[stackie]

I had an AC separation in my last year of anesthesia residency. Saw an orthopedic surgeon who said was grade 3 and could go either way. Got second opinion who said was grade 4 and given my young age and athletic profile as a cyclist opined that I would be good candidate for repair. I wound up have the first surgeon repair as he was a more sports oriented ortho. He fixated the clavicle with a screw. At the time of surgery, he found clavicle was beginning to disrupt the deltoid muscle so met criteria for grade 5. I had problems with screw loosening and had to have tightened and eventually removed. I am at grade 2 separation now.

I don’t have any limitations or arthritis... yet. I expect at some point I will need a distal clavicle excision. But so far so good.
I can do over the shoulder work and ride without any shoulder issues. So I am happy for that. Would I have been ok without repair? Probably not. But who knows.

You said you are older (50 years) and have a desk job so it sounds like you might do well with conservative treatment.

Knowing what I know now after 20 years of anesthesia and seeing a lot of ortho pods, two opinions is not enough. I would dig around seriously and find out someone with inside intelligence on the local orthopods. Like an anesthesiologist or maybe surgical technologist. Even an orthopedic sales rep and ask them who they would go to for the particular injury.

Modern approach would be a arthroscopic coraco clavicular repair with a cadaver allograft. In my neck of the woods I’d only have 1 out of maybe 12 orthopedic surgeons do it. There are some who would refer me to the correct person. But there are some who would try to do an outdated repair because that’s what they know. Sad to say.