For those who are unsure about undergoing surgery for an acromioclavicular joint dislocation.

 
When diagnosed with an acromioclavicular (AC) joint dislocation, determining the best treatment for optimal functional recovery can be a very challenging issue. If the diagnosis is made by a physician who is not a shoulder specialist, it's common to be told that non-surgical (conservative) treatment is sufficient—even if the joint is dislocated—because the shoulder often improves without surgery.
 
We performed coracoclavicular ligament reconstruction for acute acromioclavicular joint dislocation and reported long-term outcomes over a period of more than ten years. This work was presented at a symposium during the 95th Annual Meeting of the Japanese Orthopaedic Association.
 
The paper ( ronbun.pdf ) and presentation ( koen.pdf ) we reported have been made available for download and viewing. Please feel free to take a look if you're interested.
 
Our paper can be accessed at the following website.
https://pubmed.ncbi.nlm.nih.gov/30229219/
 
Based on the results, I would like to share the following points:

1. If you are seeking a full recovery, surgery is recommended.
2. The downside is that it takes time to achieve full recovery, and a certain period of physical therapy is necessary.
3. Even after surgery, mild subluxation of the acromioclavicular joint may still be observed occasionally.
4. If you choose conservative treatment and time passes without surgery, pain—including night pain—may persist.

 
These points may naturally be of great concern. It's understandable to feel uncertain about what to expect in cases like 3 and 4. Therefore, I would like to share the experiences of individuals who have gone through such situations.
 
This patient underwent coracoclavicular ligament reconstruction and has been followed for 10 years. Postoperatively, displacement of the right acromioclavicular joint has been observed; however, the degree of displacement is less than it was before surgery.
 

 
This patient has diligently followed a rehabilitation program and reports no difficulties in daily life. Below is a scene from a consultation with this patient.
 

 
This patient was diagnosed with an acromioclavicular joint dislocation at another hospital but continued to experience shoulder pain for over a month. More than three months after the injury, the patient visited our clinic. Below is an account from the consultation with this patient.
 

 
In cases of acromioclavicular joint dislocation, range of motion often recovers relatively well even without surgery. Some individuals with strong musculature may report little pain. Because of patients like these, there are doctors who say that surgery is not necessary.
 
Therefore, as a summary, I would like to share the following points.
 
1.For acromioclavicular joint dislocation, if you are willing to invest the necessary time and effort and wish for complete recovery without functional impairment in the future, surgery is recommended—especially for those with severe displacement of the joint. By "severe," please understand it as a degree where the dislocated joint is clearly protruding when viewed in a mirror.
 
2.However, if surgery is not initially chosen and symptoms persist, it is still possible to achieve functional recovery through surgery even after a significant amount of time has passed. Such surgery requires reconstruction using autologous tendon grafts (http://www.shoulder-doctor.net/sick/sick_10.html).