肩锁关节稳定术
Patients › Rehabilitation
Rehabilitation after AC joint stabilisation or reconstruction, with the protective phase and staged return to sport.
本方案涵盖基兰·希尔帕拉（Kieran Hirpara）医生在罗克汉普顿 Mater 私人医院进行的肩锁（AC）关节稳定术后的康复训练，旨在通过悬吊装置（有时辅以肌腱移植）矫正锁骨与肩胛骨之间关节因脱位导致的对位不良。请在首次物理治疗就诊时携带此页面或其 PDF 版本，以确保康复计划的协调一致。您的物理治疗师将根据您肩部的恢复情况，按以下阶段个体化推进您的康复进程。
如果您在术后对伤口有任何疑虑，请联系诊所。拍摄伤口照片并通过电子邮件发送以供审查通常很有帮助。
预期情况
肩锁关节（AC joint）稳定术与大多数关节镜肩关节手术不同：此处存在需要保护以促进愈合的修复，而对其施加负荷最大的是手臂自身的重量。重力持续将手臂（连同肩胛骨）向下拉，使其远离锁骨，而这正是稳定结构必须抵抗的方向。因此，早期康复刻意采取保护性措施：吊带承担手臂重量，活动保持在安全范围内，强化训练则需待修复组织成熟后进行。
吊带起保护作用。佩戴吊带 6 周，在前 3 周 睡眠时也需佩戴，因为即使平躺，手臂的重量也会牵拉修复处。三周后可在卧床时取下。在洗澡或进行锻炼期间若取下吊带，需支撑手臂：将前臂置于枕头或桌面上，而非让手臂下垂或提举任何物品。夜间，大多数人仰卧或健侧卧位最为舒适；若仰卧，可在肘部和前臂下垫一个小枕头，以防止肩部向后塌陷。修复愈合期间，避免患侧肩部着床。
佩戴吊带期间严禁驾驶。 对于此类手术，通常意味着约六周内不得驾驶。
您的锻炼计划包含三种类型的活动，您的医疗团队将标明适用于您的类型：
- 主动活动范围（Active range of motion）： 无需辅助或帮助即可进行的活动。
- 主动辅助活动范围（Active-assisted range of motion）： 使用健侧手臂或物体辅助移动患肢。
- 被动活动范围（Passive range of motion）： 完全放松，由健侧手臂或外力完成 100% 的活动。
简要康复进程：
- 第一阶段：保护修复， 第 0–6 周
- 第二阶段：恢复活动度， 第 6–12 周
- 第三阶段：强化训练， 第 12–18 周
- 第四阶段：重返运动和重体力劳动， 第 18 周起
周数范围仅为典型参考，并非固定不变；此类手术的公开方案各不相同，您的物理治疗师将根据修复情况和活动度进展来推进康复，而非依据日历。大多数人约在三个月时可使用手臂进行日常活动。重返对抗性和碰撞性运动通常需要四到六个月，而对于某些运动和职业，恢复过程可能更长。
第一阶段——保护修复（第0–6周）
前六周的重点是让修复处愈合，同时保持手臂其余部分的活动。只要您起身活动，就应使用吊带托住手臂的重量。从第一天起，您的手、手腕和肘部应保持活动：在手臂佩戴吊带期间，可用手进行写字和进食等轻度活动。肩关节本身从轻柔的钟摆练习开始，并在严格限制范围内进行辅助活动：活动范围不得高于肩高，禁止向身体对侧伸手，禁止向后背伸手。冰敷和规律服用止痛药可使练习变得可耐受。请在进行练习和物理治疗前服用止痛药。在伤口护理建议允许的情况下，您可以淋浴；清洗手术侧手臂下方时，请弯腰，让手臂自然轻柔地远离身体，这与钟摆练习的姿势相同。
在此阶段，手术侧手臂不要提起超过约0.5公斤的物品，不要在该侧提包，不要倚靠手臂，不要使用该手臂从床或椅子上支撑身体起身，也不要让手臂无支撑地悬垂：上述每种情况都会使肩胛骨向下远离锁骨，从而对修复处产生负荷。
