Acromioclavicular Joint Arthritis Research Articles

Iatrogenic Excessive Clavicle Resection as a Complication of Arthroscopic Distal Clavicle Excision.

Arthroscopic distal clavicle excision (DCE) is a reliable procedure to treat acromioclavicular joint arthritis. Typically, only 1 to 2 cm of distal clavicle should be removed. Resection of too much bone can lead to instability of the joint or lack of support to the shoulder. We describe 2 patients who had excessive clavicular bone removed arthroscopically, leading to irreparable clavicular pain and dysfunction. The 2 female patients, ages 56 and 60 years, presented to our clinic with continued pain after DCE. Both had pain intractable with nonoperative treatment and loss of range of motion of the shoulder. Radiographs revealed a distal clavicle defect of 7.5 cm in 1 patient. The second patient had a 2-cm distal clavicular defect with an adjacent 2-cm clavicle bone fragment between the defect and residual clavicle shaft. Both underwent surgery with subtotal claviculectomy for pain control. During surgery, 1 patient had a subclavian vein requiring vascular repair. After 1 year of follow-up, both patients had reduced but residual pain and restricted range of motion. Only 1 patient could rejoin her preinjury occupation. Neither patient could continue with preinjury recreational sports. Excessive removal of the distal clavicle during DCE can result in continued pain and disability of the shoulder. Methods to visualize the anatomy of the distal clavicle and its articulation to the acromion should be considered when performing this operation arthroscopically. Reoperation to remove subtotal clavicle has good clinical outcomes but may lead to serious complications due to the proximity to major neurovascular structures. [Orthopedics. 2024;47(1):e57-e60.].

Hook plate fixation of Neer type II distal clavicle fractures results in satisfactory patient-reported outcomes but complications and revisions are high

BackgroundSurgical treatment of distal clavicle fractures Neer type II is challenging. A gold standard has not yet been established, thus various surgical procedures have been described. The purpose of this study is to report the radiological and clinical outcomes using hook plate fixation in Neer type II distal clavicle fractures.MethodsWe retrospectively reviewed data of 53 patients who underwent hook plate fixation between December 2009 and December 2019 with ≥ 2 years of follow-up. Patients with preexisting pathologies or concomitant injuries of the ipsilateral shoulder were excluded. Pre- and postoperative coracoclavicular distance (CCD), bony union and patient-reported outcomes were collected, including the Constant Score (CS) and Subjective Shoulder Value (SSV). Complications and revisions were recorded.ResultsAt a mean final follow-up of 6.2 years, mean SSV was 91.0% (range, 20–100) and mean CS was 80.9 points (range, 25–99). The mean preoperative CCD was 19.0 mm (range, 5.7–31.8), the mean postoperative CCD was 8.2 mm (range, 4.4–12.2) and the mean CCD following hardware removal was 9.7 mm (range, 4.7–18.8). The loss of reduction following hardware removal was statistically significant (P = 0.007). Eleven (20.8%) patients had complications, with 5 cases of deep or superficial infection (9.4%), four non-unions (7.5%), one periosteosynthetic fracture, one postoperative seroma, one implant failure and one symptomatic acromioclavicular joint arthritis (all 1.9%). A total of 10 patients (18.9%) underwent revision surgery at a mean of 113 (range, 7–631) days.ConclusionMedium-term patient-reported outcomes for hook plate fixation of Neer type II distal clavicle fractures are satisfactory; however, one in five patients suffers a complication with the majority of them requiring revision surgery.

