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Pagkukumpuni ng Katatagan ng AC Joint

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Rehabilitation after AC joint stabilisation or reconstruction, with the protective phase and staged return to sport.

Updated Jun 2026
Illustrasyon ng acromioclavicular joint sa itaas ng balikat.
Ang acromioclavicular (AC) na kasukasuan, kung saan nagtatagpo ang collarbone at ang shoulder blade. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ang protocol na ito ay sumasaklaw sa rehabilitasyon pagkatapos ng pagkakaroon ng stabilisasyon ng acromioclavicular (AC) joint kay Dr. Kieran Hirpara sa Mater Private Hospital Rockhampton, upang maibalik ang tamang pagkakahanay ng joint sa pagitan ng collarbone at shoulder blade pagkatapos ng dislokasyon gamit ang suspensory device, minsan ay pinapatibay ng tendon graft. Dalhin ang pahinang ito o ang PDF nito sa iyong unang bisita sa physiotherapy upang manatiling koordinado ang iyong rehabilitasyon. Ang iyong rehabilitasyon ay unti-unting pinapahusay ng iyong physiotherapist sa pamamagitan ng mga yugto sa ibaba, depende sa kung paano ang pag-unlad ng iyong balikat.

Kung mayroon kang anumang alalahanin tungkol sa iyong sugat pagkatapos ng operasyon, makipag-ugnayan sa mga kwarto. Madalas ay nakakatulong na kumuha ng litrato ng sugat at ipadala ito sa pamamagitan ng email para sa pagsusuri.

Ano ang inaasahan

Ang stabilisasyon ng AC joint ay naiiba sa karamihan ng keyhole shoulder surgery: mayroong repair na dapat protektahan habang ito ay naghihilom, at ang pinakamalaking load dito ay ang timbang ng sarili mong braso. Ang gravity ay patuloy na humihila sa braso (kasama nito ang shoulder blade) pababa, palayo sa collarbone, na eksaktong direksyon kung saan kailangang lumaban ang stabilisasyon. Kaya’t ang early rehabilitation ay disenyadong protektibo: ang sling ang dala ang timbang ng braso, ang movement ay pinapanatili sa loob ng ligtas na limitasyon, at ang strengthening ay hinihintay hanggang sa mature na ang repair.

Ang sling ay protektibo. Suotin ito ng 6 linggo, at sa unang tatlong linggo panatilihin ito habang natutulog, dahil kahit nakahiga, ang timbang ng braso ay humihila sa repair. Pagkatapos ng tatlong linggo, maaari itong tanggalin sa kama. Kapag tinatanggal ang sling para sa paghuhugas o ehersisyo, panatilihin ang suporta sa braso: pahigpitin ang forearm sa isang unan o mesa imbes na hayaang mahawakan ang braso o magdala ng anumang bagay. Sa gabi, karamihan sa mga tao ay komportableng nakahiga sa likod o sa hindi na-opera na gilid; kung nakahiga ka sa likod, ang maliit na unan sa ilalim ng elbow at forearm ay pumipigil sa shoulder na bumaba pabalik. Iwasan ang paghiga sa operated shoulder habang naghihilom ang repair.

Hindi ka dapat magmaneho habang naka-sling. Para sa operasyong ito, karaniwang ito ay humigit-kumulang anim na linggo.

Ang iyong exercise program ay gumagamit ng tatlong uri ng movement, at ang iyong medical team ay magtatak kung alin ang angkop sa iyo:

  • Active range of motion: ang movement ay pinapayagan nang walang tulong o tulong mula sa iba.
  • Active-assisted range of motion: gumagamit ng kabilang braso o bagay upang matulungan ang paggalaw ng braso.
  • Passive range of motion: ganap na nakarelaks, gumagamit ng kabilang braso o puwersa upang gawin ang 100% ng trabaho.

Ang buod ng proseso:

  • Phase I: Pagprotekta sa repair, linggo 0–6
  • Phase II: Pagbawi ng iyong movement, linggo 6–12
  • Phase III: Pagpapalakas, linggo 12–18
  • Phase IV: Pagbabalik sa sports at mabigat na trabaho, linggo 18 pataas

Ang mga range ng linggo ay karaniwan lamang at hindi eksakto; ang mga published na protocols para sa operasyong ito ay nag-iiba, at ang iyong physiotherapist ay magpapatuloy sa iyong rehab base sa kalagayan ng repair at iyong movement, hindi base sa kalendaryo. Karamihan sa mga tao ay gumagamit na ng braso para sa normal na araw-araw na gawain sa humigit-kumulang tatlong buwan. Ang pagbabalik sa contact at collision sport ay karaniwang tumatagal ng humigit-kumulang apat hanggang anim na buwan, at para sa ilang sports at propesyon, mas mahaba ang proseso ng build-up.

