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Acromioclavicular (AC) Joint Fixation

Dr. Lingaraju A P - Consultant Orthopaedic & Joint Replacement

What is Acromio-Clavicular joint?

The acromioclavicular (AC joint) is a joint between the clavicle (collar bone) and the acromion (part of scapula). AC joint serves as a primary link between the axial skeleton and the upper extremity. The AC joint has dynamic and static stabilizers and it is movable in all planes so it is not a rigid structure. Its complex ligamentous structure is critical to the normal function of the shoulder girdle. The acromioclavicular (AC) and Coracoclavicular (CC) ligaments are the static stabilizers whereas the deltoid and trapezoid muscles are the dynamic stabilizers.
What is Acromio-clavicular joint injury?
AC joint injury is the separation of the acromioclavicular joint, it means that the ligaments are torn and the collarbone no longer lines up with the acromion. The injury to the AC joint ligament can be graded as mild to severe. Classification

Type I is a sprain injury of the AC ligament; there is no complete tear and both AC and CC ligaments are intact.

Type II is a tear of the AC ligament but not of the CC ligaments.

Type III injury involves tears of both the AC and CC ligaments, with 25% to 100% displacement of the clavicle compared with that on the contralateral side.

Type IV injury, both the AC and CC ligaments are torn and there is posterior displacement of the distal clavicle into the trapezius fascia.

Normal AC Joint

Normal AC Joint

AC Joint Dislocation

AC Joint Dislocation

AC Joint Reconstruction

AC Joint Reconstruction

What are the symptoms of AC joint dislocation?
The most common symptoms of AC joint dislocation are acute severe shoulder pain and unable move the shoulder in sideways
How the AC joint dislocation treated?
There are various options depending on the type of tear, your age, activity level and requirements. Options will be discussed with you
Nonsurgical options:
Nonsurgical Treatment: Type I and type II AC joint injuries are treated by nonsurgical. Options may include,
  1. Rest to the shoulder with sling immobilisation and limiting the shoulder activities.
  2. Ice packs to shoulder daily for 20 min
  3. Nonsteroidal anti-inflammatory medication. Drugs like ibuprofen and naproxen reduce pain and swelling.
  4. Physiotherapy to strengthen your shoulder muscles.
  Surgical options: The two techniques most commonly used for AC joint repair are,
  1. Open repair
  2. Arthroscopic repair
The technique of repair depends on the size of your tear, your anatomy, and the quality of the tendon tissue and bone. Contact Best Orthopedic in Jayanagar Bangalore
When AC joint surgery is indicated?
Surgical treatment is indicated when,
  1. Your tear was caused by a recent, acute injury
  2. Type IV and total dislocation
  3. Some active patients with type III
  4. Old tear with AC joint instability
 
How AC joint repair done?
Usually done under combined brachial block and general anaesthesia. In open technique the AC joint exposed and the AC ligament and CC ligament reconstructed with sutures and endobuttons. Arthroscopy allows a better, greater and clearer visibility around the coracoid, and extensive dissection of the deltotrapezial fascia is not required. This clearer visibility also puts the important neurovascular structures at less risk. The suprascapular nerve and the suprascapular artery are the structures with the closest proximity to any implanted material. Besides, arthroscopy makes it possible to get a straight vision of the inferior aspect of the base of the coracoid – a particularly important anatomical area, especially when placing CC fixation systems.
How long i need to stay in hospital after AC joint repair?
Many AC Joint repairs are done on day-care basis and do not require you to stay overnight in the hospital.
How will be my recovery after AC joint repair?
You will be advised simple shoulder exercises immediate post-surgery and shoulder immobilizer for 3 weeks followed by shoulder exercises as per the protocol. You can return to all normal activities and sports by 3 months
What will happen if AC joint dislocation not repaired?
If you have AC joint dislocation and you keep using it despite increasing pain, you may cause further damage. Shoulder muscles start becoming weak. You will not be able to take full load on the shoulder.

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