the CC ligaments is possible when the injury is recent. Reconstruction of the CC ligaments is indicated when the injury is older (occurred over 6-8 weeks ago) and typically involves using grafts to restore the normal alignment and function of the shoulder. The graft can be fixed in place using various methods, including screws, suture anchors, or buttons.

The patient is placed in an immobilizer sling for six weeks, and no weight should be lifted from that shoulder during that time. Movement at the elbow, wrist, and hand is allowed while the shoulder is healing for activities such as writing, typing, dressing/bathing, and eating. A structured rehabilitation program with a physical therapist begins at six weeks with gentle range of motion exercises and gradual advancement to strengthening exercises as healing progresses. Full return to activities, including sports, typically occurs between 5 to 6 months, depending on the individual’s healing process and adherence to rehabilitation.

Surgical repair and reconstruction of the AC and CC joints generally have high success rates, with most patients returning to their previous levels of activity. AC and CC joint repair and reconstruction are surgical procedures tailored to the patient’s specific needs based on the type and severity of the injury. Advances in surgical techniques and rehabilitation strategies continue to improve outcomes for patients returning to their prior level of activity with these challenging shoulder injuries.