Acromioclavicular joint repair or reconstruction
Content reviewed by✓Mr Andrew Davies, PhD FRCS (Tr & Orth)· Reviewed June 2026Surgery for AC joint injury is performed for high-grade injuries (Grades IV–VI) or Grade III injuries causing persistent pain and dysfunction in active patients. The type of operation depends mainly on how soon after the injury it is done. This guide explains what to expect.
Step 1 - Your pre-operative assessment
ℹ️ Your pre-assessment is usually 2–4 weeks before surgery. AC joint surgery is typically a day-case or one-night procedure.
The type of operation depends mainly on how long it has been since the injury, because this changes whether your own ligaments can still heal. There are two approaches:
Acute repair (within about the first 3 weeks)
When surgery is done soon after the injury, the torn ligaments can still heal. The joint is moved back into position and held there - usually with strong sutures passed around or through the collarbone and the bone just beneath it, often using small "button" devices. This holds everything in place while your own ligaments heal back together. As no graft is needed, it is generally the simpler operation.
Delayed reconstruction (after about 3 weeks)
If more time has passed, the original ligaments have usually scarred and can no longer heal on their own. Instead, the supporting ligaments are rebuilt using a tendon graft (your own or a donor graft), anchored to the collarbone and the bone beneath it to recreate the normal support. This is a larger reconstruction, and the graft takes longer to heal in.
Blood tests and baseline checks
Routine bloods to confirm fitness for anaesthesia.
Imaging review
Your surgeon will have reviewed pre-operative X-rays (taken standing, with and without weights) to grade the injury and plan whether a repair or a reconstruction is needed.
Anaesthetic discussion
Usually general anaesthesia with or without an interscalene nerve block. The nerve block provides excellent post-operative pain relief for the first 12–18 hours.
Arrange home help
You will be in a sling for 4–6 weeks. Arrange help with washing, dressing, cooking, and childcare as needed.
Hardware awareness
Some fixation devices (e.g. suture buttons) are permanent and do not need removal. Others may require a second procedure to remove metalwork at 3–6 months. Confirm the plan with your surgeon.
The day of surgery
ℹ️ You will be given a specific arrival time. Have no food from 2am on the day of surgery; you may drink clear water until 6am. Bring your medication list and any documents sent by the hospital.
Arrive at the time given
You will be admitted to the ward or day surgery unit, change into a gown, and be seen by the nursing, anaesthetic, and surgical teams before theatre.
Consent and marking
Your surgeon will confirm the procedure, mark the operative side, and you will sign a consent form before going to theatre.
Anaesthetic
You will meet the anaesthetist in the anaesthetic room. Once anaesthesia is established, the procedure will begin.
Recovery room
After surgery you will wake in the recovery room where nurses monitor your vital signs until you are stable and comfortable.
In hospital
Most patients having arthroscopic or day-case procedures go home on the day of surgery. Those having joint replacement typically stay 1–2 nights. Before discharge, the team will check your pain is controlled, give you wound care instructions, and confirm your follow-up appointment.
Pain control
You will be given oral pain relief before discharge. Take it regularly for the first 48 hours rather than waiting until pain is severe.
Wound check and dressing
A nurse will check the wound before you leave and explain how to keep it clean and dry.
Discharge letter and follow-up
You will receive a letter for your GP and details of your next outpatient appointment - usually at 2 weeks for a wound check.
You must not drive yourself home
Arrange for a family member or friend to collect you. You must not drive on the day of surgery if you have had a general anaesthetic or sedation.
Going home
⚠️ Important: Do not attempt to lift anything with the operated arm while in the sling. Both an acute repair and a graft reconstruction need time to heal and integrate - overloading the repair in the first 6 weeks can cause the fixation to fail and the clavicle to displace again.
Keep the wound clean and dry
Avoid getting the wound wet until it is fully healed - usually 10–14 days. Use a waterproof cover or cling film when showering.
Take your pain relief as prescribed
Do not wait until pain is severe before taking medication. Regular simple analgesia (paracetamol, ibuprofen if appropriate) is more effective.
Attend your wound check appointment
This is usually 2 weeks after surgery. Sutures or clips will be removed if used.
When to contact the hospital
Seek urgent advice if you develop increasing redness, warmth, swelling, discharge from the wound, or a temperature above 38°C - these may indicate infection.
Recovery week by week
Pre-assessment
Blood tests, imaging review, anaesthetic discussion, home preparation.
Repair or reconstruction
Operation takes 60–90 minutes. Usually day case; occasionally one night in hospital.
Sling and protected movement
Arm in sling. Pendulum exercises and hand/wrist/elbow movement encouraged. No lifting.
Active physiotherapy
Sling discontinued. Progressive range-of-movement and strengthening programme.
Return to activity
Return to non-contact sport at 3 months; contact sport at 4–6 months when strength is symmetric. A graft reconstruction may be protected a little longer than an acute repair.
Why does the timing of surgery change the operation?
Within roughly the first 3 weeks the torn ligaments can still heal, so the joint can be held in place while they recover (an acute repair). After that the ligaments have usually scarred and will not heal, so the support has to be rebuilt with a tendon graft (a delayed reconstruction). This is why having surgery sooner, when it is indicated, can mean a simpler operation.
Will the bump at the top of my shoulder disappear?
In many cases, a small residual prominence remains even after successful surgery. This is usually cosmetic and does not indicate a surgical failure. Full function is typically restored even if some step remains.
When can I return to contact sport?