致您的物理治疗师：
目标
- 保护手术稳定性并允许软组织愈合
- 控制疼痛和肿胀；保护伤口愈合
- 在受保护的活动范围内预防肩关节僵硬
- 维持手、腕、肘和颈部的活动范围
管理
- 起身活动时佩戴吊带6周；摘下吊带时手臂需得到支撑
- 每日多次进行钟摆练习
- 在肩胛骨平面内进行被动和主动辅助上举，限制在90度
- 根据舒适度进行被动和主动辅助外旋（初始约为30度）
- 手、腕、肘和前臂的主动活动范围练习；握球挤压
- 肩胛骨定位（后缩和下压）及姿势矫正
- 在可耐受范围内进行次极量、无痛的等长内旋和外旋（中立位）
- 根据需要软组织及肩胸关节松动术；伤口愈合后进行疤痕按摩
- 冰敷15–20分钟，每日多次，按需进行；练习和疗程前服用止痛药
注意事项
- 不要让手臂的重量牵拉固定物：禁止手臂悬垂、禁止提物、禁止向下牵引
- 任何平面内上举不得超过90度
- 禁止进行处方辅助计划之外的主动肩关节活动
- 禁止交叉身体（水平）内收及背后内旋
- 禁止提起超过约0.5公斤的物品；禁止通过手臂支撑体重
- 佩戴吊带期间禁止驾驶
进展标准
- 肩胛骨平面内被动屈曲达到约90度
- 肩胛骨平面内被动外旋达到约30度
- 耐受活动范围和等长练习计划，且疼痛和肿胀逐渐消退
第二阶段 — 恢复活动度（第6–12周）
大约从第6周开始，您逐渐脱离吊带，活动限制逐步解除。辅助运动转变为主动运动，活动范围稳步增加；作为参考，已发表的方案每周大约以15度的幅度增加活动范围，目标是在大约第12周时实现完全活动。本阶段开始进行针对肩袖和肩胛骨肌肉的轻阻力弹力带练习。修复部位仍需谨慎对待：负重限制在约1公斤，避免用力推、拉、俯卧撑，以及过体前或过头顶的提举动作。手伸向背后的动作通常是最后被解除限制的活动。
致您的物理治疗师：
目标
- 逐渐脱离吊带
- 逐步恢复所有平面的主动活动范围（大约在第12周时达到完全或接近完全）
- 开始轻柔的力量训练；最小化肌肉萎缩
- 重建肩肱节律和神经肌肉控制
管理措施
- 从主动辅助运动进展至主动上举运动；进行墙壁滑动和台面滑动以进行屈曲练习
- 在肩胛平面进行上举运动，注意肩胛骨力学：避免出现耸肩代偿
- 逐步引入背后内旋运动（最初仅至腰带水平）
- 水平内收仅作为主动伸展：暂不进行被动拉伸
- 弹力带内旋和外旋、二头肌弯举、划船和 serratus punch（前锯肌冲拳）
- 动态肩胛骨和肩袖训练：侧卧外旋、俯卧划船、俯卧伸展、俯卧“T”字和“Y”字动作、站立侧平举
- 本体感觉和节律性稳定训练
- 根据需要实施手法治疗和关节松动术
注意事项
- 患臂负重不超过约1公斤
- 避免用力推或拉；禁止俯卧撑
- 避免过头顶或过体前举起重物
- 避免向交叉内收的终末端进行拉伸；背后运动需逐步进展
进展标准
- 被动屈曲至少达到约140度，肩胛平面被动外旋至少达到60度
- 抗重力主动屈曲至少达到约100度，且力学动作良好
- 耐受主动活动范围和早期力量训练方案
第三阶段——强化训练（第12–18周）
随着修复组织成熟且活动度基本恢复，重点转向重建力量。此前受限的拉伸动作（如过体前拉伸和背后内旋）现在用于争取最后几度的活动范围。抗阻训练从弹力带逐步过渡到轻重量，俯卧撑从靠墙开始，随后逐步进阶。通常在约第16周重新引入健身房器械力量训练，初期采用有限活动范围和轻负荷。本阶段仍避免重负荷过头举以及强力推、拉动作。
致物理治疗师：
目标
- 所有平面的主动和被动活动度完全恢复
- 肩袖和肩胛稳定肌群的力量、耐力和神经肌肉控制逐步增强
- 为逐步恢复专项运动负荷做好准备
管理措施
- 多方向终末端拉伸：过体前拉伸、背后内旋、双手抱头、睡眠者拉伸、外展90度位外旋
