Name of the Procedure:

Open treatment of acromioclavicular dislocation, acute or chronic; with fascial graft (includes obtaining graft)
Common name(s): AC Joint Repair, AC Joint Reconstruction

Summary

An open treatment for acromioclavicular (AC) dislocation involves surgically repairing the damaged joint between the collarbone and shoulder blade. The procedure includes the use of a fascial graft, which is tissue taken from another part of the body to help stabilize and repair the joint.

Purpose

The procedure addresses acromioclavicular joint dislocation, a condition where the collarbone separates from the shoulder blade. The goal is to restore normal function, reduce pain, and improve the stability of the shoulder joint.

Indications

• Severe pain and shoulder dysfunction
• Visible deformity of the shoulder
• Acute injury from trauma or chronic instability
• Failure of conservative treatments such as physical therapy or bracing

Preparation

• Patients may be advised to fast for 6-8 hours prior to surgery.
• Adjustments to medications, especially blood thinners, may be required.
• Preoperative imaging tests such as X-rays or MRIs to assess the extent of the injury.

Procedure Description

1. Anesthesia: General anesthesia or regional block is administered.
2. Incision: A surgical incision is made over the AC joint.
3. Exposure: The dislocated joint is exposed, and damaged or displaced tissues are identified.
4. Graft Harvesting: A graft, often taken from the thigh (fascia lata), is prepared and harvested.
5. Repair: The graft is used to stabilize the AC joint by securing the collarbone to the shoulder blade.
6. Closure: The incision is closed with sutures and covered with a sterile dressing.

Duration

The procedure typically takes 1-2 hours, depending on the complexity of the dislocation and the specific surgical techniques used.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Scrub techs
• Possibly a surgical assistant

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Graft failure or re-dislocation
• Nerve or blood vessel damage
• Stiffness or reduced shoulder mobility

Benefits

• Restoration of normal shoulder function
• Pain relief
• Improved joint stability
• Enhanced ability to perform daily activities and sports

Recovery

• Patients may need to wear a sling to immobilize the shoulder for a few weeks.
• Physical therapy begins soon after surgery to promote healing and regain strength.
• Full recovery may take several months, with restrictions on heavy lifting and overhead activities.

Alternatives

• Non-surgical treatment with physical therapy and bracing.
• Arthroscopic surgery, a minimally invasive option.
• Each alternative varies in effectiveness, recovery time, and potential for complete return to pre-injury activities.

Patient Experience

• Moderate pain and discomfort immediately after surgery, managed with pain medication.
• Swelling and bruising around the surgical site.
• Gradual improvement in function and pain over the weeks following surgery.
• Physical therapy and adherence to postoperative guidelines are crucial for optimal recovery.