Do all AC separations require surgery?

No. In fact the vast majority of AC separations do very well with conservative treatment of the symptoms. Most AC injuries are grade I, II, or III and these generally do not require surgery. Usually the joint remains sore for two to six weeks and then full return to activity is the norm. Only unstable grade III injuries and high-energy AC separations, which are often the result of motor vehicle accidents, require surgery for full recovery.

Will the "bump" ever go away?

The clavicle will become stable in its newly elevated position, but without surgery the "bump" will remain. The joint will function normally and will not remain tender to touch or movement. This minor cosmetic deformity will persist but will not interfere with overhead activities or participation in sports.

Are there downsides to a resection of the AC joint?

An AC resection is a procedure in which the end of the clavicle is removed and the acromioclavicular ligament in reattached into the end of the clavicle to replace the ligament torn during injury. Once the initial injury has healed and the clavicle has regained stability from scar tissue there is no functional loss with an AC resection. In the rare instance that the AC joint remains painful after a separation, but does not require stabilization, an AC resection is very effective in relieving pain without sacrificing function. If, however, the clavicle is unstable at the time of resection, a full reconstruction of the coracoclavicular ligaments is necessary to maintain the stability of the upper extremity.

Will I be able to return to athletics if an AC injury is not treated?

Absolutely. Most athletes in contact sports have had a low energy AC separation at some time in their careers. Except for the slight deformity that remains, there is no clinical significance to a healed AC separation. Occasionally high-energy AC separations that have disruption of the AC and CC ligaments will require surgery, but these injuries are usually apparent early on with a correct X-ray evaluation. Grade I, II, and most grade III AC separations will heal without treatment and a full return to sports can be expected.

References