- 在动态训练程序中逐步增加抗阻（约0.5–2.5 kg）：侧卧外旋、俯卧划船、俯卧伸展、俯卧“T”和“Y”字动作、站立侧平举
- 弹力带进阶训练：“T”字、“W”字、对角线动作、外展90度位内旋和外旋
- 闭链训练：约第12周开始靠墙俯卧撑，根据耐受度逐步进阶
- 约第16周开始器械力量训练：有限活动范围、轻负荷（划船、高位下拉、二头肌和三头肌训练；推类动作谨慎重新引入）
- 节律性稳定训练、本体感觉训练及肩肱节律训练
注意事项
- 避免重负荷举重，尤其是过头动作，以及强力推、拉
- 强化训练应在无痛范围内进行，避免达到诱发疼痛的终末端负荷
- 全程保持肩胛骨控制：若出现耸肩或代偿动作，应降低负荷
进阶标准
- 所有方向的主动和被动肩关节活动度达到功能范围内
- 耐受渐进式强化训练，无症状加重
第四阶段 — 重返运动与重体力劳动（第18周起）
最终阶段是逐步恢复高强度工作、过头负荷及体育运动。增强训练计划中叠加了增强式训练和专项运动训练，间歇性训练计划指导患者重返投掷、游泳、高尔夫及隔网对抗类运动。重返接触性和冲撞性运动通常需要术后四至六个月，具体取决于关节活动度、力量及上肢信心的完全恢复；针对冲撞性运动运动员的已发表康复方案有时会更长，可达约九个月。力量型运动员通常也在相似的时间框架内逐步恢复至其常规训练水平。您的物理治疗师和主刀医生将指导最终的康复许可，部分冲撞性运动运动员在回归赛季的第一年选择佩戴肩部护具。
致您的物理治疗师：
目标
- 维持全范围关节活动度
- 提升力量、爆发力及耐力，以满足患者工作和运动的需求
- 基于标准，逐步重返接触性及过头运动
管理
- 继续并推进第三阶段的强化训练计划
- 闭链运动进阶：在不稳定表面上的俯卧撑进阶，靠墙弹力球训练
- 投掷及过头运动运动员的增强式训练：反弹器投掷、负重球训练、靠墙运球、减速训练
- 投掷、高尔夫、网球及游泳的间歇性运动训练计划
- 针对功能及职业特定的动力链力量与耐力训练
注意事项
- 仅在关节活动度完全恢复、力量重建完成并获得手术许可后，方可重返接触性及冲撞性运动
- 进阶过程以症状为导向：若出现疼痛或不稳感，应退回至上一阶段
术后康复方案
上述阶段源自已发表的肩锁关节（AC joint）稳定与重建康复方案：包括马萨诸塞州总医院布里格姆医疗中心（Massachusetts General Brigham）运动医学科、马萨诸塞州总医院运动医学科肩锁关节重建项目、英国肩部专科单位的肩锁关节（ACJ）稳定指南，以及针对公开可用的肩锁关节重建方案的系统综述。周数范围为典型区间而非固定值，且已发表方案存在差异；您的持续康复由您的物理治疗师与本院合作，根据您修复部位及功能恢复情况个体化指导。本页面内容应与本院的一般术后恢复建议配合使用；详见术后疼痛管理和伤口护理。关于手术本身及其所治疗的损伤，请参阅肩锁关节稳定术。本方案背后的证据（包括重建技术、复位丢失相关文献及康复研究）已汇总于“证据”部分，可从本页面顶部下载PDF版本。
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
- 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.
- 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.
- 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.
- 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
