Shoulder Surgery

Acromioclavicular Joint (ACJ) stabilisation

Acromioclavicular Joint (AJC) stabilisation

AC joint dislocations (shoulder separations) are common shoulder injuries and in most cases can be managed without surgery. When indicated, surgery produces a more reliable outcome for younger patients and for those who work overhead or in a manual capacity.

Patients stay in hospital overnight and wear a sling for 6 weeks. A day surgery procedure is required at 3 months to remove hardware; and strengthening is commenced just after 3 months postoperatively.

The principle of ACJ stabilisation surgery is to bring the acromion and distal clavicle (end of the collarbone) back into alignment and hold them in that position to allow the torn ligaments to heal over 3 months. There are various techniques to stabilise the AC Joint.

Generally speaking, Grade I and II injuries do NOT need surgery and will do fine with a sling, analgesia and physiotherapy.

Grade III injuries are often managed without surgery; however, in select cases, they may do better with surgery – this is a case by case decision.

Grade IV, V and VI injuries should be stabilised. This is because they are inherently unstable and if left untreated will reliably result in loss of shoulder function, particularly with overhead activity.

Sportspersons and those with occupations that require their arm to be at chest height or higher should be treated with more consideration and offered earlier surgery when appropriate.


  • The procedure is under a  General Anaesthetic where you will be positioned on your back.
  • A 5cm incision is made over the AC Joint dislocation (top of the shoulder)
  • The AC Joint is carefully cleared out and the dislocation is reduced and held in position
  • There are many techniques by which to stabilise the AC Joint – Dr Pant prefers a Hook Plate (as pictured below)
  • The “Hook” is placed under the roof of the shoulder (Acromion) and the plate is fixed to the end of the collarbone
  • During surgery, X-rays are taken to confirm adequate reduction of the joint and hardware position.
  • The capsule of the ACJ is then repaired and the wound closed in a regular fashion; dressings are then applied and your arm placed in a sling.
  • Dr Pant will then organise close follow up at regular intervals and liaise with your Physiotherapist to maximise your recovery
  • The Hook plate is routinely removed at 3 months post-surgery (this is a day-surgery procedure)

Medical diagram showing an acromioclavicular joint dislocation treated with a hook plate

Xray showing a hook plate AC Joint Stabilisation

Most patients report a sense of “relief” after their AC joint is stabilised and can commence light activity with the operated arm (such as self-care, feeding, and using a mobile phone) immediately.

There are three essential components to a good outcome from surgery:

  • Your surgeon
  • You as a patient
  • Your physiotherapist.

Dr Pant utilises the JPL pathway for most patients and this will form the basis of your rehabilitation after surgery.

The JPL pathway allows for self-directed, early passive shoulder range of movement:

  • Passive – assisted with your other arm
  • Active – you move the affected arm independently

A sling is required for the first 6 weeks after your surgery. The following 6 weeks it is worn as required.

The plate is routinely removed at 3 months post-surgery. It is important that while the hook plate is in your shoulder that you do NOT raise your arms above shoulder height. Once the plate is removed there are no restrictions to your shoulder range of motion or activity.

Driving after shoulder surgery

  • After shoulder surgery, you will be in a sling and you may be unable to drive for at least 6 weeks
  • This does vary depending on the complexity of your surgery and the patient. Some patients may be able to drive at 2-4 weeks, and some may not be able to drive for the full 12 weeks. This will be individualised to your situation.

Showering and getting dressed

  • You may take the sling off to shower
  • Lean forward and allow your arm to “dangle” to wash under your arms
  • The dressings applied are waterproof and you may shower with them on
  • Usually, before you are discharged from Hospital, your dressings are changed after your morning shower.
  • These “new” dressings are then kept intact until your review at 10-14 days
  • When getting dressed, you may use your good arm to move your affected (operated arm) to place your arms through the sleeves carefully

Sleeping after Shoulder Surgery

  • Most patients find it difficult to lie flat after shoulder surgery.
  • Consider using a few pillows to prop yourself up and sleep at a slight incline; this may be necessary for 4-6 weeks after surgery. You should keep your sling on while asleep.

Elbow and hand movement

  • Keep your elbow and hands joints moving and supple for the duration of time you are in the sling. The best time to move your elbow (into full extension and flexion) is when you are in the shower, just out of the shower and about to get dressed.

General risks of Acromioclavicular Joint stabilisation surgery

Surgery is a carefully choreographed process and you are being treated by a sub-specialist shoulder surgeon and a highly experienced team; however, all surgeries inherently carry some risk of complications.

The risk of complications after Acromioclavicular Joint stabilisation surgery is less than 1% in the Sydney Shoulder Unit experience. General risks include:

  • Infection
  • Bleeding
  • Wound healing problems
  • Damage to blood vessels or nerves
  • Sensory changes around the surgical scar

Specific risks relating to Acromioclavicular Joint stabilisation surgery

  • Hardware complication – erosion of bone under the acromion
  • Neurovascular injury during surgery
  • Failure of ligaments to heal over time – loss of fixation
  • Frozen shoulder

Reoperation and failure of Acromioclavicular Joint stabilisation surgery

  • When performing an ACJ stabilisation, the plate will reduce the joint back down; however, we are relying on your body to heal the ligaments over three months.
  • In some cases after the hook plate is removed, the ligaments may have only partially healed and the AC Joint may separate again. If this happens it is usually only a Grade I or II separation. This is uncommon and in the SSU practice, it occurs in < 1% of cases.
  • The advantage of the hook plate insertion and later removal is that you will NOT have any hardware or implants in your collarbone or shoulder. If you happen to have another injury (such as at rugby, off your bike or at work) you will not “break” around the hardware and cause additional issues.

Patients who smoke, use tobacco products, have diabetes, or are elderly are at higher risk of complications both during and after surgery. They are also more likely to have problems with wound and bone healing. Most healthy patients, however, cope well with ACJ stabilisation shoulder surgery and are unlikely to have complications. 

The outcome after Acromioclavicular Joint stabilisation surgery is excellent; most patients report a feeling of the shoulder being stable and secure the day after surgery; and by two weeks they are back to basic things around the house. At 3 months, after the plate is removed, patients can commence overhead shoulder activity and strengthening exercises. Contact sport is allowed 4-6 months from surgery.

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