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Acromioclavicular Joint Stabilisation
1. Acute Dislocation
Indications for operation:
Acute ACJ Dislocation

Anaesthetic:
General Anaesthetic with an interscalene block. (Fully asleep with a local anaesthetic injection into the side of the neck will numb the nerves to the shoulder for post-operative pain relief)

Operation type:
Arthroscopic

Incisions:
3 ½ cm incisions will be made in the shoulder, one to the back, one at the side and one at the front of the shoulder.
Procedure:
The glenohumeral joint is examined and the front of the joint is exposed to reveal the coracoid process. A special jig is then used to enable a hole to be drilled through the clavicle and the coracoid. The Tightrope system is then passed through the 2 holes and secured, placing the clavicle back in the correct position.

Wound Closure:
Small butterfly paper stitches will be used to close the wounds.

Dressings:
Elastoplast dressings will be placed over the top of the paper stitches and an adhesive bandage over the top of this.

Immediate aftercare:
A sling will be placed on the arm and it may feel numb for the rest of the day. You can go home when you feel comfortable and will be given instructions on what to do next.

2. Chronic Dislocation
Indications for operation:
Chronic ACJ Dislocation

Anaesthetic:
General Anaesthetic with an interscalene block. (Fully asleep with a local anaesthetic injection into the side of the neck will numb the nerves to the shoulder for post-operative pain relief)

Operation type:
Open

Incisions:
A 5cm incision will be made over the top of the shoulder
An additional 5cm incision will be made over the inside of the knee to take one of the hamstring tendons. This will be used as a graft to replace the ligaments that have torn.

Procedure:
The last 1cm of the clavicle will be removed as this is often a cause of pain if not removed. The top of the coracoid will be exposed and a small hole drilled in the top of it. 2 further holes will be made in the clavicle. Through the incision over the knee one of the hamstring tendons will be removed to use as the graft in the shoulder. The graft will be passed through the holes to replace the torn ligaments and secure the clavicle.

Wound Closure:
Small butterfly paper stitches will be used to close the wounds.

Dressings:
Elastoplast dressings will be placed over the top of the paper stitches and an adhesive bandage over the top of this.

Immediate aftercare:
A sling will be placed on the arm and it may feel numb for the rest of the day. You can go home when you feel comfortable and will be given instructions on what to do next.
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