The acromioclavicular (AC) joint is where the collarbone (clavicle) meets the highest point of the shoulder blade (acromion). Injuries to this area, known as AC joint separations or dislocations, occur when the strong ligaments connecting these two bones are damaged. When the damage is severe (typically Rockwood Type III through VI), the joint becomes unstable, requiring surgical intervention to restore normal alignment and function. This surgical repair aims to stabilize the joint by reconstructing or reinforcing the torn ligaments.
Surgical Procedure Duration
The actual time spent in the operating room for AC joint surgery generally falls within a predictable range, typically between 60 to 120 minutes from incision to closure. This duration covers the core surgical steps involved in the repair or reconstruction of the ligaments to restore anatomic stability. The operating time does not include essential pre-operative preparation, such as anesthesia administration or patient positioning. It also excludes the immediate post-operative period spent in the Post-Anesthesia Care Unit (PACU) for monitoring.
How Surgical Technique Affects Timing
The specific technique chosen by the surgeon is the primary factor determining the procedure’s duration. Surgery performed shortly after the injury, known as acute fixation, is often the quicker option. This procedure usually involves reducing the joint and stabilizing it with temporary fixation devices or modern suture-button techniques.
A more involved procedure is required for chronic injuries, which are treated several weeks or months after the initial trauma. In these cases, the original ligaments are often no longer viable for simple repair, necessitating a full anatomic reconstruction. This chronic reconstruction typically requires using a tendon graft or synthetic material to rebuild the coracoclavicular ligaments. The need for specialized graft preparation and precise tunnel drilling extends the surgical time toward the upper end of the range.
Immediate Post-Operative Recovery
Following surgery, the patient is moved to the recovery room for approximately one hour while they wake up from anesthesia and their vital signs stabilize. Acute pain management is a primary focus, often initiated with a pain pump or controlled release of medication. Most AC joint surgeries are performed on an outpatient basis, allowing the patient to return home the same day, though some may require an overnight stay.
For the first four to six weeks post-surgery, the shoulder is placed in a sling or specialized immobilizer to protect the repair during initial healing. Movement is highly restricted during this phase, limiting patients to passive range of motion to protect the surgical construct. Narcotic pain medication is often prescribed for the first week, followed by a transition to non-steroidal anti-inflammatory drugs (NSAIDs) as acute pain subsides.
Full Rehabilitation and Return to Activity
The long-term timeline for a full return to function extends over several months, with physical therapy (PT) being the cornerstone of recovery. The goal of the initial weeks is to protect the repair and prevent stiffness in the surrounding joints.
Around six weeks, once the sling is discontinued and initial biological healing is underway, rehabilitation shifts to active range of motion and light strengthening exercises. Patients progress to using resistance bands and light weights to restore muscle strength and stability. This phase aims to regain full, unassisted motion in the shoulder without pain.
Key milestones for returning to daily life activities are typically reached after three months. Patients can often return to non-manual jobs within a few weeks, but light manual labor or lifting greater than five pounds is restricted until the three-month mark. A full return to contact sports, heavy overhead labor, or high-demand activities generally takes six to nine months post-surgery, dependent on achieving strength parity and dynamic stability.