ACJ Stabilization

There are different options of surgery which will be discussed with you and the best option used.

The stabilization of the unstable / dislocated Acromio-Clavicular (ACJ) is undertaken using a ‘Bra Strap’ incision about 10 cms long over the ACJ. An artificial ligature / tape is used to repair the Coraco – Clavicular (CC) ligaments which connect the clavicle to the coracoid bone. This is usually held with a screw in the clavicle. Sometimes to provide a biological supplement to the artificial ligament the Coraco-Acromial Ligament may be transferred to the repair. Occasionally a donor graft tendon may be used, especially in revision surgery.

At the end of surgery, the wound is closed with dissolvable sutures and tied over the skin. Butterfly stitches, splash proof dressing and a pad is applied, and the arm rested in a sling.

Questions that are often asked

Is the surgery necessary?

If your symptoms are persistent and causing problems with Activities of Daily Living or sports then surgery may be considered.

Before Admission:

No food for 6 hours, or drink for 2 hours, prior to surgery.
Please avoid smoking for 12 hours prior to surgery.
Please continue to take all your medication as advised by the preassessment team.

What happens on the day of surgery?

You will need to report to the main reception on arrival. You will be shown to your room where you will be checked in by the nurse and also see Prof. Singh and the anaesthetist. This will give you chance to ask any questions before surgery. You will also be given an approximate time of your procedure. Please read the instructions on ‘Preparing for Surgery’.

What are the possible complications?

Scar: This area can be firm to touch & tender for 2 – 3 months. This can be helped by massaging the area with moisturizing cream once the wound has healed.
Infection: Can occur after any operation. This would be treated with antibiotics. This is uncommon following surgery for ACJ stabilization.
Nerve Damage:It is common to have some numbness below the clavicle immediately after surgery, but this usually resolved over 6 months, sometimes this may be permanent, but is usually not disabling.
Bleeding: Can cause a collection of blood under the stitches which can cause wound problems. Tell the surgeon if you are on anticoagulants or aspirin
CRPS / Stiffness: About 5% (1 in 20) of people are sensitive to surgery and their hand and whole arm may become swollen, painful and stiff after any operation. This problem cannot be predicted but will be watched for afterwards and treated with therapy.
Failure:Sometimes the fixation can fail, or the ligament fails and then patients can have recurrence of the problem. Commonly the ligament becomes a bit lax and a complete displacement is rare.

What kind of anaesthesia is used?

A combination of general anesthesia and a nerve block is used for most surgeries. Before the surgery, the anaesthetist will inject numbing medicine around the nerves of the shoulder. This numbs the arm and helps to control your pain after surgery.

How long will I be in the hospital?

The surgery is done as a day case and you should home within a few hours.

After hospital care:

Sling: After your surgery, you will be fitted with a high arm sling, which is to be used for 2 – 4 weeks.
Medication: The nerve block usually lasts between 18 – 24 hours. Patients are encouraged to start taking painkillers before the pain starts i.e. on return home and for at least 48 hours.
Wound care &Removal of stitches: At the end of the surgery you have dissolvable sutures to close the skin which are tied over the skin. The sutures will need to be removed at 14 days after surgery which can be performed at your GP practice or nurse at the hospital or by the therapist
Follow-up orthopaedic clinic: You will need to be reviewed in clinic after your operation. This is usually 2 –4 weeks after surgery.
Physical Therapy A physiotherapist will assess you at the time of your operation and will give you exercises to do before you go home. You will be referred to physiotherapy either in the community or an outpatient department.
Return to Work: Managerial or Supervisory: 2– 3 weeks, Light Manual: 4 – 6 weeks (e.g. clerical, secretarial), Heavy Manual: 6 – 10 weeks (ground worker, HGV). Please discuss with your consultant / therapist if you have any queries.
Driving you may be able to drive once the pain is under control and you have movements in the arm – usually around 4 to 6 weeks after surgery. Please let your Motor Insurance Company aware of your procedure.