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Acromioclavicular Joint Repair/Reconstruction
Dr. James Chen, M.D. - In San Francisco, CA

Dr. Chen's surgical technique for AC joint repair reconstruction:

Dr. Chen's surgical technique for AC joint repair reconstruction is an arthroscopic procedure performed to restore acromioclavicular (AC) joint stability and alignment after a severe dislocation of the joint. 2 or 3 small incisions are made around the shoulder. Holes are drilled near the end of the clavicle (collar bone) and another in the coracoid process of the scapula which sits below the clavicle. A suture that is attached to stainless steel buttons is passed through the bones with buttons seated below the coracoid and above the clavicle. Sutures can then be tensioned bringing the clavicle into its proper orientation. This constitutes a repair. A reconstruction will further stabilize the joint by adding a soft tissue graft that is passed around the clavicle and coracoid and secured in place.


Dr. Chen's surgical technique for acromioclavicular joint repair using a tensioned suture cerclage system has been featured in Arthroscopy Techniques - The Journal of Arthroscopic and Related Surgery.

Acromioclavicular Joint Repair Using a Suture Cerclage Tensioning System

Download the PDF

Grade 5 AC separation equivalent
with distal clavicle fracture

Tensioned cerclage repair of
AC joint with bone tunnels

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Common Questions about Acromioclavicular Joint Repair/Reconstruction

How is a shoulder separation diagnosed?

A shoulder separation, also known as an AC separation, is diagnosed clinically with a large prominence seen at the AC joint. An xray is performed which shows the clavicle superior to the acromion process of the scapula.

How are shoulder separations treated?

AC joint separation is also known as a shoulder separation. AC joint separation is graded from 1 to 5, with grade 4 and 5 treated with surgical repair or reconstruction. Grade 1 and 2 injuries are treated nonsurgically in a sling. Grade 3 injuries typically can be treated nonsurgically, however symptomatic or unstable Grade 3 injuries can be treated surgically.

How long does it take for a shoulder separation to heal?

Shoulder separations typically heal within 6 to 8 weeks.

When is an allograft or cadaver used in AC joint surgery?

Allograft or cadaveric tissue is used for an AC joint reconstruction when the AC separation is chronic in nature. If surgical treatment is performed several months after the initial injury an allograft is usually required.

What causes a shoulder or AC joint separation?

The most common mechanism is a fall onto the anterior or superior shoulder such as going over the handlebars of a bicycle or a fall during skiing or snowboarding. Typically in trauma to the shoulder the clavicle (collarbone) will either break or an AC joint separation with occur. A combination of a fracture of the clavicle and an AC separation is rare.

How is AC joint repair or reconstruction performed?

AC joint repair can performed arthroscopically by drilling a hole in the distal clavicle and coracoid. A metal button is placed on top of the clavicle and below the coracoid process of the scapula. A strong suture is tied between the two which reduces the AC joint.

Open AC joint repair is performed by drilling two holes in the distal clavicle, weaving strong suture around the coracoid and up through those two holes, then tying the sutures together.

What is the rehabilitation after AC joint surgery?

After surgery a sling is worn for 6 weeks. The patient attends physical therapy for two to three months after sling removal to regain motion.

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