Acromio-Clavicular Joint (ACJ) Stabilisation Rehabilitation Protocol.
(Weaver Dunn, Tight Rope, Surgilig)
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This surgery is undertaken to stabilise an unstable and symptomatic ACJ (Acromio-Clavicular Joint). The procedure can be undertaken arthroscopically or open. The procedure can be an acute procedure to reduce and stabilise a damaged joint and allow healing of the ligaments or a late reconstruction where the function of the damaged ligaments is augmented, typically with a ligament transfer or tendon graft.

Aims:
The aims of rehabilitation are to protect the reconstruction or stabilisation in the early stages and to optimise function in the long-term.

General Points:
• Do not push through pain.
• Do not sacrifice quality of movement for range of movement.

No Horizontal flexion/cross body adduction or elevation/abduction above 90 degrees elevation until 8 weeks post surgery.

Immobilisation:
The patient is to wear a sling for 3 weeks, 24 hours a day, only removing it for physiotherapy and exercises.

At 3 weeks, the patient can be weaned out of the sling during the day. The patient should continue to wear the sling at night for a further 3 weeks. The total period of sling use is 6 weeks.

Post Operative instructions:

0-6 weeks:
Hand wrist elbow exercises.
Pendular exercises
Active assisted ER
Active assisted elevation to shoulder height only.
Encourage optimal Scapulo-Thoracic position.

From 3 weeks:
Gradually wean out of sling
Light activities only within field of vision

From 6 weeks:
Progress active assisted to active ROM – do not push for overhead activities
Sub maximal isometrics rotator cuff in neutral.

From 8 Weeks:
Gradually increase ROM into elevation and initiate cross body adduction
Isometrics in variable starting positions.

12 weeks +
Progress to resisted through range strengthening.

Activity Time Scales:
Driving (See general principles of rehabilitation)
Cycling (non-competitive road) - 8-12 weeks
Swimming - 12 weeks +
Racquet Sports/ Golf – 16 weeks+
Contact Sport e.g. rugby, football, mountain biking, hockey, climbing - 6 months+