Yugong I — Pagprotektahan ang pagkakaayos (Linggo 0–6)

Ang unang anim na linggo ay tungkol sa pagpapahintulot sa paggaling ng pagkakaayos habang pinapanatili ang galaw ng karamihan ng braso. Ang sling ay nagdadala ng bigat ng braso kapag ikaw ay nakatayo at gumagalaw. Ang iyong kamay, pulso, at siko ay dapat patuloy na gumagalaw mula sa unang araw: gamitin ang kamay para sa magaan na gawain tulad ng pagsulat at pagkain habang nasa sling ang braso. Ang balikat mismo ay nagsisimula sa banayad na pendulum exercises at assisted movements sa loob ng mahigpit na limitasyon: walang pagtaas sa itaas ng antas ng balikat, walang pag-abot sa tawid ng katawan, at walang pag-abot sa likod ng likod. Ang yelo at regular na pagpapagaan ng sakit ay nagpapadali sa mga ehersisyo. Kumain ng iyong painkillers bago ang iyong mga ehersisyo at sesyon ng physiotherapy. Maaari kang mag-shower kapag pinayagan na ng iyong payo sa pag-aalaga ng sugat; upang hugasan sa ilalim ng operadong braso, yumuko sa baywang at hayaang mahulog nang banayad ang braso palayo sa katawan, ang parehong posisyon ng ehersisyo sa pendulum.

Sa yugong ito, huwag magbuhat ng anumang mas mabigat kaysa humigit-kumulang kalahating kilo gamit ang operadong braso, huwag magdala ng mga bag sa gilid na iyon, huwag tumakip sa braso o gamitin ito upang itulak ang iyong sarili pataas mula sa kama o upuan, at huwag hayaang ang braso ay nakasabit nang walang suporta: ang bawat isa sa mga ito ay humihila sa scapula pababa palayo sa collarbone at naglalagay ng load sa pagkakaayos.

Para sa iyong physiotherapist:

Mga Layunin

  • Protektahan ang surgical stabilisation at pahintulutan ang paggaling ng soft tissue
  • Kontrolin ang sakit at pamamaga; protektahan ang paggaling ng sugat
  • Pigilan ang stiffness ng balikat sa loob ng mga protektadong range
  • Panatilihin ang range of motion ng kamay, pulso, siko, at leeg

Pamamahala

  • Sling sa loob ng 6 linggo kapag nakatayo at gumagalaw; suportado ang braso kapag inalis ang sling
  • Pendulum exercises ilang beses sa isang araw
  • Passive at active-assisted elevation sa plane ng scapula, limitado sa 90 degrees
  • Passive at active-assisted external rotation ayon sa kaginhawahan (sa simula, hanggang humigit-kumulang 30 degrees)
  • Aktibong range of motion ng kamay, pulso, siko, at forearm; pagpi-piga ng bola
  • Scapular setting (retraction at depression) at pagwawasto ng postura
  • Sub-maximal, walang sakit na isometric internal at external rotation sa neutral ayon sa kakayahang tanggapin
  • Soft-tissue at scapulothoracic mobilisation ayon sa kinakailangan; scar massage kapag nagaling na ang sugat
  • Yelo sa loob ng 15–20 minuto, ilang beses sa isang araw, ayon sa pangangailangan; analgesia bago ang mga ehersisyo at sesyon

Mga Precaution

  • Huwag hayaang ang bigat ng braso ay humila sa fixation: walang nakasabit na braso, walang pagdadala, walang downward traction
  • Walang elevation sa itaas ng 90 degrees sa anumang plane
  • Walang aktibong range of motion ng balikat na higit sa ang nakaresetang assisted program
  • Walang cross-body (horizontal) adduction at walang internal rotation sa likod ng likod
  • Walang pagbuhat ng mas mabigat kaysa humigit-kumulang kalahating kilo; walang suporta ng bigat ng katawan sa pamamagitan ng braso
  • Walang pagmamaneho habang nasa sling

