When should I have AC Joint Surgery?

There are several things that someone should consider if they should have AC Joint Surgery.  For certain AC Separation grades (Grade 4 or Grade 5), surgery is highly recommended since it will debilitate the use of your shoulder with everyday tasks.  For an Grade 3 AC Joint Separation, there are additional things one should consider:

  • Injury severity
    It is important to know the severity of the injury. If your shoulder separation is complete (grade 3 or higher) you are a candidate for surgery. This can easily be determined by a simple X-ray. An MRI is rarely indicated in evaluating this injury.
  • Activity level
    Patients who are very active or have demanding occupations are more likely to be unhappy with nonsurgical care. The more you demand your shoulder the more likely you will need surgery.
  • Appearance
    The deformity associated with a complete shoulder separation is permanent. Cosmesis alone is not an indication for surgery but surgical repair is the only way to normalize the deformity
  • Consequences
    Early repair is a simple procedure with reliable results. When the repair if done soon after the injury (earlier than 3-6 weeks) the complexity of the surgery is less than repairs that are done after a failed trial of nonsurgical treatment. The end result may possibly be better as well. This makes the decision making process difficult because there are serious consequences to consider if surgery is delayed.
  • Commitment
    It is necessary to use a sling for one month following the procedure and then it will be necessary to go through rehabilitation to optimize shoulder function. That requires an understanding of the process and a commitment to see it through in order to achieve the best result. By comparison nonsurgical treatment is an easier process so it is important to weigh out whether you are committed to the surgical and postoperative process
  • Risk
    All surgical procedures have risk. The procedure takes about an hour and requires either a regional or general anesthesia. There is a very small risk of infection. Preoperative antibiotics reduce this risk to very low levels. Postoperative stiffness can occur but is minimized by adhering to a standard rehab protocol.Not all patients are medically capable of undergoing elective surgery. It will be necessary to make sure any preoperative problems are identified and optimized before undergoing a surgical procedure