PHYSICAL THERAPY PROTOCOL

AC Joint Reconstruction
Physical Therapy Protocol

Rehabilitation following acromioclavicular (AC) joint reconstruction focuses on protecting the ligament reconstruction while progressively restoring shoulder motion, strength, scapular mechanics, and function. Early rehabilitation should prioritize biologic healing of the reconstruction.

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0–6 Weeks

Protect Reconstruction

6–12 Weeks

Restore Motion

12–20 Weeks

Strengthening

Goal

Stable AC Joint

Important Note

This protocol serves as a general guideline. Revision surgery, chronic AC joint instability, graft augmentation, associated rotator cuff repair, or other concomitant procedures may require modification. The surgeon's postoperative instructions always take precedence.

Rehabilitation Philosophy

The reconstructed coracoclavicular ligaments require time to heal and incorporate. Early rehabilitation should protect the reconstruction while minimizing stiffness. Strengthening is delayed until adequate biologic healing has occurred.

Phase I: Protection Phase

Timeframe: 0–6 Weeks

Goals

Protect the ligament reconstruction
Control pain and swelling
Maintain elbow, wrist, and hand motion
Prevent excessive shoulder stiffness
Protect reduction of the AC joint

Sling

Sling full time except hygiene and therapy
Sleep in sling
No lifting
No supporting body weight through the arm
No shoulder shrugging against resistance

Exercises

Pendulum exercises
Passive forward elevation within comfort
Protected passive external rotation
Elbow, wrist, and hand range of motion
Grip strengthening
Gentle scapular setting exercises

Avoid

Cross-body adduction
Heavy lifting
Pushing or pulling
Supporting body weight through the arm
Forceful stretching

Phase II: Motion Phase

Timeframe: 6–12 Weeks

Goals

Restore shoulder motion
Normalize scapular mechanics
Gradually discontinue sling
Restore functional arm use

Exercises

Cane-assisted exercises
Table slides
Wall walks
Pulleys
Scapular stabilization
Gentle stretching

Phase III: Strengthening

Timeframe: 12–20 Weeks

Goals

Restore rotator cuff strength
Improve scapular stability
Improve endurance
Restore normal shoulder mechanics

Exercises

Theraband strengthening
Rotator cuff strengthening
Scapular strengthening
Progressive dumbbell strengthening
Closed-chain stabilization
Functional strengthening

Phase IV: Return To Activity

Timeframe: 20–24+ Weeks

Strength

Restore normal shoulder strength and endurance.

Function

Progress work-specific and recreational activities.

Sports

Return after restoration of motion, strength, and AC joint stability.

Return To Activity Guidelines

Desk Work

Usually within 1–2 weeks.

Driving

After sling discontinuation and when safe vehicle control has returned.

Daily Activities

Gradually increase after the first 6 weeks while avoiding heavy lifting.

Weight Training

Typically resumes around 4–5 months with gradual progression.

Golf

Usually resumes around 4 months depending on comfort and strength.

Contact Sports

Usually 6 months after surgery once strength and stability have returned.

Therapist Notes

Protect the coracoclavicular ligament reconstruction during the first 6 weeks.
Avoid cross-body adduction early in rehabilitation.
Emphasize restoration of scapular mechanics.
Delay strengthening until biologic healing has occurred.
Progress according to function rather than discomfort alone.
Contact the office if there is concern for recurrent deformity, increasing pain, or loss of reduction.

Red Flags

Contact The Office For

Increasing deformity of the AC joint
Increasing pain after initial improvement
Drainage or redness
Loss of shoulder function
Persistent swelling

Seek Urgent Care For

Chest pain
Shortness of breath
Calf pain or swelling
Severe uncontrolled pain

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