Arthroscopic Treatment of
Acromioclavicular Dislocation

What is arthroscopic treatment of acromioclavicular dislocation?


 

Acromioclavicular dislocation is a traumatic injury that occurs after a fall onto the shoulder or outstretched upper limb.

Cirurgia-Navegada​

Which acromioclavicular dislocations benefit from surgery?

Acromioclavicular dislocation occurs when there is injury to the ligaments that stabilize the clavicle at its joint with the shoulder blade – the acromion. Depending on the energy involved in the trauma, the ligament injury can be so extensive that healing is only possible when stability in this region is reestablished.

Evaluation by an orthopedic surgeon specializing in shoulder surgery is recommended to interpret additional examinations (e.g., x-rays) and discuss existing treatment options. When stabilization is necessary, surgical treatment prevents shoulder drop and dysregulation of the stabilizing muscles of the shoulder blade, improves function, and reduces aesthetic deformity.

What does arthroscopic treatment of acromioclavicular dislocation consist of?

The acromioclavicular joint is stabilized by two sets of ligaments called the acromioclavicular (more superficial) and coracoclavicular (deeper and main stabilizers) ligaments.

When the coracoclavicular ligaments are torn, they can be repaired using a system of sutures that stabilize the clavicle in its position and allow the native ligaments to heal correctly. This system is fixed superficially to the clavicle and deep to the coracoid, a bony structure of the shoulder blade that is covered by muscle mass.

Through the minimally invasive video-assisted surgery method, a camera is introduced through a small incision, aided by working instruments, which allow visualization of the surface of the coracoid where the suture system must be anchored. A small incision on the clavicle is normally used to control the position of this system in the most superficial region, as well as the repair of the acromioclavicular ligaments.

 

What are the advantages of arthroscopic treatment of acromioclavicular dislocation?

Arthroscopic surgery allows for better visualization of the deep structures of the shoulder, enabling more anatomical placement of the fixation systems in the coracoid and reducing complications from inadequate positioning. On the other hand, it prevents muscle dissection and reduces postoperative pain and rehabilitation time. The aesthetic aspect is improved compared to conventional surgery, since the resulting scars are small (about 5 mm) and almost imperceptible after the stitches are removed.

 

What to expect after arthroscopic stabilization of acromioclavicular dislocation?

The surgery lasts approximately 1 hour and can be performed on an outpatient basis (admission and discharge on the same day) or with an overnight stay (discharge in less than 24 hours). After surgery, simple immobilization of the arm is recommended for comfort for approximately 2 weeks. Passive mobilization begins on the first postoperative day and rehabilitation is recommended from 2-4 weeks, for a period of 3-4 months.

 

What is the expected time to return to work or sports activity after arthroscopic treatment of acromioclavicular dislocation?

A return to normal daily activities is expected within the first month after surgery. For professional activities that do not require handling loads or significant effort of the upper limbs, a return to these activities is expected within 2 months after surgery.  However, more demanding professions from this point of view may require more time to gain range of motion and muscle strengthening.  Non-contact sports can generally be resumed after 3 months, but contact sports should be allowed to return to their normal activities after 6 months, to allow complete healing and reduce the risk of recurrence.