An AC joint excision removes a small amount of bone from the end of the clavicle (collarbone), so that the worn joint surfaces no longer rub against each other. The gap that is left fills with fibrous scar tissue. It is used to treat pain from arthritis or injury at the acromioclavicular joint, where bone has begun rubbing on bone.
The procedure
Biomechanical studies indicate that around 5mm of bone needs to be resected to reliably stop the bone ends contacting each other.
The operation can be performed open or arthroscopically. The arthroscopic approach preserves the superior capsule of the joint, which lowers the risk of instability afterwards. Older open techniques removed 1.5 to 2cm of the distal clavicle and resulted in instability in around 10% of patients, which is why how much bone is removed, and what is preserved, matters as much as the removal itself.
Around 1.5 hours of theatre time is typically booked for this procedure.
Risks and complications
This is generally a low-risk procedure. It does not produce a normal joint, but for most people it is an improvement on a worn out, painful one.
General surgical risks
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Bruising and haematoma. Common and usually settles on its own.
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Infection. Uncommon, usually treated with antibiotics.
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DVT and pulmonary embolism. Recognised and treated promptly, the risk of serious consequences is greatly reduced.
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Anaesthetic risks. Mortality from general anaesthesia in Australia is in the order of 1 in 100,000.
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Wound problems. Usually superficial.
Risks specific to AC joint excision
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Insufficient bone removal, leaving the bone ends still in contact
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Failure to preserve the superior capsule, which raises the risk of instability
- Frozen shoulder
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Nerve or blood vessel damage, which is rare
- AC joint instability
- Persistent pain, or incomplete relief of symptoms
Before surgery
- Confirm with your health fund that the hospital fee is covered, and confirm your anaesthetist's fees.
- Register your details with the hospital, and complete and return the paperwork to the office.
- Plan transport home, as you cannot drive yourself.
- Arrange any recommended pre-operative physiotherapy or pathology tests.
- Apply benzoyl peroxide 5% wash to the shoulder five times: twice daily for two days, then once on the morning of surgery, to reduce the risk of infection from Cutibacterium acnes.
- Pack medications in their original packaging, a loose button-up shirt, nightwear, toiletries, and your CPAP machine if you use one.
- Ring the office about blood thinners, and your anaesthetist about diabetic tablets.
- Confirm admission details one to two business days beforehand.
The day of surgery
Admission can be as early as 6am, so patients travelling from outside Brisbane are usually advised to stay the night before. See our accommodation options.
The anaesthetist will consult with you before theatre, and Dr Cutbush will mark the operation site with you. The usual stay is one night, with discharge after about 10am following a review. You will be given a post-operative pack containing your operation letter and rehabilitation information. Arrange someone to drive you home.
Recovery and healing
Because no repair is performed, there is nothing to tear and no sling is required. You may want to use one in the first week purely for comfort.
Gentle movement starts immediately. Driving can resume once you can control the vehicle safely, which is usually a few days to a week after surgery. Returning to work may be possible after about a week, depending on what your work involves and how you are progressing.
Rehabilitation
Rehabilitation focuses on restoring range of motion. Some improvement is immediate, but full range can take up to six months.
Day one
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Sling. For comfort only. Aim to stop wearing it within a week.
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Activity. Light activities within the limits of pain. Avoid repetitive or loaded work above chest height.
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Pain relief. Ice, positioning and your prescribed medication.
Day one exercises (active-assisted range of motion)
- Pendulums
- External rotation at neutral
- Supine flexion
- Forward lean on a bench
- Horizontal flexion
- Hand to head
- Internal rotation, hand to hip
Forward flexion and hand-behind-back exercises may be reduced to begin with, as pain tends to be higher in the early days after an ACJ excision than after some other arthroscopic procedures.
Follow-up
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Week 2. Local physiotherapist review.
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Week 6. Review with Dr Cutbush and the shoulder physiotherapist, in person or by video.
Results after surgery
This procedure is generally effective for pain and function, and most people return to normal activity. As with an acromioplasty, rehabilitation is slower than most people expect, often at least four months, and some aching for a period afterwards is common.
Next steps
This page is general information about a surgical procedure and is not a recommendation that you have it. Whether surgery is appropriate for you can only be determined after assessment. All surgery carries risk; the risks relevant to you are discussed in consultation before any decision is made.
