I figured I would provide an update for anyone else, who like me is following recovery stories and trying to decide between surgical and non-surgical routes for a Level 3 separation. I was scheduled for surgery for August 13th, which was ~9 weeks post crash. After consulting with with another orthopedic friend of mine, and my bike mechanic, I came away with the feeling that I will be completely fine and perhaps better off going the non-surgical route. My decision to "indefinitely post-pone" surgery was based on the following:
- My orthpedic (hip specialty) friend informed me that surgery comes with risks (i.e. nerve damage, infection, allograft rejection, etc), albeit small
- Full recovery would take 4 to 6 months with significant physical limitations for 8 weeks
- Orthopedic friend's brother-in-law suffered a level 3 playing hockey 6 months ahead of me and recovered 100%
- Risk of re-injury is relatively high, given my active lifestyle. Re-injury could be problematic because the clavicle bone is weakened by the holes drilled in it.
- My bike mechanic had the same injury about 10 years ago and is totally fine, except for the cosmetic lump
- The bike mechanic has gone back down on the same shoulder without sustaining major re-injury--the tears were slightly worse as a result, recovery was quick, functionality is full
- While I can't confirm the statistic, I heard that ~70% of NHL players have had an AC separation and ~0% have had surgery to repair it
- Studies suggest that surgical and non-surgical cases experience the same rebound in functionality and outcome (although I personally believe this may be misleading because it doesn't control for "all" activities. i.e. I would want to see a study comparing groups rock climbers, tennis players, athletes in general at their respective sports)
- My functionality continues to improve, any pain is very manageable, and I can do virtually anything I want to do. Throwing a ball (ie. baseball, softball, football) are all possible, but probably only back to ~65% of what I was able to do before)
There is a significant part of me that wishes I had forced the surgical route immediately, so as to avoid the "double" recovery periods. However, I would still be very concerned about the risks of re-injury, especially given the clavicle would be compromised. Changing out the lump for a scar [immediately] after the injury and likely having functionality that would be at least as good, if not better, than the non-surgical route may have been a preferable path.
If you're new to the level 3 injury and in the very early days post injury, I suggest researching the potential complications of re-injury post surgical route. If you can get comfortable with those risks, the surgical route may leave you with less 2nd guessing. At this point, I can attest that I probably don't "need" the surgery, and if I knew at the time of the injury what I know now, I would focus on the re-injury risk. If I were able to get comfortable with that, I would most likely have the surgery.