AC joint surgery (acromioclavicular joint reconstruction) rebuilds the ligaments that hold the outer end of the collarbone down at the top of the shoulder. It is usually done for a high-grade separated shoulder, or for a lower-grade one that still hurts or limits work or sport after months of rehab. Expect a sling for about 4 to 6 weeks, limited lifting for about 3 months, and contact sport around 4 to 6 months after surgery, often closer to 6.
The weeks before surgery are a good time to set up your home and build strength in the muscles that will protect the shoulder later. Your surgeon’s protocol comes first. If their instructions differ from anything here, use theirs.
Key takeaways
- What it does: AC joint reconstruction rebuilds the ligaments between the collarbone and the shoulder blade, usually with a tendon graft, strong suture tape, or both.
- Sling time: most people wear a sling for about 4 to 6 weeks. Driving often waits about 6 to 8 weeks, so plan rides and help for that long.
- Lifting: lifting and carrying with the operated arm are usually limited for about 3 months.
- Before surgery: if your surgeon allows it, keeping the shoulder blade and rotator cuff muscles active can make the later rehab easier.
- Surgeon first: your surgeon’s protocol comes first on sling time, movement and lifting.
What the operation does
Two sets of ligaments hold the AC joint together. The small ligaments around the joint itself control front-to-back movement. The stronger coracoclavicular ligaments, running from the collarbone down to a hook of bone on the shoulder blade (the coracoid), hold the collarbone down. In a high-grade separation, both sets are torn and the collarbone rides up as a bump.
Common methods include:
- Graft reconstruction: a tendon, often taken from the hamstring or from a donor, is looped from the collarbone around or through the coracoid to replace the torn ligaments.
- Suture button or tape fixation: strong suture tape is passed through small holes in the bones and held with small metal buttons. This is sometimes combined with a graft.
- Hook plate: a metal plate that hooks under the acromion holds the collarbone down while the tissues heal. It is usually removed in a second operation after a few months.
Some procedures are done through keyhole surgery, others through a cut over the top of the shoulder. The method affects how long the arm is protected, so ask which one is planned.
What to set up at home
- Clothing: loose front-opening tops, a size larger than usual. Slip-on shoes, elastic-waist pants and front-fastening bras.
- Sleeping position: many people sleep propped up for the first 2 to 4 weeks. Set up a reclining chair or a stack of pillows, with one to support the elbow so the arm does not hang.
- Kitchen and bathroom: move daily items to between waist and chest height. Avoid anything that needs carrying with the operated arm.
- Driving and help: arrange rides for about 6 to 8 weeks, plus help with shopping, laundry and lifting children.
- Work and sport: desk work often returns in 1 to 3 weeks. Tell your coach or employer that manual work usually takes 4 to 6 months, and contact sport around 4 to 6 months, often closer to 6.
The arm hanging by your side is the load the reconstruction is least ready for.
What to practice before surgery
- The sling: put it on and take it off with one hand, with the operated elbow supported so the arm never hangs free.
- One-handed tasks: dressing, washing, eating and typing with the other hand.
- Getting out of bed: roll to the other side and push up with the other arm.
- Shoulder blade and rotator cuff exercises: if your surgeon or physical therapist allows, gentle shoulder blade setting and light rotator cuff work that does not hurt the AC joint. These muscles carry more of the load in the months after surgery.
- General fitness: walking, cycling and leg strength help fitness and mood while the arm rests.
Questions to ask your surgeon
- Which method will you use: a graft, suture buttons or tape, or a hook plate?
- If a graft, where does it come from?
- How long will I wear the sling, and must I wear it at night?
- Which movements must I avoid, and for how long?
- When can I lift, drive and return to work?
- When could I return to my sport, and what test decides that?
- Will I need a second operation to remove anything?
- When does physical therapy start?
The first 48 hours
Many people go home the same day or after one night. You will wake with the arm in a sling and a dressing at the top of the shoulder. A nerve block, if used, can leave the arm numb for several hours. Start your pain medication before it wears off, and take it on schedule at first.
Keep the elbow supported so the arm does not hang. Bruising at the top of the shoulder and down the upper arm is common over the first few days. If a hamstring graft was taken, expect soreness and bruising at the back of the thigh as well. Gentle hand, wrist and elbow movement, if allowed, helps limit swelling.
Call your surgeon or emergency number if
- Sudden breathlessness or chest pain: call your local emergency number.
- The hand turns pale, cold or blue: call your local emergency number.
- One calf swollen, hot or painful: call your surgeon’s team or a doctor the same day.
- Fever or wound changes: 38°C (100.4°F) or above, spreading redness, discharge or a bad smell from the wound.
- Numbness that stays or spreads: numbness or weakness in the arm or hand that lasts well beyond the nerve block or is spreading.
- A pop and a returning bump: a sudden pop with the end of the collarbone rising again. Call your surgeon’s team.
More on this area: surgery recovery guides.
Set the house up so the arm never has to hang or carry, and the reconstruction gets the time it needs.
Written by Louise Yow, Neck & Shoulder Physio.