AC Joint Reconstruction Recovery
Acromioclavicular Joint Reconstruction
What the operation does
When the shoulder is separated, the strong ligaments running from the collarbone down to the coracoid — a hook of bone on the shoulder blade — are torn. Without them the collarbone is no longer tethered down, and the shoulder blade and arm sag away from it. This operation rebuilds that tether, usually with a tendon graft, a strong suture and button device, or both, passed between the collarbone and the coracoid.
It is the shoulder dropping, not the collarbone rising
Worth understanding, because it explains the whole recovery. The bump you can see is not the collarbone pushing upward — it is the weight of your arm pulling the shoulder blade downward, away from a collarbone that is no longer tied to it. That downward pull does not stop. It is there every waking hour, and it is what the reconstruction has to resist while it heals.
Why the sling is doing real work
Following from that: the sling is not just comfort. By supporting the weight of the arm it takes the constant downward load off the reconstruction. That is why it is worn for around six weeks and why letting the arm hang unsupported — standing with it dangling, carrying a bag, reaching down — is discouraged even when it does not hurt.
Why many separations never need surgery
Most AC separations are treated without an operation, and do well. The bump often remains, but strength and function usually return, and many people never think about it again. Surgery is generally reserved for high-grade separations where the collarbone has displaced markedly, for people whose work or sport demands overhead strength, and for separations that stay painful months later. If you had surgery, one of those applied.
What you are protecting against
Weight through the arm, in every form: carrying, lifting, pushing up out of a chair, leaning on it, and hanging the arm unsupported. Also reaching across the body and overhead early, which shears the joint. Moving the shoulder gently in a supported way is encouraged; loading it is not.
Loss of reduction
The honest section. Some settling of the collarbone back toward its displaced position is common after this operation — reported in a meaningful minority — because the reconstruction spends months resisting a load that never lets up. Often it is partial, the shoulder still works well, and no further treatment is needed. It is the commonest disappointment after this surgery, and it is far easier to hear now than at a follow-up appointment.
The bump may not fully disappear
Related, and worth setting expectations on. Even a well-healed reconstruction can leave some prominence at the end of the collarbone, and it is generally more noticeable when compared side to side than it is significant. If appearance was a large part of why you had the operation, that is worth discussing openly at review.
Fracture through the tunnels
Where the reconstruction passes through drill holes in the collarbone or coracoid, those holes are a small weak point until they fill in. Fracture through one is uncommon but recognised, usually from a fall or heavy load in the first months. It is one reason the return to contact sport is later than the shoulder feeling ready would suggest.
Stiffness
Less of a problem here than after most shoulder operations, because the shoulder joint itself was not operated on — the work is above it. Movement usually returns readily once the sling is off. What takes longer is confidence loading the arm.
Carrying and lifting
The last things to come back, and the ones that matter most day to day. Carrying shopping in that hand, a bag on that shoulder, or a child on that side all put the exact load the reconstruction resists. They are generally reintroduced gradually from around three months rather than resumed.
Returning to sport
Non-contact activity commonly returns around four to six months. Contact and collision sport, and heavy overhead lifting, generally wait until at least six months and often longer — particularly where the reduction is being watched on X-ray. Judged on strength and imaging rather than on how the shoulder feels.
Pain and the early weeks
Pain over the top of the shoulder settles over the first two to three weeks. Sleeping is awkward while in the sling and many people prop themselves up. The neck and upper back often ache from holding the arm still, which is why gentle neck work is in the programme from the start.
Driving and work
Driving generally waits until you are out of the sling and can control the wheel with both hands comfortably — commonly around six to eight weeks. Desk-based work is often possible within one to two weeks with the sling on. Work involving lifting, carrying, or overhead reaching commonly waits four to six months.
How the recovery usually unfolds
Six weeks in a sling, with gentle supported movement and no weight through the arm. Six to twelve weeks the sling goes and active movement returns. Three to five months brings strengthening, with pulling and shoulder blade work leading. Five to eight months brings heavier loading and carrying. Eight months onward is contact sport and full overhead work.
Staying in touch with your care team
How far the collarbone had displaced, what was used to reconstruct it, and how the position holds all shape this recovery, and your surgeon will be following it on X-ray. If something about your recovery is worrying you or does not match what is described here — particularly the bump becoming more prominent — contact your care team.
Exercises for AC Joint Reconstruction
An illustrated, phase-by-phase exercise program for this procedure. View the AC Joint Reconstruction exercise program.
Recovery education · Condition guides · Exercise programs
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This guide is general education and doesn't replace evaluation by a licensed provider. Recovery and treatment vary by person — follow the guidance of your own surgeon or care team.