Arthroscopic resection of the acromioclavicular joint (ARAC)

Abstract

In 65 patients an arthoscopic resection of the AC-joint (ARAC) was performed. The data of 27 male and 24 female patients with a minimum follow-up of 6 months were available for analysis. 2 patients had bilateral procedures. Patients with rotator cuff tears were excluded from this series. The patients were aged between 22 and 69 years (average 48.4 years). The mean interval from the onset of pain to conservative treatment was 4.6 months and the average period of conservative management prior to surgery was 9.8 months. The indication for ARAC was pain which interfered with the patients' activities of daily living, work, or athletic activities and had not responded to conservative therapy for at least 6 months. Patients' data were recorded before and after surgery according to a 100-point score as well as with a visual analogue scale. The patients' mean preoperative score was 67.8(±14.6). After surgery, a significant improvement to 93.3(±12.3) was achieved. Comparing the different parameters we found significant differences in pain during shoulder movement, function, and active range of motion. Prior to surgery the other parameters already scored well, so they did not serve as good discriminators for these patients. The mean resection length of the lateral clavicle was 23.2 mm inferiorly, 15.9 mm in the middle third, and 13.1 mm superiorly. No ectopic bone formation or postoperative spurs were identified in this series. We could not demonstrate regeneration of the resected parts of the lateral clavicle. No major complication was noted. Our preliminary results did not indicate less successful results than obtained by the conventional open Mumford operation. The radiologic analysis revealed no superior migration of the lateral clavicle. To what extent the preserved stabilising structures of the AC-joint will offer further advantages can not be estimated at this time. Long-term follow-up studies have to prove whether or not the arthroscopic procedure will be able to replace the conventional surgical treatment and to what extent the preservation of the stabilising structures will improve the results.