Influence of acromioclavicular joint arthritis on outcomes after reverse total shoulder

Although substantial motion at the acromioclavicular joint (ACJ) occurs during overhead shoulder motion, the influence of ACJ arthritis on postoperative outcomes of patients undergoing reverse total shoulder arthroplasty (rTSA) is unclear. We assessed the influence of ACJ arthritis, defined by degenerative radiographic changes, and its severity on clinical outcomes after primary rTSA. We conducted a retrospective review of a prospectively collected shoulder arthroplasty database of patients that underwent primary rTSA with a minimum 2-year clinical follow-up. Imaging studies of included patients were evaluated to assess ACJ arthritis classified by radiographic degenerative changes of the ACJ; severity was based upon size and location of osteophytes. Both the Petersson classification and the King classification (a modified Petersson classification addressing superior osteophytes and size of the largest osteophyte) were used to evaluate the severity of degenerative ACJ radiographic changes. Severe ACJ arthritis was characterized by large osteophytes (≥2 mm). Active range of motion (ROM) in abduction, forward elevation, and external and internal rotation as well as clinical outcome scores (American Shoulder and Elbow Surgeons Shoulder, Constant, Shoulder Pain and Disability Index, simple shoulder test, University of California, Los Angeles scores) were assessed both preoperatively and at the latest follow-up; outcomes were compared based on severity of ACJ arthritis. Multivariable linear regression models were used to determine whether increasing severity of ACJ arthritis was associated with poorer outcomes. A total of 341 patients were included with a mean age of 71±8 years and 55% were female. The mean follow-up was 5.1±2.4 years. Preoperatively, there were no differences in outcomes based on the severity of ACJ pathology. Postoperatively, there were no differences in outcomes based upon the severity of ACJ arthritis except for greater preoperative to postoperative improvement in active internal rotation in patients with normal or grade 1 ACJ arthritis vs. grade 2 and 3 (3±2 vs. 1±2 and 1±3, P=.029). Patients with ACJ arthritis and osteophytes ≥2 mm had less favorable Shoulder Pain and Disability Index scores, corresponding to greater pain (-49.3±21.5 vs.-41.3±26.8, P=.015). On multivariable linear regression, increased severity of ACJ arthritis was not independently associated with poorer postoperative ROM or outcome scores. Overall, our results demonstrate that greater ACJ arthritis severity score is not associated with poorer outcome scores and has minimal effect on ROM. However, patients with the largest osteophytes (≥2 mm) did have slightly worse pain postoperatively. Radiographic presence of high-stage ACJ arthritis should not alter the decision to undergo rTSA.

Determination of various etiological factors for diagnosis of non traumatic scapulo costal syndrome

Background: Scapulocostal syndrome, also known as "snapping scapula," is an under-recognized problem involving overhead or throwing motion of the upper extremities. It is often described as a snapping or grinding sensation accompanied with pain as the scapula touches the chest wall and an audible or palpable click near the anteromedial scapula. Method: A prospective observational study was performed at one of the biggest tertiary care centres of central India from September 2021 to March 2023. A total of 50 patients were included in this study. Patient were evaluated clinically in OPD for pain in Scapulothoracic region. All the suspected patients underwent various investigations like X-ray, ultrasonography, electromyography, nerve conduction velocity study, magnetic resonance imaging (MRI) depending on the condition to reach a diagnosis. The data was recorded and evaluated. Results: A total of 50 patients were included in the study, 30 were females and 20 males, 50 % of our patients were diagnosed with supraspinatus tendinosis, 8 patients were found to have bicipital tendinitis, 3 patients had acromioclavicular joint arthritis, 2 patients developed pain because of glenohumeral joint arthropathy, subscapularis tendinitis. There were some other conditions as well diagnosed in few patients with the help of various investigations. Conclusions: It was found that there were various reasons for pain in patients diagnosed clinically with scapulocostal syndrome. Dominant hand affection was more common. The clinical investigations play a major role in diagnosing these conditions and planning the treatment.

