What it is

AC joint reconstruction restores alignment and stability after high-grade acromioclavicular separations. Techniques include fixation and grafts to reconstruct the coracoclavicular ligaments. The goal is to reduce pain and enable participation in pressing, carrying, and contact sports.

Rehabilitation protects the repair early, then rebuilds range, strength, and contact skills.

What happens when it occurs

The clavicle is reduced and stabilised. Early phases limit elevation and cross-body loads. Strength and control progress with attention to pressing and carrying mechanics. Hardware removal occurs in some constructs.

Common causes and risk factors

  • Falls onto the shoulder in cycling and contact sports
  • Direct blows in rugby codes and AFL
  • Delays in the reduction of severe injuries

Who is most affected

Young adults in contact and action sports. Men present more often.

Typical symptoms pre op

  • Visible step at the AC joint
  • Pain with cross-body reach and pressing
  • Weakness and loss of confidence

When to seek care

Immediate assessment after a heavy fall. Ongoing review if pain and function do not improve.

How we diagnose

Clinical tests and X-rays with stress or comparison views as needed. Grading guides management and surgical timing.

Management

  • Sling comfort early, swelling control
  • Protected range and scapular set
  • Progressive strength with pressing precautions
  • Contact preparation and return by criteria

Rehabilitation milestones

Phase 1 weeks 0 to 3: sling, gentle range, avoid cross-body stress.

Phase 2 weeks 3 to 8: active range, early strength, careful pressing mechanics.

Phase 3 months 2 to 4: progressive strength, carries, and work drills.

Phase 4 months 4 to 6: contact skills, pressing progressions, return after testing.

Readiness to progress

  • No pain with cross-body reach and pressing
  • Strength and endurance within 90 per cent
  • Contact drills completed without the next day increase

Long-term care

  • Maintain posterior chain and pressing strength
  • Plan contact exposure through the season
  • Use taping or bracing during early return if helpful

Australia snapshot

  • Frequent in cycling incidents and rugby codes
  • Public and private centres offer reconstruction and rehabilitation
  • Return to manual work and sport is common with a staged plan

Latest insights

Stable alignment, combined with strong mechanics, restores pressing and carrying.

Contact skills training is as important as gym strength.

Frequently Asked Questions

Often reduced, but some prominence may remain without affecting function.

Light angles and landmine or incline options first. Flat bench and dips return later by criteria.

Sometimes, depending on the construct and symptoms.

Commonly, around four to six months after testing.