Mga Kriteryo para mag-proceed

  • Humigit-kumulang 90 degrees ng passive flexion sa plane ng scapula
  • Humigit-kumulang 30 degrees ng passive external rotation sa plane ng scapula
  • Tumatanggap sa range-of-motion at isometric program, kasama ang pagpapababa ng sakit at pamamaga

Yugong II — Pagpapatibay ng iyong galaw (Linggo 6–12)

Mula sa humigit-kumulang anim na linggo, unti-unting inilalayo ka sa sling at unti-unting tinatanggal ang mga limitasyon sa paggalaw. Ang mga nakatutulong na galaw ay nagiging aktibo na, at unti-unting dumadami ang saklaw ng galaw; bilang gabay, ang mga publikadong protokolo ay nagpapalawak ng saklaw ng galaw sa mga hakbang na humigit-kumulang 15 degrees bawat linggo, na may layuning makamit ang buong saklaw ng galaw sa humigit-kumulang linggo 12. Ang mga magaan na ehersisyo gamit ang elastic band para sa rotator cuff at mga kalamnan ng scapula ay nagsisimula sa yugong ito. Kailangan pa ring mag-ingat sa repair: panatilihin ang pagtaas ng bigat sa humigit-kumulang isang kilo, at iwasan ang makapangyarihang pagtulak at paghila, push-ups, at pagtaas ng bigat sa ibabaw ng ulo o pahalang sa katawan. Ang pag-abot sa likod ng likod ay karaniwang huling galaw na binibigyan ng kalayaan.

Para sa iyong physiotherapist:

Mga Layunin

  • Unti-unting pag-alis sa sling
  • Unti-unting pagpapatibay ng aktibong saklaw ng galaw sa lahat ng mga plano (buo, o halos buo, sa humigit-kumulang linggo 12)
  • Magsimula ng magaan na pagpapalakas; bawasan ang pag-ubos ng kalamnan
  • Itatag muli ang scapulohumeral rhythm at neuromuscular control

Pamamahala

  • Pag-unlad mula sa active-assisted hanggang aktibong elevation; wall slides at countertop slides papunta sa flexion
  • Elevation sa scapular plane na may pagtuon sa scapular mechanics: walang hitching
  • Ang internal rotation sa likod ng likod ay unti-unting ipinakilala (sa beltline muna sa simula)
  • Ang horizontal adduction ay bilang aktibong abot lamang: walang passive stretch pa
  • Theraband internal at external rotation, biceps curl, row, at serratus punch
  • Dynamic scapular at cuff work: side-lying external rotation, prone row, prone extension, prone 'T's at 'Y's, standing scaption
  • Proprioception at rhythmic-stabilisation drills
  • Manual therapy at joint mobilisation kung kinakailangan

Mga Paalala

  • Walang pagtaas ng bigat na higit sa humigit-kumulang isang kilo gamit ang operated na braso
  • Walang makapangyarihang pagtulak o paghila; walang push-ups
  • Walang pagtaas ng may bigat na mga bagay sa ibabaw ng ulo o pahalang sa katawan
  • Iwasan ang end-range stretching papunta sa cross-body adduction; ang paggalaw sa likod ng likod ay unti-unting pinapalawak

Mga Kriteryo para sa pag-unlad

  • Kahit humigit-kumulang 140 degrees ng passive flexion at 60 degrees ng passive external rotation sa scapular plane
  • Aktibong flexion laban sa gravity na kahit humigit-kumulang 100 degrees na may magandang mechanics
  • Nakakayanan ang aktibong saklaw ng galaw at maagang programang pagpapalakas

Yugong III — Pagpapalakas (Linggo 12–18)

Sa pagiging mature na ng repair at ang pagbabalik ng karamihan sa galaw, ang atensyon ay lumilipat sa pagpapatibay ng lakas. Ang mga stretch na noong nakapagbabawal (sa tayo ng katawan at pataas sa likod ng likod) ay ginagamit na ngayon upang makuha ang huling mga degree ng range. Ang resistance work ay nagprogresso mula sa elastic bands patungo sa magaan na timbang, at ang push-ups ay nagsisimula sa pader bago magprogresso. Ang weight training sa gym ay karaniwang ibinabalik mula sa mga linggo 16, na may limitadong range at magaan na load sa simula. Ang mabibigat na pagtaas ng kamay sa itaas at ang makapangyarihang pagtulak at paghila ay patuloy na iwasan sa yugong ito.

