Interest of arthroscopic distal clavicular resection in shoulder pain after rotator cuff repair and healing

Abstract

To evaluate outcomes of secondary distal clavicle resection (DCR) in patients that had failed conservative treatment of symptomatic ACJ arthropathy following isolated rotator cuff repair (RCR) with complete tendon healing. Between 2008 and 2018, the senior surgeon performed isolated RCR in 1935 patients, of which 23 (1.2%) presented with ACJ pain and discomfort at ≥ 6 m following index RCR, despite complete healing of repaired tendons. Those 23 patients underwent secondary DCR as ACJ arthropathy was confirmed clinically and radiographically. Clinical assessment before DCR included subjective shoulder value (SSV) and pain at rest. Clinical assessment at > 12 months after DCR included SSV, pain at rest, Constant-Murley score and range of motion. Study design: case series, level III. Of the initial cohort of 23 patients, 5 were lost to follow-up, leaving 18 patients aged 53.3 ± 7.6 years (range, 39–68) for outcome assessment. None of the patients had complications or ACJ instability following DCR. At a mean follow-up of 7.0 ± 3.1 years after DCR, the SSV improved to 76.1 ± 20.2, the pain at rest decreased to 2.8 ± 1.9. At final follow-up, the Constant-Murley score was 64.7 ± 20.5. Secondary DCR for symptomatic ACJ arthropathy following isolated RCR reduced pain in only 67% of patients, though 94% were satisfied and would undergo secondary DCR again. It is worth noting that residual pain is common following RCR, which does not always restore normal shoulder function.