Injuries involving the acromioclavicular joint (ACJ) are particularly common among athletes, active individuals, and anyone experiencing a significant fall or trauma to the shoulder. If you’ve suffered from ongoing pain, deformity, or loss of function at the very top of your shoulder, ACJ reconstruction offers a proven path back to strength, comfort, and confident movement.
Understanding the AC Joint
The acromioclavicular joint is a small, but critical, junction located at the top of your shoulder, where the collarbone (clavicle) meets the highest point of the shoulder blade (acromion). This joint enables overhead movement, lifting, reaching, and the ability to perform many daily tasks. ACJ injuries frequently occur as a result of direct impact—such as a fall onto the shoulder during contact sports or accidents.
What Causes ACJ Injury?
ACJ injuries can happen in various ways:
Direct Trauma: A fall directly onto the shoulder is the leading cause.
Sports Injuries: High-impact sports like rugby, cycling, or football put athletes at risk.
Repetitive strain: Constant overhead lifting or strenuous activities can weaken the ligaments over time.
Accidents: Motor vehicle incidents are also a cause, especially if the shoulder takes the brunt of a collision.
Symptoms Indicating ACJ Problems
Common signs and symptoms of acromioclavicular joint injury include:
Pain and swelling at the end of the collarbone
Difficulty or pain when raising the arm
Prominent bump or visible deformity at the top of the shoulder
Tenderness or bruising around the joint
Weakness and reduced range of shoulder motion
If conservative treatment (rest, physiotherapy, pain relief) fails to restore normal shoulder function, or if the injury is severe, ACJ reconstruction surgery may be recommended following assessment by an orthopaedic specialist.
What is ACJ Reconstruction?
ACJ reconstruction is a surgical procedure aimed at repairing or rebuilding the damaged ligaments that hold the joint together. The surgery restores proper alignment of the collarbone and the shoulder, reduces pain, and prevents long-term problems such as persistent instability or early-onset arthritis.
Surgical Techniques
Several surgical approaches can be used for ACJ reconstruction:
Anatomic Ligament Reconstruction: Uses a tendon graft (from the patient or a donor) to recreate the torn coracoclavicular ligaments.
Artificial Ligaments and Synthetic Grafts: Modern techniques employ strong, biocompatible materials to stabilise the joint.
Screw or Button Fixation: Temporary screws or buttons may be inserted to hold the joint in place while ligaments heal.
Open or Minimally Invasive Surgery: Depending on injury complexity, reconstruction may be performed via open surgery or keyhole (arthroscopic) techniques for reduced scarring and faster recovery.
Your surgeon will select the most appropriate method based on the type and severity of your ACJ injury.
The ACJ Reconstruction Procedure
The operation is typically performed under general anaesthesia. A small incision is made near the joint to access the damaged area. The surgeon then:
Realigns the collarbone with the acromion,
Repairs or reconstructs the ligaments securing the joint,
Installs any necessary fixation devices (plates, screws, synthetic bands),
Closes the incision and applies a sterile dressing.
The procedure usually takes 60–90 minutes, and most patients can go home the same day or after an overnight stay.
Benefits of ACJ Reconstruction
Choosing ACJ reconstruction delivers clear advantages:
Stability and Strength: Rebuilds the structural stability of your shoulder.
Pain Relief: Alleviates chronic pain stemming from unresolved injuries.
Restored Motion: Enables full range of movement and return to sporting or active lifestyles.
Cosmetic Improvement: Reduces unsightly bumps and restores natural shoulder contour.
Prevents Arthritis: Proper healing reduces long-term risk of ACJ arthritis due to instability.
Recovery and Rehabilitation
Immediately After Surgery
You’ll be placed in a sling to protect the joint for the first 2–4 weeks. Light hand and wrist movements begin immediately, and guided shoulder exercises start soon after.
Rehabilitation Programme
Weeks 1–4: Immobilisation in a sling; gentle hand and wrist movements.
Weeks 4–8: Gradual introduction of passive and then active shoulder exercises.
After 8 weeks: Strengthening exercises and progressive return to everyday activities.
Most patients regain full mobility and function between 3–6 months post-surgery, although the timeline depends on individual healing and commitment to physiotherapy.
Risks and Considerations
As with all surgical procedures, ACJ reconstruction carries risks such as:
Infection
Bleeding or nerve injury
Loss of fixation or graft failure
Persistent pain or instability
However, complication rates are low when the operation is performed by an experienced orthopaedic surgeon.
Why Choose an ACJ Specialist?
A successful outcome depends on both surgical skill and rehabilitation guidance. Surgeons with a focus on shoulder and upper limb surgery, such as Mr Jagwant Singh in London, offer the expertise, personalised care, and modern techniques necessary for optimal results.
Is ACJ Reconstruction Right for You?
If you struggle with ongoing shoulder pain, weakness, or deformity after an injury, seek the advice of a specialist. After careful assessment, your surgeon will discuss your options and recommend whether ACJ reconstruction is the path to restoring comfort, strength, and confidence in your shoulder.