York, ME (207) 363 3490 | Portsmouth, NH (603) 431 1121

20Hip Care
10Hip-Conditions and Injuries
Cartilage Injury
Femoroacetabular Impingement (FAI)
Gluteal Tears
Hamstring Tears
Hip Instability
Deep Gluteal Space Syndrome
Labral Tears
Psoas Impingement (Internal Snapping Hip)
Trochanteric Bursitis
10Hip-Treatment and Surgeries
Gluteal Repair
Labral Debridement
Labral Reconstruction
Labral Repair
Psoas Release
Trochanteric Bursa Debridement
33Knee Care
13Knee Conditions and Injuries
ACL Tear
Cartilage Injury
Discoid Meniscus
Lateral Meniscus Tear
LCL Injury
MCL Injury
Medial Meniscus Tear
Osteochondritis Dessicans
Patellar Instability
Patellofemoral Chondromalacia
Posterolateral Corner Injury
Trochlear Dysplasia
20Knee Treatment and Surgeries
Anterior Cruciate Ligament (ACL) Reconstruction
Cartilage Restoration Surgery – Autologous Chondrocyte Implantation (ACI-Carticel)
Cartilage Restoration Surgery – Donor Graft
Collagen Meniscal Implant (CMI)
Lateral Collateral Ligament (LCL) Reconstruction
Medial Collateral Ligament (MCL) Reconstruction
Meniscus Repair
Meniscus Root Repair
Meniscal Transplant
Medial Patellofemoral Ligament (MPFL) Reconstruction
Osteochondral Allograft Transfer
Osteochondral Autograft Transfer (OATS)
Partial Knee Replacement (MAKO)
Partial Meniscectomy
Posterior Cruciate Ligament (PCL) Reconstruction
Posterolateral Corner (PLC) Surgery
Tibial Tubercle Osteotomy
Total Knee Replacement (MAKO)
20Shoulder Care
10Shoulder-Conditions and Injuries
AC Joint Injuries
Biceps Tendon Injuries
Calcific Tendinitis
Clavicle Fractures
Frozen Shoulder
Labral and SLAP Tears
Rotator Cuff Injuries
Shoulder Dislocation/Instability
Subacromial Impingement/Busitis
10Shoulder-Treatment and Surgeries
A-C Joint Stabilization
Biceps Tenodesis
Clavicle Fracture Fixation
Pectoralis Major Repair
Rotator Cuff Repair
Shoulder Instability Surgery – Bankart Repair
Shoulder Instability Surgery – Latarjet Procedure
Subacromial Decompression and Acromioplasty
Superior Capsular Reconstruction
Total Shoulder Replacement


The clavicle (collarbone) attaches to the shoulder (acromion process) at the acromio-clavicular (A-C) joint. The A-C joint is an important structure as it connects the collarbone strut to the shoulder complex, enabling stable, painless range of motion of the upper limb. The A-C joint is stabilized by multiple ligaments that surround the joint – the joint capsule. In addition, the A-C joint and far end of the collarbone are stabilized by the coraco-clavicular (C-C) ligaments. When one sustains a low-energy injury to the A-C joint, only the A-C ligaments are injured. However, when one sustains a serious injury to the A-C joint, the A-C ligaments (capsule) and C-C ligaments are torn completely. Dr. Welch usually recommends surgery for patients who sustain this type of injury.

The goal of A-C stabilization surgery is to restore the normal position of the clavicle in relation to the acromion process. During surgery, Dr. Welch makes an incision over the far end of the clavicle. After placing the collarbone in the right position, Dr. Welch drills one or two small holes in the collarbone. He places these holes where the intact C-C ligaments attached to the collarbone. Dr. Welch then threads an allograft – donor tendon tissue – or a synthetic graft through the hole(s) in the collarbone and around the coracoid (a bony projection in front of the shoulder). After wrapping the graft around the coracoid, Dr. Welch threads the tissue through the bone tunnels in the collarbone and compresses the tissue to the collarbone with screws (interference screws).

Post-Operative Rehabilitation

Following surgery, patients are given a sling for comfort. Dr. Welch recommends intermittent icing and gentle range of motion following surgery. Dr. Welch also recommends starting physical therapy approximately 2-4 weeks after surgery. Physical therapy focuses on reducing swelling in the shoulder, restoring full range of motion, and maintaining strength in the shoulder. Patients should expect to regain their full range of motion within 8-12 weeks of surgery. It takes approximately 12-16 weeks for the reconstruction to heal, and return to sport usually requires further rehabilitation.