AC Joint Reconstructive surgery

Surgeon here has talked about a modified Weaver-Dunn procedure - moving the CA ligament over to the clavicle and supporting it with a fiber wire loop - which seems a bit different from what you described. Anyone out there have experience with this particular fix or other options?

Hi Craig,
I am familiar with the Weaver-Dunn/ac-tighrope procedure. It seems it works for some leaning more toward the "non-athlete". I discussed this procedure as a possible option with my surgeon and he said that it minimally addresses the stability and strength of the joint. Of course it all depends on the severity of the injury and how you intend to use the joint following surgery. My shoulder was about as bad as it can get...nothing left attached in there...fortunately the large muscle groups held things together for the most part...at least until I went under the knife. After some consideration it was decided to go with the graft!

Good luck with everything bro and please keep us posted with your decision and progress!

Chris

Awesome thread. Thanks to Chris for updating even years later. I recently had AC reconstruction using the fairly new arthroscopic dog bone technique.( check out arthrex) I also have a donor graft. Smashed my right shoulder snowboarding in the park. The CC ligaments were replaced, but nothing was done for my AC ligament. I'm coming up on 12 weeks post surgery. Things seem pretty good for the most part, but when I attempted a very light (I mean very, very light) cross-body stretch I felt and saw my clavicle protrude posteriorly quite a bit. Otherwise everything seems pretty stable vertically. Young surgeon is giving me mixed information. Said go full ROM at my 6 week checkup and then said no cross-body stretching until at least 12 weeks after reporting the protrusion. Acted like this was a big no-no. He also said he evaluated my AC ligament intraoperatively and that it was stretched and should heal on its own. My separation was type 3. Everything I've read says the AC ligament is torn with a type 3 and even type 2, so naturally I'm starting to question what he's telling me. How do I tear both CC ligaments and leave the AC ligament intact? My clavicle is solid. Has anyone had experience with this surgery or another method that only addresses the CC ligaments? Is it normal to still have instability on the front to back plane? Will it tighten up like he suggests? What's the point in having the surgery if it only stabilizes the clavicle on one axis? Any insights would be much appreciated. If I have to have an additional procedure to correct the AC I want to get that going while I'm still in the mindset of being injured. Thanks a ton!

Wow Chris!

Sounds like an interesting injury to that joint. Please keep us posted on your recovery/PT specifically the cross body stretching. Good luck with everything my friend and heal quickly!
C

Thanks for the response, Chris. I have a follow up with another doctor soon. We'll see what he says. I'm gonna hit rehab hard until then and try to pack some muscle back on. Hopefully that will help with stabilization. Back to climbing ASAP. No cross-overs or serious gaston-ing for now! I'll report back after I've found something out!

Chris82 wrote:Thanks for the response, Chris. I have a follow up with another doctor soon. We'll see what he says. I'm gonna hit rehab hard until then and try to pack some muscle back on. Hopefully that will help with stabilization. Back to climbing ASAP. No cross-overs or serious gaston-ing for now! I'll report back after I've found something out!

Right on!!
Good luck and work hard my friend. you'll get it back!
Grammy

It's worth mentioning that third and fourth degree separations are generally clinical diagnoses based on degree of displacement. It might be any interesting study to see how many "third degrees" involve full damage to both AC and CC ligaments, now that arthroscopic surgeries are becoming more mainstream.

As for recovery, it sucks but gets better. Nothing against surgeons, but once they're done putting you back together the PT becomes God on what is and isn't encouraged regarding movement.

Rhomboids and serratus anterior will be your best friends in regards to increasing stability, those guys are now your scapula's main support system.
If you happen to be waiting for surgey/docs I'd ask about "pre-hab" it might improve your recovery

Thanks for the advice, bking7! I'm staying on top of my rehab. I'll definitely integrate those serratus-anterior exercises into the game plan!

Hello Chris Graham and all,

This thread is getting somewhat old but there is little real time information from actual people who have undergone AC joint reconstruction surgery, so I greatly appreciate what has been discussed here.

I had a Grade 4/5 ACJ separation from a hiking accident and decided to have ACJ reconstruction with graft. It also involved FibreWire. I struggled with the decision right up until the day of the surgery.

I'm amazed at how quickly you came back Chris and your fearlessness is inspiring, I'm afraid I can't say the same. I am 4 weeks post-op and I am still a little fearful of the end result although my shoulder is healing well it seems. I have had to keep my left arm in a immobilizer sling the whole time and can begin weaning off it tomorrow at home but still wear it in public for two more weeks. I believe pendulum exercises begin tomorrow as the doctor wanted a lot of healing before I put my weight the arm due to my size...6'3" 225 lbs. 

I thought I was going to have arthroscopic surgery but it turns out I had open surgery. I seem to be suffering from some PTSD in regard to possibility of surgery failure for whatever reason including clavicle fracture from drilling the clavicle and the coracoid shown in the report below. Is this dumb or what? Has anyone else had these fears, and if so how did you resolve them? 

Really don't have to want to go through anything like this again as I am 65 and live alone.

Any reply would be appreciated!

wyatt

If anyone is interested how mine was done, here is the post-op report.

"There was a drill hole through the coracoid, a suture was passed through and then the Tightrope fixation device was passed through the coracoid and the metallic button was pulled up inferior to the coracoid."

Further; "a graft was placed beneath the clavicle using a semi-tendinosis graft and it was looped under the coracoid.
A drill hole was made into the clavicle and then one of the graft was place through the drill hole and an inference screw by Arthrex 4.75 mm was placed to hold the graft in place. The sutures of the TightRope were pulled through the anchor to minimize holes in the clavicle.

Additionally, two small holes were placed into the anterior clavicle and lateral clavicle for placement of FiberWire wire sutures to repair the native tissue. The second limb of the graft, the second limb of the graft was pulled very firmly. The TightRope was tied down while reducing the joint anatomically. The TightRope sutures were tied over the metallic button superiorally. This held the clavicle reduced in anatomic position.

The graft was then pulled very firmly and then sewn back onto itself and sewn to the clavicle anteriorally.
The sutures were placed through clavicle using Fiberwire and these were passed through the anterior soft tissue including the remaining coracoclavicular ligaments.
Additionally sutures were placed over the AC joint. One limb of the graft was placed across the AC joint and sewn into the soft tissue there to provide better anterior and posterior stability."

Hi Wyatt,

Wonder how you are doing. It has been a while, tell me, in a similar situation. thank you, Dima

Hello and thank you very much for your reply. In my case, i had grade 2-3 after a bicycle fall and was recovering, when i made a wrong move during weight training and completely messed it up - grade 4-5 now. The feeling of something moving inside my shoulder have not left me since. I would love to chat with you and ask a few more detailed questions, please. My email dimabaikov@gmail.com 

Thank you so much in advance

Dima

Rikwrote: I have a grade 5 AC separation, and I missed about 2 weeks of climbing before it didn't hurt to bad to climb. I decided not to have surgery, and it doesn't bother me at all after 3 years. Collar bone still sticks up though.

this seems wrong. Grade 5 is horrendous... I have one. you positive of that grade 5? Cause from experience anything over grade 3 is rare AF.
It took me almost 2.5-3 years til it felt normal. 2 weeks for even a grade 3 is way out of the question for anyone ive ever known to have had one.
Are you superman?

Agree 100% with Mr Rogers. Rik you have been misdiagnosed or it is simply a bravado. Yes, you can recover from grade 5 non-operatively, but in two weeks you would be crying like a baby just to lift a coffee cup.