How is the procedure performed?
The procedure is performed under a combination of general and regional anaesthesia. A Hamstring tendon is harvested from the leg and prepared by placing reinforcing sutures along its length. An incision is made over the acromioclavicular joint and the joint is exposed along with the outer end of the collarbone. Tunnels are drilled in the clavicle. A nonabsorbable tape is placed between the clavicle and the coracoid and tightened to stabilise the coracoclavicular interval. The tendon graft is passed around the coracoid and through the tunnels in the clavicle, pulled taut and fixed with small interference screws. The capsule (or sleeve) around the acromioclavicular joint is repaired with sutures placed through drill holes in the bones. At the end of the procedure the overlying muscles are repaired and the skin is closed with sutures placed deep to the skin.
Benefits
The main benefit of the procedure is to repair the damage, restore stability and improve the function of the joint. More than 90% of patients achieve benefit from surgery.
Risks
Pain - The shoulder and the leg may be painful for some weeks after surgery.
Bruising – Bruising may occur around the joint and the scars and usually resolves 2-3 weeks after surgery.
Bleeding – A small amount of bleeding from the surgical wound is not unusual and will usually settle after a day or two.
Stiffness: This is not uncommon after surgery and will resolve as you start moving the arm.
Numbness around the scar: A small patch of numbness adjacent to the scar is not uncommon but does not cause any functional problems.
Hardware or fixation failure – Occasionally the sutures or screws used to fix the graft may loosen, cut out of the bone or fail. This may require further surgery.
Fracture of the clavicle or coracoid – These have been reported but are rare.
Infection – Infection is a possibility but is rare (1%). You will be given antibiotics as a precaution.
Nerve injury – This is possible but rare.
Arthrosis – Wear and tear in the joint following an injury may lead to symptoms at a later date. These can be treated as necessary.
Aftercare
Following the procedure the surgical wound is covered with a shower-proof dressing, which should be left undisturbed as far as possible for 14 days. If the dressing is removed for any reason they should be replaced with similar dressing or waterproof plaster. Prior to discharge from hospital a physiotherapist will provide instructions about looking after the shoulder. You will be advised to protect the shoulder by wearing a sling for 4 weeks and intermittently performing movements of the shoulder within certain limits. After 4 weeks you may stop wearing the sling and will be allowed to move the shoulder actively through a greater range. Strengthening exercises are started after 8 weeks. Vigorous use of the arm or lifting heavy objects should be avoided for 3 months. Outpatient physiotherapy will be arranged and may need to be continued for 3-6 months.
Resuming activities
You may resume driving at 1 week or when you have regained control of the arm. Return to work will depend on your occupation. Manual activities should be avoided for at least 3 months. Non-contact sports may be resumed at 3 months and contact sports at 6 months.
Follow-up
An appointment will be arranged for you to be seen 2 weeks after the procedure. Follow-up is required for at least 12 months after surgery or until a satisfactory recovery is achieved.