An Overview on Revision AC Joint Repair
Injuries to the acromioclavicular (AC) joint are quite common, especially in the young, active population. In particular, young patients competing in contact sports are at significant risk of suffering an injury to the AC joint. The coracoacromial (CA) ligament and coracoclavicular (CC) ligaments provide stability to the AC joint in its native form. These ligaments also form a connection between the clavicle and the front of the scapula. However, if the shoulder experiences an impactful force, indirectly or directly, the AC joint and its surrounding ligaments may be disrupted. Although these injuries can be typically resolved through non-operative management, more severe cases of an AC injury may require AC joint repair surgery to return full function. If an AC joint repair surgery fails to alleviate symptoms, Dr. Matthew Provencher, orthopedic shoulder surgeon serving the Vail, Aspen and Denver, Colorado communities, recommends a revision AC joint repair surgery.
Since AC joint injuries, including those requiring surgical intervention, are highly common, complications surgery are also commonly seen. Revision AC joint repair is reserved for patients who have experienced a failed surgery in the past. More specifically, if the patient continues to experience pain and overall low functioning level following primary surgery, then revision surgery is necessary in this particular patient. Moreover, certain patients may require a revision procedure if poor rehabilitation efforts were involved after the first AC joint treatment.
The success of Dr. Provencher’s revision AC joint repair is dependent on a thorough review that reveals the cause of failure of the initial surgery. Dr. Provencher will perform a detailed physical examination and review the shoulder joint entirely through a series of x-rays, MRI scan and CT scan in order to identify what led to failure of the surgery and determine the proper course of action to resolve any persistent AC joint injury symptoms.
Many revision AC joint surgery cases require reconstruction of the surrounding ligaments, including the CA and CC ligaments, which results in reestablishment of stability of the distal clavicle. Due to overlaying scar tissue and prior surgical failure, revision AC repairs can be particularly challenging. In many cases, a tissue autograft is derived from the hamstring tendon that will be passed through the two halves in the joint for revision of the previous surgery. If the revision AC joint repair requires an autograft, Dr. Provencher will plan around the harvest sites (i.e. upper aspect of shinbone).
The exact revision AC joint repair varies from patient to patient given that each case presents a unique failed treatment and original injury. As a result, Dr. Provencher will explain each patient’s revision AC joint surgery options in great detail at the first consultation with an individualized treatment plan that will resolve all symptoms.
Revision Acromioclavicular- Coracoclavicular (AC-CC) Reconstruction: Use of Precontroured Button and Two Allografts
Recovery and Rehabilitation Following Revision AC Joint Repair Surgery
Following a revision AC joint repair, patients will be required to wear a sling or similar device for several weeks. The sling is designed to keep the arm immobile following surgery and to protect the joint as it heals. A physical therapy program will be prescribed to gradually strengthen the repaired joint and eliminate sling use.
For additional resources on revision AC joint repair surgery, or to determine the exact cause of failure of your original AC joint surgery and discuss possible options for revision surgery, please contact the Vail, Aspen, and Denver, Colorado orthopedic practice of shoulder surgeon Dr. Matthew Provencher.