Coracoclavicular Ligament Reconstruction
A shoulder separation is a specific injury to the part of the shoulder called the acromioclavicular joint, or AC joint. The AC joint is the area where the collar bone, or clavicle, meets the acromion, which is part of the shoulder blade, or scapula. The scapula is held in place by two ligaments, the coracoclavicular ligaments, or CC ligaments, which connect the underside of the clavicle to an extension of the scapula called the coracoid process.
A shoulder separation is typically caused by a high-impact injury to the shoulder such as a fall or a direct blow like a collision in soccer or a tackle in football. The CC ligaments are partially or completely torn. The result of the injury is a painful deformity of the AC joint. The injury is characterized by the appearance that the end of the collar bone is “popping up” relative to the shoulder.
Conservative treatment is an option for most AC joint separations. If there is persistent pain or loss of function after conservative treatment such as immobilization, prescription medicines, physical therapy, and occupational therapy, your surgeon may recommend reconstruction surgery. Some patients may elect to have surgery because of the requirements of their work or sport.
Surgery for a shoulder separation involves reconstruction of the CC ligaments with donor tissue. An incision is made over the end of the collar bone. A portion of the end of the clavicle is removed to prevent formation of arthritis in the AC joint. Holes are drilled in the clavicle, and the donor ligament is suspended around the coracoid process and anchored through the holes in the clavicle. A braid of temporary suture is used to reinforce the repair during the healing process. The muscles and tissue layers are repaired and the skin is closed. Patients may spend one night in the hospital to ensure recovery from surgery.
Complications are rare after CC ligament reconstruction surgery. Some of the common complications include infection, stiffness or restricted movement, nerve and vessel injury, failure of the procedure, and side effects of general anesthesia.
Following surgery your arm is kept in a sling for four to six weeks to facilitate healing. Your physiotherapist will show you use of the sling and instruct on simple exercises. You may have slight pain after surgery for which pain medications are prescribed. Apply ice packs on the shoulder to help reduce the swelling. You can use a pillow under your shoulder while lying in bed. Avoid lifting and driving during the first 6 weeks. You will be given specific instructions regarding activity and a rehabilitation program of exercise and strengthening.