A ROOT CAUSE ANALYSIS OF DISSATISFACTION IN PATIENTS UNDERGOING SUBACROMIAL DECOMPRESSION SURGERY

Sub-acromial decompression surgery (SAD) has been widely used to treat shoulder impingement. Its validity has been questioned in multi-centric clinical trials and dissatisfaction rates can be high (35%). It is difficult to predict which patients will benefit operatively as research into predictive factors is limited. The study aim was to conduct a root-cause analysis of reasons for dissatisfaction in a cohort of operated patients.All patients with SAD dissatisfaction in the local Upper Limb database between 2015-19 (n=74/296) formed our study cohort. Patients were scored on Oxford shoulder score (OSS), QuickDASH score, EQ-5D-3L (TTO+VAS) at weeks 26 and 52 post-operatively. Patients' clinical history, radiographs, consultation and operative notes were reviewed.28% of patients were dissatisfied with surgery. Mean age =52.3±13.4 years with equal gender distribution. 87% were operated arthroscopically. 67% were in physically demanding occupations. There was a significant increase in OSS and QuickDASH at weeks 26 and 52 post-operatively (p<0.05), similar improvement was not noted in VAS pain score. Pain followed by stiffness were the main contributors of dissatisfaction. Multiple implicating factors were noted, the most common being acromio-clavicular joint arthritis (25.7%), suggesting concomitant pathologies as an additional cause for patient dissatisfaction.This is the first study to evaluate reasons for dissatisfaction following SAD. We noted high rates (28%) of dissatisfaction and a predilection for those involved in physically demanding occupations. We recommend meticulous pre-operative workup to identify co-existing pathologies and appropriate pre-operative counselling to improve outcomes in selected patients needing SAD following failure of conservative management.

Factors impacting time to total shoulder arthroplasty among patients with primary glenohumeral osteoarthritis and rotator cuff arthropathy managed conservatively with corticosteroid injections.

The purpose of this study was to identify predictors of the time from initial presentation to total shoulder arthroplasty (TSA) in patients with primary glenohumeral osteoarthritis (OA) and rotator cuff (RTC) arthropathy who were conservatively managed with corticosteroid injections. We conducted a retrospective cohort study of patients who underwent TSA from 2010 to 2021. Kaplan-Meier survival analysis was used to estimate median time to TSA for primary OA and RTC arthropathy patients. The Cox proportional hazards model was used to identify significant predictors of time to TSA and to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Statistical significance was set at P<0.05. The cohort included 160 patients with primary OA and 92 with RTC arthropathy. In the primary OA group, median time to TSA was 15 months. Significant predictors of shorter time to TSA were older age at presentation (HR, 1.02; 95% CI, 1.00-1.04; P=0.03) and presence of moderate or severe acromioclavicular joint arthritis (HR, 1.45; 95% CI, 1.05-2.01; P=0.03). In the RTC arthropathy group, median time to TSA was 14 months, and increased number of corticosteroid injections was associated with longer time to TSA (HR, 0.87; 95% CI, 0.80-0.95; P=0.003). There are distinct prognostic factors for progression to TSA between primary OA patients and RTC arthropathy patients managed with corticosteroid injections. Multiple corticosteroid injections are associated with delayed time to TSA in RTC arthropathy patients.

Unusual-massive acromioclavicular joint cyst associated with complete reabsorption of the humeral head and outcomes of long-standing surgical stabilization for recurrent dislocations: a case report

