- Type
- Open / arthroscopic-assisted reconstruction
- Anaesthesia
- General + regional block
- Hospital stay
- Day surgery or 1 night
- Sling
- 3 weeks
- Return to driving
- ~3 weeks
- Return to contact sport
- 4–6 months
When it is done.
AC joint reconstruction is offered for:
- High-grade acute AC separations (Rockwood IV, V and VI), where the displacement is too great to manage non-operatively.
- Persistent symptoms after a grade III separation in a high-demand overhead athlete or manual worker, when non-operative treatment has failed.
- Chronic AC instability with ongoing pain and dysfunction, typically months to years after the original injury.
How it is performed.
Performed under general anaesthesia with a regional block. A short incision is made over the AC joint and lateral clavicle. The displaced clavicle is reduced into its native position relative to the acromion and coracoid. The coracoclavicular ligaments (conoid and trapezoid) are reconstructed using two elements:
- Suture-button fixation — a strong synthetic loop passing through a tunnel in the clavicle and around the coracoid, providing initial stability while the biological graft heals.
- Biological graft — an allograft tendon (most commonly semitendinosus) is woven around the clavicle and coracoid to restore native ligament structure.
The AC joint capsule is also repaired. The wound is closed in layers.
Recovery.
Weeks 0–3
- Sling worn for the first 3 weeks to protect the reconstruction.
- Pendulum and gentle passive range of motion from day 1.
- No driving. No lifting more than a kilogram.
Weeks 3–8
- Sling discontinued at 3 weeks. Active-assisted range of motion under your physiotherapist.
- Driving resumed at approximately 3 weeks once off opioid analgesia.
- Light desk and daily activities resumed.
Months 2–6
- Strengthening commences from 8 weeks.
- Return to non-contact sport at 3 months; contact sport at 4–6 months.
Recovery guidance
Your physiotherapist receives specific post-operative instructions on the day of surgery. View the recovery roadmap for the full rehabilitation journey, or visit For Physiotherapists for protocol requests.
Frequently asked questions.
Will the bump go away?
In most patients the reduction is restored at surgery; the cosmetic bump is significantly reduced or eliminated. Some patients have a small residual prominence.
Why is a graft used as well as a button?
The suture-button alone provides initial mechanical stability. The biological graft restores native ligament structure, providing durable long-term stability.
When can I return to contact sport?
4–6 months — based on strength, range of motion, and confidence rather than the calendar alone.
Are the fixation devices permanent?
The suture-button fixation is permanent (low-profile and rarely symptomatic). The biological graft incorporates over time.
Can the joint loosen again?
Some loss of reduction has been reported in long-term follow-up. Function is usually maintained even when a small loss of reduction is seen radiologically.
References.
- Mall NA, et al. Acromioclavicular joint reconstruction. J Am Acad Orthop Surg. 2013;21(5):295–305.
- Beitzel K, et al. Current concepts in the treatment of acromioclavicular joint dislocations. Arthroscopy. 2013;29(2):387–397.