Author's Reply

Abstract

We do appreciate Dr. Wiwanitkit's comments about our recently published article on the outcome of open versus arthroscopic acromioclavicular joint (ACJ) resection, and we would like to address all the points that Dr. Wiwanitkit has made. Dr. Wiwanitkit's first comment was about a recent article that showed the superiority of the arthroscopic versus other alternatives including the mini-open rotator cuff repair. We do not believe that the conclusion in this article could be projected to ACJ resection. The ACJ is a superficial joint that could be approached through a very small incision, and surgery could be accomplished easily by resecting an adequate piece of the distal clavicle. The location, approach, and type of procedure are completely different than those in the case of shoulder rotator cuff repair. Thus the conclusion of the article mentioned should be applied only for rotator cuff repair and not for ACJ resection. Dr. Wiwanitkit's second comment about the retrospective nature of the study is completely valid. However, this does not mean that our data were not complete. We had a large number of patients, and we compared all comers, based on a certain set of inclusion criteria, who had either procedure done and we could not find a difference in the outcome between the 2 groups. Dr. Wiwanitkit's third comment that “there is no comparison of the intraoperative attempt” is not very clear. What is meant by intraoperative attempt? Regarding Dr. Wiwanitkit's comment about reporting the complications in each group, we did report the complications in both groups of patients including the most common complications in each group, and we also reported new findings of bony overgrowth in a few patients after arthroscopic ACJ resection, which we did not observe with the open technique. Another comment was about the comparison of cost-effectiveness of the 2 methods, which we did not do because it was not one of the purposes of the study. Logically, in cases with isolated ACJ resection, the open technique should be cheaper because arthroscopic instruments are not used. Dr. Wiwanitkit's last comment was again about the retrospective nature, which might have led to different outcomes. Again, we say that although a prospective randomized study would be more ideal, in this study we compared 2 groups based on certain inclusion criteria including (1) localized pain and tenderness at the ACJ refractory to conservative management, (2) complete though temporary relief of pain with an injection of local anesthetic into the ACJ, (3) resection of the ACJ with an open or arthroscopic technique, (4) no previous major tendon transfer surgery or surgery to the ACJ, (5) surgery performed by the senior surgeon, and (6) at least 1 year of follow up after surgery with appropriate radiographs. This better validates the groups selected and compares specifically the relief of symptoms originating from the ACJ after either procedure. In conclusion, we were interested to know the difference in outcome between these 2 surgical techniques, and this was the main reason that we conducted the study. We believe that the way we performed the study, the inclusion criteria, the adequate time of follow up, and the appropriate outcome measures were all valid and did give us the answer to our question. Open Versus Arthroscopic Acromioclavicular Joint ResectionArthroscopyVol. 26Issue 6PreviewI read the recent article by Elhassan et al.1 in the November 2009 issue with great interest. The authors reached the following conclusion: “This study did not show a significant difference in the outcome between arthroscopic and open ACJ [acromioclavicular joint] resection.” The usefulness of arthroscopic surgery for the acromioclavicular joint is still a controversial issue. Recently, the arthroscopic approach was mentioned for its superiority to other alternatives including the mini-open approach. Full-Text PDF