Your acromioclavicular (AC) joint provides stability and motion within your shoulder. When it becomes severely injured, AC joint surgery is one option to help you regain function.
The AC joint is found where your collarbone meets the uppermost point of your shoulder blade. It’s a plane-type synovial joint, which is a junction of bones connected by ligaments that allow them to slide and shift, but not hinge.
AC joint injuries account for
AC joint surgery is reserved for severe injuries that have major bone displacement or complete ligament tear, or injuries that aren’t healing well with conservative approaches.
AC joint separations are graded on what’s called the Rockwood classification system, which considers the severity of the damage to the joint and surrounding muscle system. In this system, type III through VI separations are those most likely to need surgical repair. Many type III AC joint separations can also be managed without surgery.
If you do need AC joint surgery, the focus involves repairing the ligaments and realigning your bones, securing them into position with surgical hardware.
Repair of your AC joint ligaments depends on how severely they’ve been damaged. Incomplete tears might only need to be stitched together. If a tear needs total reconstruction, a tendon graft from another part of your body or from a donor is used to recreate the joint’s stabilizing ligaments.
The Bosworth screw is a piece of surgical hardware used to realign and stabilize your AC joint by temporarily attaching your collarbone to your shoulder blade.
Clavicle hook plates are another way to realign your AC joint and hold it stable while it heals. Hook plates use smaller screws to attach the flat part of the plate to your collar bone while an “L” shaped extension hooks under the part of your shoulder blade called the acromion.
Tension band wiring is another fixation method that rejoins your collarbone with the shoulder blade. It’s very similar in placement to a hook plate but uses wire to connect the bones, which may provide a wider range of motion.
Endobuttons are just that — titanium buttons. With this minimally invasive approach, a surgeon drills small holes in your collarbone and clavicle and passes wire to align the injured bones. Titanium buttons attach to each end of the tightened wire to restore joint integrity.
If you’ve been living with chronic AC joint problems, you may be a candidate for debridement, which is a procedure that removes debris and damaged tissue that might be causing pain or limiting the function of the joint.
The merits of AC joint surgery are a topic of debate. In general, it allows your bones to be correctly positioned for healing, which can lower the chances of shoulder deformity.
Overall, AC joint surgery outcomes may not be that much better than conservative treatments.
According to a 2019 review, surgery might not be superior to conservative treatment when it comes to regaining shoulder function, returning to former activities, or improving quality of life 1 year after treatment.
In fact, the review noted that at the 6-month recovery mark, outcomes appeared better for people in the conservative treatment group.
Similar findings have been noted before. A
Surgery also comes with a
Just because AC joint surgery has similar outcomes to conservative treatment doesn’t mean it’s ineffective.
According to a 2022 review, AC joint surgery often brings in satisfactory results, with
Surgery may also be successful even if you don’t have it right away.
In a 2021 study, researchers found delayed surgical treatments for AC joint fixation were just as beneficial as early interventions.
According to Medicare estimates, the 2022 national average cost was between $4,534 and $6,987. That number only includes the surgical facility and doctor fee.
You may encounter some challenges when it comes to covering the costs of AC joint surgery.
With no clear standards on when (or if) surgery is absolutely necessary, some private companies may require you to try conservative treatments first or provide additional details, like a second opinion.
If AC joint surgery is found to be necessary, your coverage will depend on your individual policy.
Medicare will cover up to 80% of medically necessary AC joint surgeries.
In the beginning, you’ll be asked to stick to a 6-week period of immobilization in an arm sling. Ice pack applications to your shoulder and pain medications can help keep you comfortable. During this time, your rehabilitation specialist may introduce basic wrist and elbow movements, but nothing for your shoulder just yet.
After the 6-week mark, if you’re healing as expected, use of the sling is slowly decreased, and you can begin to work on structured range-of-motion exercises.
It may be several months before you’re allowed to lift your arm above 90 degrees. Even when you can, recovery will focus on building strength and meeting a full range of movement up to the 6-month mark.
Is AC joint surgery worth it?
There’s no universal answer as to when AC joint surgery is the best option. It’s a decision that factors in how severe your injury is, your age, your current activity level, and how important shoulder mobility is for you in the future.
It’s always OK to seek multiple medical opinions in situations where conservative treatments may have similar outcomes.
AC joint surgery is an option for stabilizing your AC joint if it becomes injured. It involves realigning your collarbone and shoulder blade with medical hardware such as screws, plates, wire, or titanium buttons.
It can also include ligament reconstruction or debridement, the surgical removal of debris, and damaged joint tissues.
While surgery offers a way to ensure proper bone positioning during the healing process, there’s no clear benefit of AC joint surgery over conservative treatment.
Every clinical situation is unique. Be sure to clearly communicate your goals and expectations to your doctor. That’s the only way you can optimize outcomes.