Arthroscopic AC Joint excision is a minimally invasive keyhole procedure to treat AC Joint arthritis. It is often done as a part of other keyhole procedures in the shoulder, such as a subacromial decompression and acromioplasty, biceps tenodesis and a rotator cuff repair.
After an isolated arthroscopic ACJ excision a sling is worn for 1-2 weeks; and JPL therapy commenced two weeks after surgery. Strengthening is allowed at 6 weeks; and full unrestricted activity is possible at 6-12 weeks after surgery. This pathway may vary if other procedures are carried out at the same time.
Arthroscopy is a procedure where keyhole incisions are used to insert surgical instruments into a joint. In this case the shoulder joint, subacromial space, and finally the acromioclavicular joint are all accessed and visualised.
A metallic burr is then used to “excise” (or remove) the arthritic end of the collarbone (distal clavicle excision).
The main goal of an Arthroscopic ACJ excision is to treat the ACJ arthritis by removing bone from the distal clavicle (outside part of the collarbone) and medial (inside part) acromion. To access the AC Joint, however, it is necessary to first do a subacromial decompression and acromioplasty.
So in all cases of Arthroscopic ACJ excision, this is combined with a subacromial decompression and acromioplasty. It is important to also pre-surgery to identify if biceps tendonitis or a rotator cuff tear is present as they are frequently associated and can be treated arthroscopically at the same time.
Bone spur and bursa
The area above the tendon and any bursitis is shaved away carefully and the bone spur is identified. A special 5.5mm metallic burr is then used to shave away the spur and create more room to allow the tendon to move freely.
AC Joint excision
There are three essential components to a good outcome from your surgery:
Post-operative physiotherapy
Dr Pant utilises the JPL pathway for most patients and this will form the basis of your rehabilitation after surgery; it will be modified to suit your individual circumstance.
The JPL pathway allows for self-directed, early passive shoulder range of movement:
Therapy overview
After the surgery you will be in a sling and protect your shoulder to allow the shoulder to heal. At two weeks after the surgery Dr Pant will see you at your review appointment and discuss the JPL rehabilitation protocol with you. This JPL physiotherapy protocol will commence two weeks after your surgery.
The therapy program will focus on flexibility and range of motion exercises initially. These gentle stretches will improve your range of motion and prevent shoulder stiffness. As the shoulder begins to heal you will be able to progress to exercises that strengthen your shoulder muscles. Shoulder strengthening is commenced at 6 weeks post isolated AC Joint Excision surgery.
Sling
The type of sling is selected specific to you and your shoulder surgery.
Subacromial Decompression +/- Biceps tenotomy/tenodesis +/- AC Joint Resection
Driving after shoulder surgery
Showering and getting dressed
Sleeping after Shoulder Surgery
Elbow and hand movement
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 clavicle fracture surgery is less than 1% in the Sydney Shoulder Unit experience. General risks include:
Specific risks relating to Arthroscopic ACJ excision surgery:
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 keyhole shoulder surgery and are unlikely to have complications.
Dr Sushil Pant is a leading Australian trained orthopaedic shoulder surgeon. He is the founder and medical director of the Sydney Shoulder Unit; and is a Shoulder Surgeon at Sydney Sports Medicine Centre at Sydney Olympic Park.
This 48 year old gentleman presented with pain over the top of his shoulder over many months. A diagnosis of AC Joint arthritis was made and he responded well to an ultrasound guided cortisone injection initially. However, that wore off over a few months and he was unable to sleep on the affected shoulder and very keen to get back to his active lifestyle, so he elected to proceed with surgery.
He underwent an Arthroscopic Acromioclavicular Joint (ACJ) excision via 3 small keyhole incisions. His procedure was routine, he stayed overnight in hospital, and was discharged home the following morning with oral painkillers.
He commenced immediate range of motion and discarded his sling between 1 -2 weeks after surgery. At three months, he is back to the gym and kayaking and is happy with his outcome; his keyhole incisions were only barely visible at the 3 month follow up.
Arthroscopic AC Joint excision is a very successful operation when non-surgical measures have been exhausted.
Enquiries between 8am-6pm (Mon-Fri) will be responded to within 30-60 minutes.
"*" indicates required fields
Alternatively, if you have any further questions or would like a consultation with Dr Pant get in touch:
Dr Sushil Pant is a leading Australian trained Orthopaedic Shoulder Surgeon. He is the founder and medical director of the Sydney Shoulder Unit; and is a Shoulder Surgeon at Sydney Sports Medicine Centre at Sydney Olympic Park.
1. Medicare Number
2. Position on card
3. Expiry Date