Most patients return to contact sport at 4–6 months after surgery, once physiotherapy confirms symmetric strength and there is no pain with contact simulation. A graft reconstruction may be protected slightly longer.
Will I need a second operation to remove hardware?
This depends on the fixation technique used. Suture buttons are usually left in permanently. Clavicle hooks (used in some techniques) require removal at 3–6 months. Your surgeon will confirm the plan.
What happens if I do not have surgery for a Grade III injury?
Most Grade III injuries treated conservatively achieve good functional outcomes, though some patients have residual discomfort with heavy overhead work. Surgery is reserved for those with ongoing significant pain or functional limitation after 3–6 months.
Recovery calendar
A week-by-week guide to recovery. Individual timelines vary, always follow your surgical team.
Consent information
Purpose and intended benefits
The aim of AC joint stabilisation is to reduce the displaced clavicle back to its normal position and maintain this reduction while biologic healing of the coracoclavicular ligaments occurs, resolving pain and restoring normal shoulder mechanics.
What the procedure involves
Under general anaesthetic, the procedure may be performed arthroscopically or with a small open incision above the clavicle. A cortical button device, synthetic ligament (e.g. TightRope or Leeds-Keio), or anatomical reconstruction using tendon graft is used to reduce and stabilise the AC joint by restoring the coracoclavicular distance. Screws or plates may be used in some techniques. The procedure takes approximately 45-75 minutes.
Alternative treatments
Non-operative management (Types I-III)
A broad arm sling for 1-4 weeks followed by physiotherapy. Achieves equivalent functional outcomes to surgery in most Type III injuries. A cosmetic deformity (step at the shoulder) usually persists.
Different stabilisation technique
Multiple techniques exist (cortical button, hook plate, synthetic ligament, anatomical reconstruction). The choice depends on the severity of injury and surgeon preference.
Distal clavicle excision (Mumford procedure)
For chronic symptomatic AC joint arthritis causing persistent pain with cross-body activities and overhead lifting. Removes the joint surfaces but does not address instability.
Risks of the procedure
The most common complication. The reduction may be lost as the ligaments heal, particularly with techniques using synthetic materials alone without biological augmentation. May result in residual deformity.
Buttons, screws, or synthetic ligaments may fail or migrate. Hook plates require planned removal at 3-6 months. Other implants may require removal if symptomatic.
Rare complication of tunnel drilling for button fixation through the coracoid.
Wound or deep infection, which may require implant removal and antibiotics.
The brachial plexus structures are in proximity. Injury is rare.
Some limitation of shoulder movement during the recovery period, usually resolving with physiotherapy.
Expected and managed with regular analgesia.
The arm is in a sling for 4-6 weeks. Discomfort and restriction are expected.
The clavicular scar may be tender for several months.
Some implants (particularly hook plates) require a planned second procedure for removal at 3-6 months after confirmed healing.
If you choose not to have surgery
For Types IV, V, and VI AC joint dislocations, non-operative management is generally inappropriate due to the severity of displacement. For Type III injuries, the majority of patients achieve satisfactory functional outcomes with non-operative management, though a cosmetic deformity usually persists. There is no significant risk to the shoulder from delaying Type III surgery.
Your questions, answered
Plain-English answers to the things people most often ask, drawn from real patient questions and grounded in published guidance. Tap a question to open it.
About thisWhat is an AC joint injury?
The AC (acromioclavicular) joint is where the collarbone meets the tip of the shoulder blade. A fall onto the shoulder or a contact-sport knock can sprain or tear the ligaments there. Injuries are graded from a mild sprain to a full separation.
Your choiceDo I need surgery?
Most AC joint injuries are managed without surgery: a sling for comfort, pain relief and a guided return to movement. Surgery is usually reserved for the most severe separations or for symptoms that do not settle. Even some higher-grade injuries do well without an operation, so it is worth a specialist discussion.
Pain & sleepHow do I manage pain and sleep early on?
Simple pain relief such as paracetamol (and an anti-inflammatory if suitable for you), a sling for the first days to weeks, ice, and sleeping propped up all help. Start gentle hand, wrist and elbow movement straight away, and come out of the sling as comfort allows to avoid stiffness.
The bumpWill the bump on my shoulder go away?
If a step or bump remains, it is the end of the collarbone sitting higher than the shoulder blade. It often stays even after the pain settles, but for most people it is a cosmetic issue rather than one that limits the shoulder. Raise it with your surgeon if it bothers you.
Getting backHow long until I recover?
Many people settle over roughly 6 to 12 weeks, with movement returning first and strength later. Return to contact sport is usually a bit later and is guided by your strength, comfort and confidence rather than a fixed date.
UrgentWhen should I seek urgent help?
Seek urgent review if the skin over the bone looks stretched and about to break, if there is severe deformity, or if the hand becomes numb, cold or pale. After any major chest or shoulder trauma with breathing difficulty, treat it as an emergency.
WellbeingIs it normal to worry about how my shoulder looks?
Yes. A residual bump can be frustrating, especially if you are active. Most people function well and adapt to it; if the appearance or ongoing symptoms trouble you, that is a reasonable thing to discuss with your surgeon.
- NHS: Shoulder pain
- NICE CKS: Shoulder pain (clinical knowledge summary)
- British Elbow & Shoulder Society: patient information
- British Elbow & Shoulder Society: early exercises and sling care
These links are to UK clinical guidance and patient information from recognised organisations. This page is for general information and does not replace personalised advice from your own clinical team.