I tore apart my right AC joint this spring and have been playing a waiting game since then to see if we could avoid surgical intervention. I am afraid that I lost that bet. The joint is still unstable and there are a number exercises or movements that I still cannot do. Pushups, pullups, golf swing, are all right out and the aftermath my first two days of swimming this past week were not pleasant.
I am meeting with my doc Thursday to have the final discussion and we are tentatively scheduled for News Years Eve surgery. I will be asking him all these questions, again, but I am hoping to get some of the accumulated wisdom of ST.
Can anyone tell me their experience with this sort of repair (tendon from leg to replace ruptured ligaments in AC joint)? How long in immobilizer, how long to return to full range of motion, time to begin sitting on a bike on a trainer, time to return to swimming, etc.
WI - As you’ve learned, injury to the AC joint can lead to a variety of treatments, or no treatment at all. Your current choice of a delayed primary repair is an operation done in a variety of ways, with a variety of outcomes. And it’s pretty challenging surgery. We as a profession get much better results now than even ten years ago. Your post op course will depend on what procedure is done, how easy/hard it was to accomplish, your particular post op goals, etc. In short, you are an individual and this will be tailored to you. You should be back on the trainer in no time.
I’d suggest you write down 4 questions (not 40) you want answered at this appointment and tell him, because you’re a triathlete, you’ll follow the post op orders 110% and be a great patient.
Best of luck, you have a long road ahead, but with a little luck you’ll do well. Good luck from all of us.
John: Thanks for the reply. My doc is a friend of mine and we have had several conversations through the course of waiting to see if surgery was necessary. He works with a number of athletes, including major and minor baseball players, and I am very comfortable with him. He fixed my ankle a few years ago with a Brostrum procedure that has had a great outcome. We have talked generally about his thoughts on possible outcomes and time frames and I feel that he has answered all of my questions so far as we head into the final stretch.
This was grade 3 separation. The procedure he is proposing is to harvest a tendon from the leg and use that to reattach the joint. I did not ask him the name of this procedure (we weren’t at the point of really considering this option) so I have not really been able to research the literature for outcomes in others. I will ask him the proper name but i was just digging around to satisfy my curiosity as I wait to see him on Thursday.
Just for background, swimming for the first time since the accident last week is what pushed me over the edge. I did two sessions (750m total and 800m total) and now it feels like my shoulder is even more unstable than it was at the beginning of the week. Not painful while swimming (but twinged a bit swimming breast) and really painful afterwards, just more unstable. I started swim team at age 6 and just turned 50 this year. My mechanics are good and the stroke was not labored in anyway, just the aftermath was very troubling. I do not want to lose the ability to hit the water. I also do not want to have major concerns regarding my next bike accident. Right now I feel that if I fell on my right shoulder, I would be in real serious trouble.
All I want is a stable shoulder and I am looking for some info on other triathletes’ (or triathletes’ doctors’) experience with this sort of procedure. Any info you can share in this regard would be greatly appreciated.
My wife had a grade 3 separation and decided to go with the surgery. As you mentioned they took a tendon from her leg and used it to attach a hook plate in the shoulder. The hook plate was removed about 6 months later. I’ve asked her a few times if she was glad she choose the surgery and she always gets a look of uncertainty on her face. I think in the end it was the right choice given that she has basically fully recovered. It still aches a bit from time to time (this was in 2012) but she has full use and strength of it. The reason for her uncertainty is that it hurt - a lot. The surgery itself left her in a lot of pain and the hook plate caused her a lot of pain while it was in place as well. She basically got immediate relief when it was removed.
Zenmaster: Thanks for the info. That’s a good data point to have. I generally am pretty good with pain and have not had significant pain issues with prior surgery, fractures or illness, but it is good to know what some possibilities are.
A point of differing opinion: I had a grade 3 AC separation June 2012 when I was hit by a car. Spent 8 months doing very aggressive physical therapy. Ultimately decided not to do surgery after many conversations with orthopedic physician who has taken care of tons of these (including a huge number of pro athletes) and encouraged against surgery. The first several swims were not awesome to say the least - felt clicking, weak, and genearlly off which was bizarre for me having been a former HS swimmer. Even with all of the strengthening exercises my shoulder was not where I wanted it to be. I continued the PT and was patient with the recovery. 2 years later - IM swim time was faster than pre-injury and shoulder doesn’t bother me in water (even in full wetsuit) or in aero for hours on end. Still do the therapy - both strengthening and flexibility exercises on my own intermittently. Good luck with whatever you decide to do and best wishes for an ongoing recovery.