The acromioclavicular (AC) joint is where the collarbone (clavicle) meets the highest part of the shoulder blade (acromion). Strong ligaments stabilize this joint. When a high-energy injury causes these ligaments to tear, resulting in a shoulder separation, surgical repair may be necessary to restore stability and correct the deformity. The procedure’s duration depends heavily on the injury’s complexity and the specific surgical technique used.
The Surgical Duration (Incision to Closure)
The actual time spent performing the AC joint repair, measured from incision to closure, typically falls within a range of 60 to 120 minutes. For many straightforward stabilization procedures, the operation is often completed in about 90 minutes. This period only accounts for the time the patient is under anesthesia and the surgeon is actively working to reconstruct the joint.
The chosen surgical approach is a primary factor influencing this duration. Minimally invasive techniques, such as arthroscopic fixation using specialized devices like suture buttons, may take slightly longer than traditional open surgery. This is due to the added time required for setting up the arthroscopic equipment, establishing the camera portals, and performing the fixation through small working channels.
Variables That Increase Operative Time
Several factors can extend operative time, pushing the procedure toward the higher end of the expected range. The severity of the injury is a major determinant, with high-grade separations classified as Rockwood Types IV, V, or VI involving greater displacement and more extensive ligamentous damage. These complex cases require meticulous reduction of the clavicle, which adds time.
Another significant variable is the need for ligament reconstruction versus a simple repair. Acute injuries, treated soon after the trauma, may allow for a simple repair of the torn ligaments. However, chronic separations, or those that have gone untreated for several weeks, often necessitate a full reconstruction of the coracoclavicular ligaments, frequently using a tendon graft from the patient or a donor. Harvesting or preparing and securing this graft material adds considerable time.
The surgeon must also address any concomitant injuries found within the shoulder joint. During an arthroscopic procedure, the surgeon may identify and repair other issues, such as a partial rotator cuff tear or a labral injury, that were either missed on pre-operative imaging or caused by the same traumatic event. Combining these separate procedures into a single surgical session is more efficient for the patient but will naturally increase the total operative time.
Total Time Spent at the Surgical Facility
The time spent under anesthesia is only a fraction of the total time commitment on the day of surgery. Most AC joint repairs are performed as outpatient procedures, meaning the patient goes home the same day, but the overall facility time is typically between four to six hours. This extended period accounts for necessary steps required before and after the operation.
The pre-operative process, which includes check-in, meeting with the anesthesia team, receiving a nerve block, and site marking, usually takes between 90 minutes and two hours before the patient is moved to the operating room. This time is used for detailed safety checks and preparation. Following the operation, the patient is transferred to the Post-Anesthesia Care Unit (PACU) to wake up.
The PACU stay generally lasts between one and three hours, where nurses monitor vital signs, pain level, and recovery. Discharge criteria are strict, requiring the patient to be alert, have controlled pain, and be able to tolerate oral fluids before they are released to a responsible adult escort. System factors, such as waiting for the escort to arrive, can sometimes contribute to delays in the final discharge.
Key Milestones in Early Recovery
The initial recovery phase focuses on protecting the surgical repair and regaining motion. The arm is placed in a sling or specialized shoulder immobilizer, worn continuously (even during sleep) for two to six weeks. The precise duration depends on the surgical technique; open repairs may require six weeks to allow for healing of the deltoid and trapezius muscles.
Pain management is a primary focus during the first one to two weeks, utilizing prescribed medications and ice to control swelling. Physical therapy is introduced early, though the timing and intensity vary based on the surgeon’s protocol. Passive range-of-motion exercises, where the therapist moves the arm without the patient’s muscle activation, may begin as early as two weeks post-surgery.
Active motion, where the patient moves the shoulder independently, is typically restricted until six weeks to protect the healing ligaments and fixation. Clearance to drive is a common early goal, usually occurring around six weeks post-surgery once the sling is discontinued and the patient has regained sufficient pain-free motion.