AC Joint Reconstruction (Shoulder Separation Surgery)

Overview

A shoulder separation tears the ligaments that hold the end of the collarbone to the shoulder blade. Most separations, including many moderate (type III) injuries, do well without surgery; a meta-analysis found similar long-term results with and without surgery for type III to V injuries ^{[1, 2]}.

Surgery is considered for severe separations in which the collarbone is markedly displaced, and for separations that remain painful, weak or unstable after a course of rehabilitation. In these cases the coracoclavicular ligaments, which run from the collarbone down to the coracoid, are reconstructed with a tendon graft and strong suture or tape, and the AC joint itself is often stabilized as well ^[3].

In a systematic review of chronic AC joint reconstruction, outcomes were similar with the patient's own tendon or a donor tendon, and adding stabilization across the AC joint or suture augmentation may lower the risk of the reduction being lost ^[3].

Benefits

• Restores the position of the collarbone
• Can relieve pain and weakness from a chronic separation
• Improves strength for overhead work and sports

Who is a Candidate?

AC Joint Reconstruction may be appropriate for patients who meet certain criteria. Ideal candidates include:

• Severe separations with marked displacement (types IV to VI)
• Type III separations that remain painful or weak after rehabilitation
• Chronic separations with persistent symptoms

Recovery & Rehabilitation

A sling is worn for about six weeks to protect the reconstruction, followed by gradual motion and strengthening. Heavy lifting and contact sports are usually resumed at four to six months.

References

1. Lameire DL, Cecere M, Chan A, et al. Outcomes After Operative Versus Nonoperative Management of Type III to V Acromioclavicular Joint Dislocations: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Orthop J Sports Med. 2026;14(7):23259671261440812. doi.org/10.1177/23259671261440812
2. Mazzocca AD, Arciero RA, Bicos J. Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med. 2007;35(2):316-29. doi.org/10.1177/0363546506298022
3. Eigenschink M, Heuberer PR, Pauzenberger L, et al. Allo- and autografts show comparable outcomes in chronic acromioclavicular joint reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2021;29(7):2202-2211. doi.org/10.1007/s00167-021-06445-7