Introduction. Acromioclavicular joint cysts (AJC) are rare findings associated with acromioclavicular (AC) joint arthritis or rotator cuff tear arthropathy. AJC type 1 are very rare and caused by an advanced degenerative arthritic process of the AC joint alone, without a rotator cuff tear; AJC Type 2 cysts are associated with a massive rotator cuff tear. Surgical excision represents the treatment of choice, since the aspiration of the cyst and the contextual injection of corticosteroid is burdened by a high rate of recurrence. We report the case of an unusual-massive acromioclavicular joint cyst associated with complete reabsorption of the humeral head and outcomes of long-standing surgical stabilization for recurrent dislocations. Case presentation. An 83-year-old man presented to our outpatient clinic complaining of a large cystic mass over the right shoulder region. Clinical examination revealed a mass over the right AC Joint, tender on palpation with normal overlying skin. Active range of motion (ROM) was limited but did not cause any discomfort to the patient. Imaging revealed complete reabsorption of the humeral head, and advanced shoulder degenerative arthropathy with loosening of the implanted hardware. Magnetic resonance imaging (MRI) revealed a ganglion cyst with the pathognomonic Geyser sign. The patient underwent surgical excision of the mass and an excision of 1 cm of the distal clavicle was performed to reduce the risk of recurrence. After one year of follow-up the patient is asymptomatic with no signs of recurrence. Discussion. Acromion-clavicular joint cysts are a rare consequence of advanced AC joint arthritis or chronic rotator cuff tear. The case presented is particularly interesting since it describes an AJC associated with an end stage shoulder arthropathy as a result of a surgical treatment for shoulder instability of only historical interest and certainly very rare to encounter in current clinical practice. Complete reabsorption of the humeral head associated with the mobilization of the implanted pins resulted in the formation of a fibrous cystic mass that replaced the head of the humerus; a complete cuff tear and a defect in the inferior capsule of the AC joint led to leakage of the synovial fluid through the AC joint which formed a cyst that appeared to be communicating through an isthmus with the previous described subacromion cyst. For the aforementioned reasoning, we believe that the formation of the acromioclavicular cyst is strictly related to the outcome of the previous surgery and represents the novelty of the case presented. Because of age, low demands and few symptoms lamented by the patient, we considered to perform only excision of the mass and resection of distal clavicle; patient satisfaction and no recurrence of the cyst after one year of follow-up rendered the therapeutic choice satisfying. Clinical presentation, instrumental diagnosis, and therapeutic possibilities on AJC are not discussed in detail as they do not represent the specific interest of the case and are debated in several other case reports. Conclusions. Although rare findings, AJC can be encountered in clinical practice in patients affected by degenerative shoulder arthropaties. Surgical excision associated with lateral end clavicle resection is a viable therapeutic option to treat an AJC in the elderly, which resulted in an appropriate treatment of the mass with no sign of recurrence after one year of follow up in the case presented.

Effectiveness of arthroscopic distal clavicle resection for symptomatic acromioclavicular joint arthritis

To investigate the effectiveness of arthroscopic distal clavicle resection for the symptomatic acromioclavicular joint arthritis. The clinical data of 14 patients with symptomatic acromioclavicular joint arthritis treated by arthroscopic indirect distal clavicle resection between January 2020 and March 2021 were retrospectively analyzed. There were 5 males and 9 females with an average age of 46.3 years (range, 18-57 years). The 4 cases of left shoulder and 10 cases of right shoulder were accompanied with acromial impingement, without the history of shoulder trauma. The average disease duration was 20.4 months (range, 9-48 months), and the average visual analogue scale (VAS) score was 7.6 (range, 5-9) preoperatively. The results were evaluated using the University of California Los Angeles (UCLA) shoulder rating score before and after operation, further, the patient satisfaction rate was also calculated. All 14 patients were followed up 5-18 months, with an average of 13 months. There was no postoperative pain of acromioclavicular joint in 12 patients; 1 case had occasional mild pain, which could be controlled by painkillers. Moreover, there was only 1 acromioclavicular joint subluxation due to early fitness training at 2 weeks postoperatively, and the symptoms gradually relieved after 1 month of conservative treatments. The UCLA score was 22.1±6.2 preoperatively, which improved to 30.2±3.4 at last follow-up, showing significant difference ( t=5.359, P<0.001). The patient satisfaction rate was 92.9%, with 12 excellent cases, 1 good case, and 1 fair case. Arthroscopic distal clavicle resection for symptomatic acromioclavicular arthritis is a safe, reliable, and repeatable procedure.

Mid-term outcome of arthroscopic TightRope fixation of displaced lateral end clavicular fractures: Average follow-up of 6.1 years

