AC Joint Surgery | Why You Might Need Them, Your Options, and More

Written by on October 29, 2021 — Medically reviewed by John Doe

Not everyone is thrilled to go under the knife – and rightfully so. It’s painful, it can leave a scar, and, depending on where you live, it can be expensive. But, sometimes, it’s also necessary. Don’t worry, though. I’m here to give you the lowdown on AC joint surgery.

Hopefully, this helps give you some peace of mind. Here’s a list of topics you’ll find here:

  • When you should get surgery
  • Surgery options for different AC joint injuries
  • What to expect after surgery
  • Recovery period and possible complications

Let’s start!

When is AC joint surgery indicated?

 You should consider having shoulder surgery if:

  • You have exhausted all conservative treatments available
  • Severe pain that seems to be getting worse
  • Joint pain even at rest
  • It’s affecting your quality of life

Another thing to keep in mind is the severity of your injury. It’s better to get surgery ASAP if you have a high-grade shoulder separation. Early surgical treatment has superior outcomes compared to delayed surgery. (1)

What are the surgical options for each AC joint injury?

1. AC joint arthritis

AC joint arthritis is the result of gradual degeneration of the cartilage of the AC joint. This can come from past trauma, including repetitive overuse and a direct blow to the joint.

Surgical procedure – Distal clavicle excision

The end of your collar bone is surgically removed to decompress your AC joint. There are two ways that your surgeon can do this: Open or arthroscopic.

But, the arthroscopic approach can also be done in 2 different ways.

  • Open approach – Uses a 3 to 5 cm transverse or perpendicular saber skin incision. An oscillating saw is used to excise a 1- to 2-cm part of your distal clavicle.
  • Direct arthroscopic approach – This approach is ideal for patients with an isolated AC joint problem issue. It uses a 2.7-mm arthroscope and mechanized burr to begin excision. Then, your surgeon uses a larger 4 mm arthroscope and instruments to complete the procedure.
  • Indirect arthroscopic approach – This approach reduces the risk of postoperative instability. But, it also involves removing your bursa for visualization of the AC joint.

2. AC separation

Falling on an outstretched hand or getting hit on your shoulder can lead to a shoulder separation. This is when the end of your collar bone dislocates from the tip of your shoulder blade. 

Surgical procedures

There are many surgical techniques for joint separation repair. But, they can be grouped into four (3):

  • Hardware fixation: This places temporary hardware on your shoulder joint. This gives your joint enough stability until the soft tissues heal. The hardware is removed after 6-8 weeks.
  •  Hook plate fixation: This uses a metal device that keeps the AC joint in place. It is fixed under the tip of your shoulder blade and collarbone with screws.
  •  Suture button CC fixation: Metal buttons are used to guide nonabsorbable sutures through your collarbone and coracoid. These sutures function as CC ligaments. A study shows that these sutures have comparable strength to the previously injured ligaments. (4
  • CC ligament reconstruction: This technique uses tissue taken from your body or from a donor to recreate your damaged ligament. It involves removing the tip of your collarbone and transferring the attachment of your artificial ligament to restore joint stability.

What to expect after surgery

Outlined below is the typical recovery process after shoulder surgery.

But, remember: This is not a one-size-fits-all timetable for ac joint separation and arthritis. Rather, it’s an overview and can change depending on your surgical procedure and previous level of activity. (5)

Phase 1

The whole of phase 1 may last for a week to a month. The goal of initial treatment is to decrease shoulder pain and swelling.

  • Immobilization: A shoulder sling paired with rest for a few days will help decrease the swelling and allow your soft tissues to heal. The arm sling also provides temporary protection and support.
  •  Medication: Nonsteroidal anti-inflammatory drugs may be prescribed to manage your pain level. Your doctor will give you instructions on when and how frequently you should be taking your meds. Make sure to follow them to prevent possible dependence and addiction.
  •  Physical Therapy: Different clinics have different protocols, but the goals will be the same. These include pain and swelling relief, reducing chances of surgical scarring, and starting a gentle range of motion and strengthening regimen.

Phase 2

This stage starts once the swelling and pain level drops to zero. This is the bulk of your recovery process and may last for 2-4 months. You will also be working closely with your physical therapist here.

The main goal is to lay down the foundational strength and flexibility your shoulder joint needs for the next stage. Sub-goals include:

  • Achieving full-range and pain-free shoulder motions
  • Strengthening the muscles around your shoulder
  • Increasing the flexibility of your muscles and joints
  • Enhancing shoulder proprioception
  • Getting your shoulder blade and collar bone to move painlessly with your arm

Phase 3

This is the last phase before you’re officially discharged from physical therapy. This stage prioritizes movement-specific drills that mimic the demands of your previous activities.

Here’s what you should expect to be doing:

  • Lifting moderate to heavy loads such as during military press and bench press
  • Trunk and core strengthening
  • Sport-specific drills
  • Upper body plyometrics


How long is recovery from surgery?

Recovery from surgery varies.

For most patients who have ac joint separation, it will take about 4-6 months to be able to go back to normal activities. (3)

For those who had AC joint arthritis, full recovery would take about 2-3 months. (2)

What are the complications after surgery?

The most common complications after surgery for AC joint separation include (3):

  • Infection
  • Shoulder pain
  • Hardware issues
  • Ligament calcification
  • Fracture
  • Loss of reduction

For AC joint arthritic surgery (2):

  • Inadequate resection
  • Diagnostic errors
  • Joint Instability
  • Shoulder Weakness

Can an AC joint heal without surgery?

“Heal” can be a misnomer. You can’t grow back joint cartilage nor can you prevent your ligaments from adapting to their new alignment.

 Asymptomatic is probably a better word to describe it. As your body adapts, you will feel less shoulder pain. This is especially true in the early stages of AC joint arthritis and AC separation.

But, it’s still better to get yourself checked to prevent any condition from getting worse.


Shoulder separation and AC joint arthritis are very painful injuries. But, hopefully educating yourself with details about each surgical procedure and treatment helps calm you down. We wish nothing but the best for you and your health.


  1. Song, Tengfei et al. “Comparison of the outcome of early and delayed surgical treatment of complete acromioclavicular joint dislocation.” Knee surgery, sports traumatology, arthroscopy: official journal of the ESSKA vol. 24,6 (2016): 1943-50. DOI: 10.1007/s00167-014-3225-9
  2. Docimo, Salvatore Jr et al. “Surgical treatment for acromioclavicular joint osteoarthritis: patient selection, surgical options, complications, and outcome.” Current reviews in musculoskeletal medicine vol. 1,2 (2008): 154-60. doi: 10.1007/s12178-008-9024-5
  3. van Bergen, Christiaan J A et al. “New insights in the treatment of acromioclavicular joint separation.” World journal of orthopedics vol. 8,12 861-873. 18 Dec. 2017, DOI: 10.5312/wjo.v8.i12.861 
  4. Lädermann, Alexandre et al. “Acromioclavicular joint reconstruction: a comparative biomechanical study of three techniques.” Journal of shoulder and elbow surgery vol. 22,2 (2013): 171-8. DOI: 10.1016/j.jse.2012.01.020
  5. LeVasseur, Matthew R et al. “Acromioclavicular Joint Injuries: Effective Rehabilitation.” Open access journal of sports medicine vol. 12 73-85. 28 May. 2021, doi: 10.2147/OAJSM.S244283