Coracoclavicular Ligament Reconstruction

The Goal

Dr. Kevin Wall provides specialized, fellowship-trained surgical treatment for CC Ligament Reconstruction to restore function and relieve pain for patients in Richmond, VA, and the surrounding Central Virginia communities. The goal of this procedure is to stabilize a high-grade AC joint separation by reconstructing the coracoclavicular (CC) ligaments. These ligaments are the primary vertical stabilizers of the shoulder; when they are torn, the collarbone "pops up," causing pain, weakness, and a visible deformity. For active patients and athletes, the goal of reconstruction is to recreate the natural tether between the clavicle and the coracoid process, restoring the strength of the shoulder girdle and allowing for a return to heavy lifting and overhead sports.

This page is designed to educate you specifically about this procedure. Additional information that generally applies to most of Dr. Wall’s surgeries can be found on these pages:

The Procedure

  • The Approach: Performed using a combination of arthroscopic assistance and a small incision over the top of the shoulder.

  • Debridement: Dr. Wall removes any scarred tissue or debris from the AC joint to allow the collarbone to sit back in its anatomical position.

  • Reconstruction: Because the native ligaments cannot be simply "stitched" back together, we use a high-strength graft (often an allograft or a synthetic "Internal Brace") to recreate the CC ligaments.

  • Fixation: The graft is passed through small, precise tunnels in the clavicle and secured around or through the coracoid process using specialized buttons or screws. This creates a robust, permanent link that mimics the original anatomy.

Post-Op Protocol

Your PT protocol may be different than below depending on the age of your injury and the exact type of surgery you underwent.

  • Phase 1 (0–4 weeks): A sling is required at all times, including during sleep, to protect the new reconstruction. You may remove the sling only for hygiene and to perform gentle elbow, wrist, and hand range of motion. No lifting, pushing, or pulling is allowed.

  • Phase 2 (4–8 weeks): You will begin weaning from the sling during the day but continue wearing it in public and at night. Formal physical therapy begins with passive and active-assisted range of motion (PROM/AAROM). Elevation is typically limited to 90° during this phase to prevent excessive tension on the graft.

  • Phase 3 (8–12 weeks): The sling is discontinued. You will progress to full active range of motion (AROM). Gentle strengthening of the rotator cuff and scapular stabilizers begins, but heavy lifting remains restricted.

  • Phase 4 (12–20+ weeks): Progressive strengthening continues. Most patients can return to non-contact sports at 4 months. A full return to collision sports or heavy manual labor typically occurs after 6 months, once full strength and stability are confirmed.

When to Seek Care

You should schedule a consultation if:

  • You have a prominent, painful "bump" on the top of your shoulder following a fall or sports injury.

  • You feel your shoulder "sagging" or experience significant fatigue when carrying heavy bags.

  • Conservative treatment (rest and a sling) has failed to resolve your pain or restore your ability to lift your arm overhead