Acromioclavicular (AC) Repair/Reconstruction

  • Procedure

  • Why AC Repair/Reconstruction

  • Candidates

  • Recovery


The patient is positioned in a sitting position on the operating room table and the arm is placed in an arm holder. A 1-2 inch incision is made over the top of the shoulder with 3 smaller incisions for the scope and arthroscopic instruments. The coracoid (small extension of the shoulder blade where the coracoclavicular ligaments attach) is exposed and a guide is positioned under the coracoid and on top of the clavicle (collar bone). A small cannulated drill is inserted through the guide from the clavicle down through the coracoid while viewing with the scope. A wire is inserted through the cannulated drill after the guide is removed. The wire is then used to shuttle strong sutures attached to a metal button, that is shaped like a dog bone, up through the small tunnel created in the coracoid and clavicle. A button is then attached to the sutures on top of the clavicle and the sutures are tensioned while the clavicle is reduced back to its normal position. If the AC sprain is more chronic (i.e. more than 3 weeks old) then an allograft (cadaver) tendon is used to reinforce the repair. This is shuttled around the collarbone and coracoid to reinforce the repair to reconstruct the ligaments that were torn. The wound is closed in multiple layers with absorbable sutures and sterile dressings are applied. The arm is placed into a sling. The surgery is performed under general anesthesia with a nerve block.

  • This surgery is usually outpatient, which means the patient will be able to go home the same day.
  • Surgery typically lasts 1-1.5 hours
  • Patients will be fit for a sling at a preoperative appointment and this sling will be placed on the patient prior to waking up from anesthesia
  • The sling is to be worn at all times until the nerve block has worn off. At that point, the arm should be removed from the sling at least three times a day for elbow, wrist, and finger motion.

Frequently Asked


How long will I need to wear my sling?

4 weeks. The sling should be removed at least 3x/day for elbow, wrist, and finger range of motion exercises as will be instructed. You should do pendulum exercises 3x/day as well.

Can I drive with a sling on?

You can drive when you feel safe to operate a vehicle with 1 functioning arm. This usually takes most patients a few weeks after surgery.

Do I have to wear the sling at night?

Yes. You are also usually unaware of their arm movements at night. The sling helps to ensure that the arm stays in a good position for healing.

When do I start PT after surgery?

Physical therapy typically starts 2-3 weeks after surgery.

When can I shower?

2 days after surgery. Once you remove the bandages, you will see 3 sticky white strips covering the wounds. These are called steri-strips and should be left in place until your first postoperative appointment.

How often do I need to use the ice machine?

The ice machine should be used for about 30 minutes at least 3 times a day until your first postop. You may ice more frequently if desired.

What is a nerve block?

An anesthetic injection performed by the anesthesiologist to turn off pain signals that go to a targeted region.

How can I control my pain after surgery?

This will be discussed at your preop appointment. If a narcotic is prescribed, the risks and side effects will be reviewed with you. We encourage you to try and discontinue these by your first postop appointment. Depending on your health history, it is encouraged to take anti-inflammatories and Tylenol instead of the narcotics.

What are the risks of an AC repair/reconstruction procedure?

The most common risk after this surgery is failure of the fixation used to stabilize the position of the distal clavicle. This causes recurrent deformity, but it almost never as severe as it was prior to the surgery. Other less common risks include infection, bleeding, arthritis, fracture of the coracoid or clavicle, stiffness, and nerve injury.

I am told I need surgery. What next?