Para sa iyong physiotherapist:

Mga Layunin

  • Buong aktibo at pasibong range of motion sa lahat ng planes
  • Progressive na lakas, endurance, at neuromuscular control ng cuff at mga scapular stabilisers
  • Ihanda ang isang graduated na pagbabalik sa sport-specific loading

Pamamahala

  • Multi-directional end-range stretching: cross-body stretch, behind-the-back internal rotation, hands-behind-head, sleeper stretch, external rotation sa 90 degrees ng abduction
  • Progressive resistance (humigit-kumulang 0.5–2.5 kg) na idinadagdag sa dynamic program: side-lying external rotation, prone row, prone extension, prone 'T's at 'Y's, standing scaption
  • Theraband progressions: 'T's, 'W's, diagonals, internal at external rotation sa 90 degrees
  • Closed-chain work: wall push-ups mula sa mga linggo 12, nagprogresso ayon sa tolerance
  • Machine-based weight training mula sa mga linggo 16: limitadong range, magaan na load (rows, pull-downs, biceps at triceps; pressing ay ibinabalik nang maingat)
  • Rhythmic stabilisation, proprioception, at mga drill para sa scapulohumeral rhythm

Mga Precautions

  • Iwasan ang mabibigat na pagtaas, lalo na sa itaas, at ang makapangyarihang pagtulak at paghila
  • Ang pagpapalakas ay nananatiling walang sakit at humihinto bago maabot ang provocative end-range loading
  • Panatilihin ang scapular control habang gumagalaw: bawasan ang load kung may hitching o compensation na lumabas

Mga Kriterya para magprogresso

  • Aktibo at pasibong shoulder motion sa loob ng functional limits sa lahat ng direksyon
  • Tolerado ang progressive strengthening program nang walang flare-up

Yugong IV — Pagbabalik sa isports at mabigat na trabaho (Linggo 18 pataas)

Ang huling yugong ay isang unti-unting pagbabalik sa masisipag na trabaho, pagtatayo ng bigat sa itaas ng ulo, at isports. Ang mga drill na plyometric at partikular sa isports ay idinadagdag sa programa ng pagpapalakas ng kalamnan, at ang mga interval na programa ang nagtuturo sa pagbabalik sa paghahagis, paglangoy, golf, at mga isports na gamit ang raket. Ang pagbabalik sa mga isports na may kontak at banggaan ay karaniwang tumatagal ng apat hanggang anim na buwan mula sa operasyon, depende sa pagbawi ng buong galaw, lakas, at kumpiyansa sa braso; ang mga publikadong programa para sa mga atleta sa banggaan ay minsan ay mas mahaba, hanggang humigit-kumulang siyam na buwan. Ang mga atleta ng lakas ay karaniwang bumubuo muli ng kanilang karaniwang pagsasanay sa loob ng katulad na panahon. Ang iyong pisyoterapeuta at doktor ang magbibigay-direksyon sa huling pahintulot, at may ilang mga atleta sa banggaan ang pumipili na magsuot ng brace sa balikat para sa unang season ng pagbabalik.

Para sa iyong pisyoterapeuta:

Mga Layunin

  • Panatilihin ang buong saklaw ng galaw
  • Pag-usbon ang lakas, kapangyarihan, at tibay upang tugunan ang mga pangangailangan ng trabaho at isports ng pasyente
  • Unti-unting, batay sa mga pamantayan, na pagbabalik sa mga isports na may kontak at sa itaas ng ulo

Pamamahala

  • Patuloyin at pag-usbon ang programa ng pagpapalakas ng Yugong III
  • Mga progresyon sa closed-chain: progresyon ng push-up sa hindi matatag na ibabaw, trabaho ng bola sa pader
  • Plyometrics para sa mga atleta na naghihagis at sa itaas ng ulo: mga throw gamit ang rebounder, trabaho ng may bigat na bola, mga dribble sa pader, mga drill para sa pagpapabagal
  • Mga interval na programa ng isports para sa paghahagis, golf, tennis, at paglangoy
  • Lakas at tibas ng kinetic-chain na partikular sa function at okupasyon

Mga Paalala

  • Ang pagbabalik sa mga isports na may kontak at banggaan ay gagawin lamang kung may buong saklaw ng galaw, nabawi na lakas, at pahintulot mula sa doktor
  • Ang progresyon ay nananatiling gabay ng sintomas: kung lumitaw ang sakit o pakiramdam ng kawalan ng katatagan, bumalik sa isang yugong

Pagkatapos ng iyong protocol

Ang mga yugto sa itaas ay kinuha mula sa mga na-publish na rehabilitation protocol para sa AC joint stabilisation at reconstruction: Massachusetts General Brigham Sports Medicine, ang AC joint reconstruction program ng Massachusetts General Hospital sports medicine, ang ACJ stabilisation guidelines ng UK shoulder units, at isang systematic review ng mga publicly available AC joint reconstruction protocols. Ang mga range ng linggo ay karaniwan imbes na fixed, at iba-iba ang mga na-publish na program; ang iyong ongoing rehabilitation ay indibidwal na pinamumunuan ng iyong physiotherapist, na nagtatrabaho kasama ang practice, batay sa kung paano bumabawi ang iyong repair at galaw. Ang pahinang ito ay kasabay ng general recovery advice ng practice; tingnan ang managing post-operative pain at wound care. Para sa operasyon mismo at sa pinsala na ito ay ginagamot, tingnan ang AC joint stabilisation. Ang ebidensya sa likod ng protocol na ito (ang reconstruction, ang loss-of-reduction literature, at ang mga rehabilitation studies) ay naka-summarize sa evidence section, na available bilang PDF mula sa itaas ng pahinang ito.

Reviewed by Dr Kieran Hirpara · 10 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

Acromioclavicular Joint Stabilisation / Reconstruction — Operative Rationale & Post-operative Rehabilitation (Evidence)

Topic scope: Post-operative rehabilitation after acromioclavicular (AC) joint stabilisation / reconstruction for a high-grade AC joint dislocation (Rockwood type III–V) — restoring the alignment between the clavicle and scapula with a coracoclavicular (CC) suspensory device (suture-button / endobutton construct), with or without a biological tendon graft (semitendinosus / pectoralis minor) and with or without a direct AC ligament reconstruction. This page also summarises the operative/non-operative evidence that frames the rehabilitation choices. It is the clinician-facing companion to the patient protocol.

Defining principle of the surgical rehab here — PROTECT the construct. Unlike a capsular release (where the enemy is re-stiffening and rehab is immediate aggressive ROM), AC joint stabilisation is a protect-the-repair pathway, closer in spirit to a rotator-cuff or instability repair. The reconstruction has to resist the constant downward pull of gravity on the weight of the arm — the exact deforming force that displaced the joint in the first place. A suspensory suture-button or tendon graft has no early intrinsic strength; biological healing of the CC/AC ligaments and tunnel incorporation takes weeks to months, and the dominant early complication is loss of reduction before that healing matures. So the rehab is deliberately conservative: the sling carries the weight of the arm (typically ~6 weeks), active elevation and any downward traction on the arm are avoided early, ROM is restricted (no elevation > 90°, no cross-body, no reaching behind the back) for the first 6 weeks, strengthening waits until the construct has matured (~12 weeks), and return to contact/collision sport is deferred to ~4–6 months. Motion progression and protection are the two levers; the single most important point distinguishing this protocol from the capsular-release inversion is that here, time and protection are the friends, not the enemy.

A. THE OPERATION & WHY REHAB IS PROTECTIVE

A high-grade AC dislocation tears the AC and coracoclavicular (conoid + trapezoid) ligaments, allowing the clavicle to rise relative to the acromion under the weight of the arm. Surgical stabilisation aims to restore the CC distance and let the ligaments heal in a reduced position. Contemporary constructs are predominantly:

  • CC suspensory fixation — a suture-button / endobutton loop passed through clavicular and coracoid tunnels (e.g. flip-button, single- or double-tunnel). Restores vertical stability.
  • + Biological augmentation — a free tendon graft (semitendinosus allograft/autograft, or the pectoralis minor / coracoacromial ligament in Weaver–Dunn-type procedures) to reconstruct the CC ± AC ligaments. The anatomy of the pectoralis minor tendon has been characterised specifically for this use [pec minor anatomy, JSES 2007].
  • + Direct AC reconstruction — adding an AC-level construct to the CC reconstruction improves horizontal stability; combined CC + AC reconstruction gives better radiographic reduction and lower reoperation rates than isolated CC reconstruction in pooled data.

The structural properties of the reconstructed CC complex have been measured biomechanically: reconstructions restore much, but not all, of the intact ligament's stiffness and load to failure [Structural Properties, Am J Sports Med 2000]. This is the mechanical basis for protecting the construct early — the graft/button is weaker than the native ligament until it heals and incorporates.

B. EVIDENCE BY THEME

1. Operative vs non-operative — only high grades benefit from surgery

  • Type I–II AC injuries are managed non-operatively. Type III is genuinely controversial and most are treated non-operatively first; type IV–V are the usual operative indications [ACJ Injuries: Evidence-based Treatment, JAAOS 2018]. A network meta-analysis of RCTs for acute Rockwood III–V found no single surgical technique clearly superior, and that surgery's advantage over non-operative care is modest and grade-dependent [network MA, JSES 2023].
  • Hook-plate fixation of acute dislocations improved radiographic but NOT clinical outcomes versus non-operative treatment [Hook-plate RCT, JBJS 2017] — a caution that radiographic reduction does not automatically translate into a better patient outcome, and a reason the hook plate (which requires removal) is not the preferred construct here.
  • The Rockwood classification itself has only moderate reliability between observers [Rockwood reliability, JSES 2021], which is part of why type III decision-making is debated.

2. Loss of reduction is the dominant complication — and it shapes the rehab

  • Loss of reduction (the clavicle drifting back up) is the most frequent radiographic failure after suspensory-device stabilisation. Clavicular tunnel widening correlates with post-operative loss of reduction in an implant-dependent way [tunnel widening, Arthroscopy 2023] — i.e. the construct and tunnel position matter.
  • Radiographic failure and reoperation rates after ACJ reconstruction are non-trivial [radiographic failure / reoperation, Bone Joint J 2016]; one suspensory-device series reported ~10–11% revision for loss of reduction / implant failure (suture fatigue, button escape, coracoid stress fracture, deep infection) [web: suspensory-device cohort].
  • Adding the AC-level reconstruction and a biological graft improves radiographic reduction and lowers reoperation versus isolated CC suture-button [web: combined CC+AC reviews].
  • Complications after operative treatment of high-grade injuries are well catalogued [complications, JSES 2023] — they include loss of reduction, coracoid/clavicle fracture, hardware problems and infection.

Rehab implication: because the early failure mode is mechanical loss of reduction under arm-weight loading, the early phase forbids active elevation, lifting, downward traction on the arm and weight-bearing through the arm — the patient protects the construct while the ligaments and tunnels heal.

3. Outcomes and return to sport are generally good — but timeline is conservative

  • Anatomic CC reconstruction with semitendinosus graft for chronic dislocation gives good clinical and radiological results [semitendinosus reconstruction, KSSTA 2020].
  • Sports activity after anatomic flip-button stabilisation is generally restored, with most athletes returning to their pre-injury sport, though return is gradual [flip-button sport, KSSTA 2016].
  • Delayed (chronic) reconstruction with a modern suspensory device does not increase fixation failure or major complications versus acute fixation [web: delayed reconstruction].

4. The rehab protocol itself is consensus/expert, not RCT-derived — and it is highly variable

A systematic review of publicly available ACJ-reconstruction rehabilitation protocols found they are widely variable: sling duration ranged 3–8 weeks (the modal recommendation was 6 weeks, in 8/18 protocols), active ROM commonly began at ~6 weeks (6/20 protocols), and heavy/strenuous shoulder use was typically prohibited for a further ~6 weeks beyond the initial 6-week protection period [Cheema et al., Arthrosc Sports Med Rehabil 2021]. There is no high-level RCT defining the optimal post-op regimen — phase timings are expert/consensus.

The patient protocol's phase boundaries (0–6 / 6–12 / 12–18 weeks, sling 6 weeks, return to contact sport ~4–6 months) sit squarely within this published range and match the Massachusetts General Brigham / MGH Sports Medicine ACJ-reconstruction guideline (Phase I 0–6 wk, Phase II 7–12 wk, Phase III 13–18 wk) and similar surgeon protocols (e.g. Dickens: 6-week sling, return to all activity months 4–6).

C. PHASED POST-OP TIMELINE (consistent with the patient protocol)

Phase Window Sling ROM Strengthening Notes
I — Protecting the repair Weeks 0–6 Yes, ~6 wk whenever up; worn for sleep weeks 0–3 (arm-weight loads the repair even lying down) Pendulum + passive/assisted elevation to 90° max in scapular plane; assisted ER to ~30°; NO active elevation, no cross-body, no behind-the-back Hand/wrist/elbow AROM; scapular setting; sub-maximal pain-free isometric IR/ER only No driving while in the sling (~6 wk). No lifting > ~0.5 kg, no carrying, no leaning/pushing up on the arm, no letting the arm hang unsupported — each loads the construct
II — Restoring movement Weeks 6–12 Wean off Progress assisted → active ROM; build toward full by ~12 wk (~15°/week as a guide); behind-the-back introduced gradually (to beltline) Light elastic-band cuff + scapular work begins (rows, IR/ER, serratus punch); side-lying ER, prone row/T/Y Lift to ~1 kg; avoid forceful push/pull, push-ups, overhead and cross-body lifting
III — Strengthening Weeks 12–18 Off Full ROM goal; end-range stretches (cross-body, behind-back, sleeper) now used to win final range Progressive resistance ~0.5–2.5 kg; wall push-ups from ~wk 12; machine weights from ~wk 16 (limited range, light load) Construct matured; still avoid heavy overhead and forceful push/pull
IV — Return to sport / heavy work Week 18 onward Off Maintain full ROM Plyometrics, sport-specific & interval programs; occupation-specific kinetic-chain loading Return to contact/collision sport ~4–6 months (collision athletes / some occupations longer, up to ~9 mo); criteria-based clearance; some wear a brace first season back

(Phase boundaries from the MGH/Mass General Brigham ACJ-reconstruction guideline; return-to-sport windows from the flip-button sport series and surgeon protocols; all within the variability documented by Cheema et al. 2021.)

D. KEY CONTROVERSIES / EVIDENCE QUALITY

  1. Type III — operate or not? The most-debated grade; most are trialled non-operatively first. No clear winner in RCT-level data, compounded by only-moderate reliability of the Rockwood grade itself. Moderate / conflicting.
  2. Which construct? Network MA shows no single technique clearly superior for acute III–V. Combined CC + AC reconstruction (± graft) gives better radiographic reduction and lower reoperation than isolated CC suture-button, but at the cost of complexity. Hook plates improve radiographs but not clinical scores and need removal. Moderate.
  3. Loss of reduction vs clinical outcome. Radiographic loss of reduction is common yet often clinically well-tolerated — radiographic and patient-reported outcomes diverge. This tempers how aggressively reduction should be chased. Moderate.
  4. The rehab protocol is consensus, not trial-derived, and published protocols vary widely (sling 3–8 wk; Cheema 2021). The patient page's timings are typical, not RCT-validated. Weak / consensus.

E. EVIDENCE-STRENGTH FLAGS (summary)

  • STRONG (RCT / SR-MA): hook-plate improves radiographic but not clinical outcomes vs non-operative (RCT, JBJS 2017); network meta-analysis of RCTs for acute III–V shows no clearly superior technique (JSES 2023).
  • MODERATE (cohorts / biomechanical / SR): anatomic semitendinosus CC reconstruction outcomes (KSSTA 2020); sports return after flip-button stabilisation (KSSTA 2016); loss-of-reduction / tunnel-widening drivers (Arthroscopy 2023; Bone Joint J 2016); complications of high-grade operative treatment (JSES 2023); reconstructed-CC biomechanics (AJSM 2000); combined CC+AC > isolated CC for reduction/reoperation; delayed reconstruction safety.
  • WEAK / CONSENSUS ONLY: the post-operative rehabilitation protocol itself — no defining RCT; protocols are expert/consensus and highly variable (Cheema 2021; sling 3–8 wk). Rockwood classification reliability only moderate (JSES 2021).

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

  • Anatomy of the pectoralis minor tendon and its use in acromioclavicular joint reconstruction. J Shoulder Elbow Surg. 2007. DOI: 10.1016/j.jse.2006.09.007
  • Clavicular tunnel widening after acromioclavicular stabilization shows implant-dependent correlation with postoperative loss of reduction. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.05.014
  • Acromioclavicular joint injuries: evidence-based treatment. J Am Acad Orthop Surg. 2018. DOI: 10.5435/jaaos-d-17-00105
  • Review of Weaver and Dunn on treatment of acromioclavicular injuries, especially complete acromioclavicular separation. J ISAKOS. 2019. DOI: 10.1136/jisakos-2019-000299
  • Structural properties of the intact and the reconstructed coracoclavicular ligament complex. Am J Sports Med. 2000. DOI: 10.1177/03635465000280010201
  • Complications after operative treatment of high-grade acromioclavicular injuries. J Shoulder Elbow Surg. 2023. DOI: 10.1016/j.jse.2023.03.019
  • Sports activity after anatomic acromioclavicular joint stabilisation with flip-button technique. Knee Surg Sports Traumatol Arthrosc. 2016. DOI: 10.1007/s00167-016-4287-7
  • Anatomic reconstruction of the coracoclavicular and acromioclavicular ligaments with semitendinosus tendon graft for the treatment of chronic acromioclavicular joint dislocation provides good clinical and radiological results. Knee Surg Sports Traumatol Arthrosc. 2020. DOI: 10.1007/s00167-020-06285-x
  • Hook-plate fixation in patients with acute acromioclavicular joint dislocation improved radiographic but not clinical outcomes compared with nonoperative treatment. J Bone Joint Surg Am. 2017. DOI: 10.2106/jbjs.16.00582
  • Radiographic failure and rates of re-operation after acromioclavicular joint reconstruction. Bone Joint J. 2016. DOI: 10.1302/0301-620x.98b4.35935
  • Treatment options for acute Rockwood type III–V acromioclavicular dislocations: a network meta-analysis of randomized controlled trials. J Shoulder Elbow Surg. 2023. DOI: 10.1016/j.jse.2023.01.039
  • A relook at the reliability of Rockwood classification for acromioclavicular joint injuries. J Shoulder Elbow Surg. 2021. DOI: 10.1016/j.jse.2021.01.016

Literature (URLs)

  • Cheema SG, Hermanns C, Coda RG, et al. Publicly accessible rehabilitation protocols for acromioclavicular joint reconstruction are widely variable. Arthrosc Sports Med Rehabil. 2021;3(2):e427–e433. https://doi.org/10.1016/j.asmr.2020.10.007 (sling 3–8 wk, modal 6 wk; active ROM ~6 wk; further ~6 wk before heavy use)
  • Acromioclavicular joint injuries: effective rehabilitation (review). PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC8169819/
  • Delayed acromioclavicular joint reconstruction using a modern tunnelled suspensory device does not increase the risk of fixation failure or major complications. PubMed. https://pubmed.ncbi.nlm.nih.gov/35781084/
  • Low rate of substantial loss of reduction immediately after hardware removal following ACJ stabilization using a suspensory fixation system. KSSTA. https://link.springer.com/article/10.1007/s00167-022-06978-5
  • Minimum 10-year outcomes after arthroscopically assisted anatomic coracoclavicular ligament reconstruction for type III and V AC joint injuries. ScienceDirect. https://www.sciencedirect.com/science/article/pii/S2666638325001835

Published rehab protocols (URLs — basis for the phase structure)

  • Massachusetts General Brigham Sports Medicine. Rehabilitation guideline for acromioclavicular joint reconstruction (including coracoclavicular ligament reconstruction). https://www.massgeneral.org/assets/MGH/pdf/orthopaedics/sports-medicine/physical-therapy/rehabilitation-protocol-for-acromioclavicular-joint-reconstruction.pdf (Phase I 0–6 wk sling, Phase II 7–12 wk, Phase III 13–18 wk)
  • Dickens JD. AC joint reconstruction protocol (Duke Sports Medicine). https://www.jondickensmd.com/pdf/ac-joint-reconstruction-protocol.pdf (6-week sling worn for sleep; return to all activity months 4–6)
  • Chambler A. ACJ stabilisation rehabilitation guidelines. https://www.andrewchambler.com/post/acj-stabilisation-rehabilitation-guidelines
  • North Tees and Hartlepool NHS Foundation Trust. Acromioclavicular joint stabilisation — LockDown/Weaver Dunn procedure. https://www.nth.nhs.uk/resources/acromioclavicular-joint-stabilisation-lockdown-weaver-dunn-procedure/
  • Stone Clinic. Acromioclavicular (AC) joint reconstruction rehab protocol. https://www.stoneclinic.com/Acromioclavicular-AC-joint-reconstruction-rehab-protocol

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