Overview
An AC joint separation is a tear of the ligaments that hold your collarbone (the clavicle) tied down to the bony shelf at the top of your shoulder blade (the acromion). Mild separations heal with rehab. High-grade injuries are different: the soft tissue holding everything together has come apart, and the collarbone visibly rides far above the shoulder. Those injuries leave a bump, persistent weakness, and pain that does not settle. AC joint reconstruction rebuilds the torn ligaments and pulls the collarbone back into its proper position.
How the Procedure Works
Your surgeon starts by pulling the collarbone back down into its proper position and confirming the position with a live X-ray (fluoroscopy). Then comes the reconstruction itself. A tendon graft is looped around a small bony hook on the front of the shoulder blade (the coracoid) and passed through two drill holes in the collarbone, at the exact spots where the original ligaments used to attach. Rebuilding the ligament at both of its original attachment points holds the collarbone more securely than a single point would. A small button device holds the position while the graft heals into the bone. The capsule of the AC joint itself is repaired over the top. Pulling the collarbone too far down (over-reduction) is a known risk, so your surgeon checks the position carefully before locking everything in.
When to Consider AC Joint Reconstruction
AC joint reconstruction comes into play when your symptoms, imaging, and the result of a real trial of non-operative care all point to surgery as the next step. The typical patient profile:
High-grade AC separation
Severe separations, where the collarbone is clearly and significantly out of position, that will not settle on their own.
Persistent pain after rehab
A high-grade separation with ongoing symptoms or functional deficit despite a course of conservative care.
Treats: AC Joint Separation
Risks & Why We Still Recommend It
Every operation carries risk. This procedure is offered because the condition, when left untreated, can cause a permanently raised, weak shoulder that fatigues with overhead work and loses power at the top of the reach. The decision to proceed weighs the risks of surgery against the limitations the condition places on daily function. Surgery does not remove risk; it addresses a problem that is otherwise progressive. Whether it is appropriate is determined for each patient in consultation with the surgeon.
The risks we discuss with you before AC joint reconstruction include:
- bleeding and infection
- anesthesia risk
- stiffness
- loss of reduction with recurrent deformity
- clavicle or coracoid fracture through the tunnels or fixation
- hardware irritation
- graft failure
The indication to proceed is a high-grade AC joint separation that's still symptomatic after a real trial of non-operative care, or an acute severe injury in a patient whose work or sport demands a stable shoulder girdle. Patients who don't need this operation don't get it.
Frequently Asked
questions we hear in clinicCan a separated AC joint heal without surgery?
Mild separations heal with rehab. High-grade injuries are different: the soft tissue holding everything together has come apart, and the collarbone visibly rides far above the shoulder. Those are the injuries considered for reconstruction, especially when pain and weakness do not settle after a real trial of non-operative care.
Will the bump on my shoulder go away?
The operation pulls the collarbone back down into its proper position, and your surgeon confirms that position with a live X-ray before locking everything in. Pulling the collarbone too far down is a known risk, so the position is checked carefully.
How is the joint actually rebuilt?
A tendon graft is looped around the coracoid and passed through two drill holes in the collarbone, at the exact spots where the original ligaments used to attach. Rebuilding both limbs of that ligament complex is more stable than a single-attachment approach, and the capsule of the AC joint itself is repaired over the top.
What happens if I leave a high-grade separation alone?
That path has its own costs: a permanently bumpy, weak shoulder that fatigues with overhead work and fails athletes at the top of their motion.
What are the main risks?
The risks we discuss before this operation include bleeding and infection, anesthesia risk, stiffness, loss of reduction with recurrent deformity, fracture of the clavicle or coracoid through the tunnels or fixation, hardware irritation, and graft failure.
Further Reading
External patient-education references and related OSI pages for additional background:
