# looking for feedback on AC surgery



## twistedlizard720 (Apr 3, 2006)

I am now 14 months post AC joint separation and am continuously having issues. I have posted in the AC separation thread, but am looking for specific info from those who have had the surgery. 

I would like to know if it was worth it and what complications you may have now. It seems like the Weaver-Dunn is the primary procedure to fix this, but if your was something else please tell. 

My biggest hesitation on scheduling it is ending up back to my current state. Grade 3 is like 50/50, but with the chronic pain issues I have it looks like surgery is the best option. 

Thanks in advance.


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## carter1 (Jan 30, 2004)

I'm about 14 weeks post injury, went to PT, did the exercises and am having reconstruction surgery a week from today. Mine didn't heal, it happens, I can't live with it the way it is. At least this way, I know it will get better.
c


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## twistedlizard720 (Apr 3, 2006)

Thanks for posting. Let me know how it goes. I keep leaning towards surgery, I still an skeptical though. Can't get any positive feedback from anyone on the procedure.


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## Sonoran_Flyer (Sep 22, 2008)

I had what is called anatomically correct AC reconstruction. It takes a while to recover from, but it provides the same level of strength as before. Another name is tight rope. It is one of the strongest repairs. Strength of the repair is only until your own ligaments grow back over the implanted ligaments. I would not hesitate for a second to have it done again, but only by the doctor who originally performed the first surgery. 

1) Do everything they tell you. Rehab etc.
2) Do not push yourself to soon. Allow your joint to heal.

I am a year out and have full range of motion and am weight training to gain full strength. I raced in Tour of White Mountains in Oct at 7 months. Just completed 24 hours of Old Pueblo.


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## carter1 (Jan 30, 2004)

I'm not sure what they call the procedure that they are doing to me, but it sounds like the same as your Sonoran_Flyer. They will be grafting 3 ligaments, 2 across (or through) the clavicle and one at the end of it.
The toughest part of this right now is the anxiety of having the interscalene block and knowing that I won't be completely out while they do this. Doctors says it's about an hour and half procedure and I'll be home by noon Monday after the surgery. 
How long before you were riding? I want to give it time to heal, but am curious if I'll be able to ride road or dirt roads soon. The thought of spending our free time this summer laying on a beach is killing me, I need to ride, it's already been over 3 months-longest time off a bike since I was 5yrs old (I'll be 50 in April). 
c


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## quinndo (Aug 13, 2007)

*I have positive things to say*

My surgery was in the summer of 2008. 
The injury was from a jump in Pacifica, and the surgeon rated it as being between a class 2 and 3. It was my choice to proceed with the operation, and I did it partly in vain because I didn't like the way my clavicle made a huge bump. I also had this naive blind faith in modern medicine, thinking I would be put back together good as new so to speak.

The procedure was a kind of a modified weaver-dunn. They drilled a hole in the clavicle and one in the scapula, and then inserted an "AC Graftrope" built with cadaver ligaments. There is an animation of the procedure on this page at the top right.

I can't exactly recall the recovery time, but I had to wait about three months between the injury and the surgery. My best guess is it was maybe 4 months b4 road bike and then another 2 months before mountain bike following the surgery

I'm thrilled to say that I can ride without pain!! I do long road rides on a racing bike with pro geometry (think lots of weight on the arms and shoulders) for hours at a time and everything is fine. I also still do freeride, downhill and ride a sport bike regularly. Throwing a baseball isn't a problem either. Occasionally it feels stiff when I keep my arm supported on an armrest (or desk) at an elevated level, and I need to return my arm to my side.

The bigger downside (depending on how you look at it) is that I have to go to the gym regularly. If I stop working out (or doing pushups) for more than a month then some minor discomfort sets in. I'm guessing it would get worse if I let the muscles weaken but no reason to test that. And if I'm lifting heavy weight I feel it too - but that seems to make me stronger such that the next time I can lift the same amount w/o pain. This was also experienced during rehab - each time I would feel more pain but only because I was pushing it hard. For reference I'm 30yo, 6ft, 170lb (160 b4 injury and regular gym). I guess the upside to this is I built more muscle mass and generally feel healthier.

So yeah, I feel happy with my decision. Based on conversations with my surgeon he would have pushed me for the surgery if I was a full class 3 as you are.

I know what all of you are going through, and it totally sucks. My hopes are that you are able to heal up soon and get back to life with minimal pain. Feel free to PM me if you have any other questions.


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## carter1 (Jan 30, 2004)

quinndo,

Thanks for the words man. That's encouraging. 

c


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## Sonoran_Flyer (Sep 22, 2008)

I had surgery year ago in February. In a sling for six weeks doing ROM exercises.
Next six weeks was physical therapy. I was officially released by the doctor after physical therapy. 

I waited until 3 months to ride (May). Started out on rode, dirt roads, and bike paths with short rides; nothing more than 10 miles. 

Did not ride dirt until 6 months,(August) tried just to do moderate rides nothing to rough. 

Eight months out rode in first endurance race.(October)

During this whole time I was still doing dumb-bell exercises for rotator-cuff.


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## edubfromktown (Sep 7, 2010)

Like quinndo said... it is important to keep it moving to avoid pain and stiffness.

I had a Grade 2+ that still causes me some discomfort (mostly a day or two after significant MTB activity). The doc's were amazed that I didn't break my clavicle or have a concussion when I got an MRI after endo slammage to the max that destroyed my helmet.

I started messing with hand held weights right away and kept working my arm to get full range of motion back. I went on a trail ride 6 days after. It took ~6 months before I could pull the front end off the ground or ride through rough stuff without significant pain.

Typically my clavicle aches more than anything else with popping and creaking at the synovial joint on my right side where it meets the chest wall. I've got the telltale big knot on my shoulder- doesn't hurt there very often.

I recently went snowboarding for the first time since I busted my shoulder up and was concerned about irritating it. No problem at all- felt like $1M.

Best of luck.


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## twistedlizard720 (Apr 3, 2006)

Sonoran Flyer, you mentioned tightrope procedure in your initial reply. From what I have found so far, the tightrope is a device used to augment the Weaver-Dunn. Was this the case for your surgery or was it tightrope only?


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## Sonoran_Flyer (Sep 22, 2008)

Was not a Weaver Dunn.

http://arthromed.org/pdf/shoulderelbow/Brochures
/The%20NextGenerationinShoulderRepairTechnology.pdf

Look at page 10 right bottom corner AR2258. This or something vary similar was implanted in my shoulder. I saw the coracoid button on top and an endo button underneath in an x-ray 2 weeks after my surgery. Anatomically correct refers to the spacing of the holes where the grafts are placed. Same location as the original tendons, and distance separating the bones.

Good luck and heal well !!


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## FisherCaliber (Apr 1, 2010)

My situation was a bit different. I had only a grade I separation, BUT I had arthritic changes in the AC joint as well. I went the resting route and it did no good. Cortisone injections provided temporary relief. Pain woke me up repeatedly at night. Not fun...

So I ended up with a modified Mumford procedure where they cut 10-20mm off the end of the clavicle where it meets up at the AC joint. It got rid of the pain because there was no more bone on bone grinding.

PT is vital and it was 3 months before I could go back to easy trials riding (motorcycle).

Good luck if you proceed with surgery!!


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## carter1 (Jan 30, 2004)

home from surgery, NOW the healing can begin!
c


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## FisherCaliber (Apr 1, 2010)

Best wishes for a speedy recovery Carter1 !!!


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## carter1 (Jan 30, 2004)

Ice water pump, percocet, Tens unit and reclining REI camp chair got me through the first night. Anyone here use the Tens unit? What settings worked best for you? c


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## carter1 (Jan 30, 2004)

whew. Got through the Percocet withdrawals! 

First post op visit today and got photos of the inside of my shoulder. Cool metal disc and some screws to hold the new ligaments in, what looks like metal fishing leader material tying up the cartilage damage and a bruise from the dislocation (the Doctor confirmed during the surgery that in addition to the separation, I also had dislocated the humerus (which we reset on the trail). 

I start PT this week, but have to take it easy for another 3 weeks. This is getting old quick!

Be careful out there.

c


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## Sonoran_Flyer (Sep 22, 2008)

As tiring and old as it may seem, follow instructions and don't push too fast. You definitely don't want to go thru it again!

Keep your head up, the first 3 months are the longest.


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## carter1 (Jan 30, 2004)

Sonoran Flyer, I see you're from Tuscon. Do you know my buddy BVoutdorz? I'm one of his old riding crew from NC (the SOFa crew!).

c


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## Sonoran_Flyer (Sep 22, 2008)

No, I don't know anyone local from NC. 

There are a ton of people who mountain bike in this area.


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## carter1 (Jan 30, 2004)

I know he sometimes posts on Tusconmtb, really good guy and talented rider, if you ever meet him......tell him c-1 says hello
c


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## carter1 (Jan 30, 2004)

another week of doing nothing except work I did start doing pendulum exercises this week. So, what did you guys do physically to "keep your mind right?" I feel like I'm loosing it some days (and nights in this damn sling). 
c


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## carter1 (Jan 30, 2004)

3-1/2 weeks post op now. Continuing range of motion exercises. I can almost "hear" all the healing going on in there! Hopefully, I'll be strengthening in another 3 weeks!
c


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## Dragon3C (Mar 19, 2011)

Carter1, 

Just keep at it. The days will pass and you will eventually get stronger. I've already gone through three invasive shoulder surgeries in the past - mostly due to injuries sustained while serving in the Army - 12+ dislocations and a ruptured bicep tendon will have that effect. Adding insult to injury, I've been battling with a Class III-IV AC separation that happened after I was hit while riding in Santa Monica. It was a complete and full separation and it didn't even come close to healing properly. Soooo... I'm going under the knife for that (for the 4th time) and am expecting it to be nothing less than miserable. C'est la vie. But, if I follow the surgeon's instructions and adhere to the physical therapy regiment, I should be good to go. This will be the first time a civilian surgeon has worked on my shoulder... although, he is a retired Colonel, so I guess that counts for something, huh?

I found the most problematic (more of a nuisance than anything) thing associated with a shoulder surgery / being in a sling for 6-8 weeks is maintaining proper hygiene / adequate sterilization of your under-arm area. Over time, it will get "ripe" and susceptible to something similar to jock rot. I found the best way to combat that, and prevent any further problems, was to take an old, clean sock, place it over your hand, and douse it in rubbing alcohol. With your fingers extended and joined, stick that high-test sock monkey up there, and give it a good once over. Sure, it will hurt like a bastard (and you will almost certainly curse my name), but you'll ensure that your under-arm will not turn into a science experiment gone mad. Getting an infection near / around your op site is the last thing you need. Gold Bond medicated foot powder also works well up there from a preventative standpoint, I've found. Just my 2 cents. 

How is your recovery coming along? Have you found a way to get sleep with the sling on? 4 weeks post-op, you should be seeing sings of improvement and increasing your ROM. How are the pendulum exercises going? Keep it up... you'll get there! One day at a time. Sooner than you know it, you'll be out of the sling, strength training, and back on the bike in time for summer. :thumbsup:

Keep us posted on how you're doing. After I go under the knife, I'll share the good, bad and ugly for those that are on the fence as to whether to pull the trigger on the surgery. 

If you have any additional questions, feel free to ask or even PM me. I'd be more than happy to share some of my experiences, frustrations, and how I overcame many of the obstacles associated with a traumatic shoulder injury.

Regards, 

Bull


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## carter1 (Jan 30, 2004)

yeah, you get used to the pain, its not fun, but you'll get over it. The underarm thing does REALLY suck though-every second of every day. Being a closet roadie, until my crash in November, I had shaved my legs for years, when I stopped, it wasn't a big deal, but growing hair in your armpit, which is basically glued to your torso for 4 weeks is a real constant pia!

Sleeping with the sling was toughest when coming off the Percocet-I got claustrophobia because of it and ended up walking the neighborhood at 3:00 am one night! After that, it wasn't too bad, it feels like it's protecting the shoulder.

I've felt a lot of improvement in the past couple of days. I had a tough pt session last Tuesday and was really really sore, went back Thursday and stretched it out and have had extra time for home pt this weekend and its definitely feeling better. Another week and a half and I'll be able to loose the sling and start some minor strength training. 

I'm genuinely sorry for anyone having to go through this, the experience has truly defined the term "this sucks," but with no hope of stability in the shoulder without the surgery, it was the best option for me and I'm sure I'll be glad I did it. The mental aspect of it has been tougher for me than the physical I think. My surgeon asked if I had issues with depression, because a lot of active folks will suffer with depression during this process and they will prescribe a mild anti-depressant. I told him that I thought I would be ok, but in hindsight and after "conversations" with my wife and daughter, I probably have suffered with depression and should have taken the necessary medical steps to deal with it-mostly for the sake of my family that has had to deal with my "helpless, woe is me" attitude. Unfortunately, you can't do anything about the "helpless" part for 6 weeks, but we're all used to it at this point and the "helpless" part is almost over. I also have a lot of riding buddies that have made efforts to keep me in the loop, stop by for a beer after rides and try their best to keep me positive. 

Good luck

c


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## twistedlizard720 (Apr 3, 2006)

It's done. Got modified Weaver-Dunn and arthroscope inspection this morning. At home now, kickin it and pretty much pain free......for now. I'll update as healing progresses and I want to thank all you guys who posted. It was a great help.

Soakin up some sun this afternoon


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## carter1 (Jan 30, 2004)

Ha! That looks like the chair that I lived in 24/7 for the first week (REI XL camping chair). Hand in there. I'm in my 4th day without the sling, amazing how tired I get having to carry my arm without help of the sling. 
Hand in there.
c


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## twistedlizard720 (Apr 3, 2006)

3.5 week update. Docs have let me go without the sling around the house, but stilluse it. The pain has ramped up quite a bit over the last few days. I think its sensory nerves making connections again. Otherwise, I am pleased with the results so far. Look forward to getting through physical therapy and back in the swing of things.

Before surgery









3 weeks After


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## snellvilleGAbiker (Apr 30, 2009)

*Same boat*

Your post-op picture look pretty good.

I separated my shoulder two weeks ago but not sure to have surgery or not. The Shoulder Doc said it's a Grade VI and he recommended surgery. I saw the Shoulder Surgeon and he said it's a Grade V. Based on my Xray, i need surgery but upon examining me, he said no surgery "for now". He said give it 3 months + PT and IF i am not happy w/ the recovery, then he can do surgery to fix it. Here is my Xray.









The surgeon said i'd need 2 surgeries. First one would be insertion of "hook and plate" and second one would be the removal of the hardware. Sucks and i'm scared.


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## twistedlizard720 (Apr 3, 2006)

I've heard anything grade 4 and above require surgery, mine was severe grade 3, I went 15 months prior to having surgery and in hindsight, would have done surgery right away. Your going to be down anyways, especially with a grade 5, might as well spend the time knowing it was done right and not have go through it all over 6 months down the road. I'm still in a sling post surgery, but glad I had it done.


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## carter1 (Jan 30, 2004)

10-1/2 weeks post op.
Range of motion is pretty good, but still pretty weak. I did a couple of easy road/greenway rides on the mtb last week. Hopefully I'll be released by the doc next week. I really don't see myself pushing to get back to the mountains for another 3-4 months. I can't believe the amount of muscle atrophy that occurred when I was in the sling. I still think the toughest part of this surgery is the mental aspect of having to be inactive for such an extended period of time.
Still the toughest injury and surgery I've been through. 

c


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## Shawnie Shawn (Nov 7, 2006)

twistedlizard720 said:


> I've heard anything grade 4 and above require surgery, mine was severe grade 3, I went 15 months prior to having surgery and in hindsight, would have done surgery right away. Your going to be down anyways, especially with a grade 5, might as well spend the time knowing it was done right and not have go through it all over 6 months down the road. I'm still in a sling post surgery, but glad I had it done.


Agree with this 100%. Past Sunday got grade 3 borderline 5 and getting surgery Monday to get it overwith and increase potential to get back to 100%. I am going to Sports Medicine DR. who specializes in shoulders who does this all the time. Not even thinking twice about it. If I'm going to be out a while, it might as well be worth it!


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## carter1 (Jan 30, 2004)

13 weeks post op, good range of motion, strengthening is coming along.
I did 2 road rides this past weekend. Other than a little tightness (mostly in the neck), everything feels good. 
I'm thinking about some easy singletrack rides this weekend-we'll see.

Hang in there guys, what don't kill ya, makes you stronger!

c


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## twistedlizard720 (Apr 3, 2006)

Sorry I haven't posted any updates lately. I have been keeping myself pretty busy. 

I started weining off the sling at about 6 weeks and was completely out at 8 weeks. Had a little issues initially but nothing too bad. I did start physical therapy at about 5 weeks using passive stretching then started with weights at 8 weeks. At 8 weeks, the doc said to start doing normal activities but keep out of the ones where reinjury is possible. Physical therapy progressed well and I was on a home program by 12 weeks. Now I am close to 16 weeks post op and nearly back to normal. I do have limits as far as how much weight I lift and the manner of lifting, and there is still a little pain at the end of range of motion. I still can't lock my hands and stretch my arm stright above, but getting close. I return to work on the 15th of August so that will be the true test coming up. 

Overall, 100% satisfied and I would recommend it to anyone who is having issues after 4 to 6 months post injury. I took a 3000 mile motorcycle ride back to Colorado and it was amazing. Most days I had no pain, and the days I did, I'd just do some excercises and the pain would be gone. I can't wait to get a year out and see where I am at then. I am looking forward to getting back on the DH bike too.


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## twistedlizard720 (Apr 3, 2006)

5 months (and some change) post op and have bee back at work for a little over a month. Everyday gets a little better. When I first returned to work my upper trap would get tight and just ache a little but it was intermittent. As time went on it got better. I now can work a whole day on the flightline and not have any issues. I do still have a couple limitations, but it is at the extreme end of my range of motion and only bothersome when I put weight behind it. I think I have said it before but will say it again. Best money ever spent getting the surgery done. Life is finally getting back to normal. I even took the DH bike out. I took it easy and only when I tried to jump did I feel discomfort. I have also returned to lifting and can work out with zero pain.


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## wsmac (Sep 5, 2010)

Nice to hear your follow-up.
What are you doing on your own now to recover strength and ROM?
I blew my Rt AC & CC ligs back in mid-Feb...
Waited 6wks to see if it would stabilize (would have taken me that long to get in for surgery anyway), went and said "Operate!", waited 2 more wks for the new surgeon to arrive, had surgery, got that 'sinking' feeling again, found out the cadaver lig stretched out, so back in 2wks later to redo the surgery (total of 10wks now), was put in a solid brace this time (better patient compliance...  lol), and after 6 more wks was out of the brace and riding (my surgeon would just shake his head and say, "Just don't do anything stupid... although I know that's your middle name!" LOL... he mtb's too... so I can say it's a Doctor-Recommended activity! :thumbsup

After I got out of my brace, I took a drive from NrthrnCA to Texas. Kept walking my fingers along the roof backwards, reaching back over the passenger headrest, stretched over to my left shoulder and the door frame... stuff like that.
When I first hit the road... I could barely lift my hand up to the steering wheel.
After a week of driving out & back (I took my Chumba HX2 along... with slicks so I'd stay off the trails... :nono, I had gotten a good amount of stretch back in my shoulder.
I've been adding weight-lifting, push-ups, and assisted pull-ups to the mix.

For my trip, I also rigged up a pulley system with a figure8 descender, some rope, and two handle-size pieces of pvc pipe. I used some nylon webbing and a buckle to lock the rig over the top of a closed door and gently, but persistently, pulled my right arm through various ranges of movement. Worked great in hotel rooms and my sister's/brother's houses.

My surgery involved looping cadaver ligament 'round the CC process, then passing the two ends up through two holes drilled in my clavicle. Two synthetic screws hold the lig in place. No metal anything... feels great! Works great!
Now that it's raining here... I'm a gonna be falling a bit more often (slick-as* mud  ), but I will be moving a tad bit slower anyway.
Since I can't afford to blow this fix... I just fall on my left side now... :thumbsup:... 
I work in a hospital and we have FANTASTIC insurance!
Original billing for two surgeries, E.D. visit, etc was around $70K.
After InsCo./Hospital negotiations, I've paid maybe a bit over $1K.
Not bad for a stupid pet trick (this was on my mtb)... well... a stupid trick even a pet dog could have done better, that is!


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