PurposeVarious surgical modalities are available to treat Neer types 2 and 5 unstable fractures of lateral end clavicle but none of them are standardized. Arthroscopic fixation of the displaced lateral end clavicle fractures provides good short-term results but mid- to long-term outcomes are not available. The purpose of this study was to show the mid- to long-term radiological and functional outcomes of these fractures treated arthroscopically by a TightRope device, and to show the complications associated with this procedure. MethodsA retrospective study was conducted over 2 years from January 2014 to December 2015 with a minimum 5-year follow-up. Active patients aged 18–50 years with acute (less than 3 weeks) displaced fracture of lateral end of the clavicle, with a minimum 5-year follow-up were included in the study. Patients with associated fractures of the proximal humerus, glenoid, scapula and acromioclavicular joint injuries were excluded from the study along with open fractures and neurovascular injuries. The outcomes were assessed by objective (complications and radiographic examination) and subjective criteria (quick disabilities of the arm, shoulder and hand score, the Constant-Murley score and the visual pain analogue scale). The data were analyzed by SPSS version 21.0. ResultsTotally, 42 patients were operated during the study period and 37 were available with a minimum 5-year follow-up. Thirty were male and 7 were female with a mean age of 29.5 years and a mean follow-up of 6.1 years. The mean quick disabilities of the arm, shoulder and hand score was 68.2 ± 4.6 preoperatively and 1.27 ± 2.32 at final follow-up (p < 0.001); the mean visual pain analogue scale score was 6.85 ± 2.2 preoperatively and 0.86 ± 1.60 at final follow-up (p < 0.001). The average Constant-Murley score was 93.38 ± 3.25 at the end of the follow-up. There were 2 fixation failures, with established non-union and 3 patients developed radiographic acromioclavicular joint arthritis. ConclusionsArthroscopic TightRope fixation of displaced lateral end clavicular fractures provides good radiological and functional outcomes at mid- to long-term follow-up. With the low complication rates and high patient satisfaction, this technique can be considered as a primary option in the surgical treatment of these fractures.

Translation, cultural adaptation, and validation of the Turkish-specific acromioclavicular score

The Specific Acromioclavicular Score (SACS) is a questionnaire that assesses functional outcomes for Acromioclavicular Joint (ACJ) pathologies. The aim of this study was to evaluate the ease of use, reliability, and validity of the Turkish-translated and culturally adapted form of the SACS. The SACSwas translated into Turkish according to Beaton's recommendations. Seventy-eight patients were included in this study (67 with acute or chronic AC instability and 11 with symptomatic ACJ arthritis). The mean interval between test and retestwas 13.2 ± 4.6 days. The reliability of the tools was measured with the intraclass correlation coefficient. External validity was evaluated using correlations between the SACS,Oxford Shoulder Score (OSS), Shoulder Pain and Disability Index (SPADI), American Shoulder and Elbow Surgeons (ASES) Shoulder score, and the SF-36 version 2 (SF-36v2). Floor and ceiling effects were also analyzed. The mean time to complete the Turkish SACS was 3 min 18 s (range, 1 min 40 s to 7 min 9 s). The test-retest reliability was excellent (ICC, 0.988). There was a very good correlation between SACS,OSS, SPADI, and ASES scores (r = 0.645, 0.645, and -0.682, respectively, P < 0.05). A poor correlationwas observed between SACS and subscales of SF-36v2 (P > 0.05). No floor or ceiling effects were detected. The Turkish version of the SACS is a reliable and valid tool tomeasure outcomes after various types of acromioclavicular joint pathologies. Level IV, Diagnostic Study.

Arthroscopic coracoclavicular button fixation versus anatomic locking plate fixation for unstable distal clavicular fractures.

HypothesisNeer type II distal clavicle fractures are unstable and associated with high nonunion rates. The aim of this retrospective study was to compare the clinical and radiographic outcomes of anatomic locking plate fixation and arthroscopic coracoclavicular button fixation for unstable distal clavicle fractures.MethodsForty-seven patients with Neer type II distal clavicle fractures were treated surgically using either anatomic locking plate fixation (group 1, n = 20) or all arthroscopic coracoclavicular button fixation (group 2, n = 27) between 2012 and 2019 in 2 centers. Clinical and radiographic outcomes after an average follow-up period of 49 months for group 1 and 32 months for group 2 were assessed using the American Shoulder and Elbow Surgeons Shoulder score, Constant-Murley score, visual analog scale score and X-rays.ResultsAt the final follow-up, the mean American Shoulder and Elbow Surgeons Shoulder score, Constant-Murley score, and visual analog scale score for group 1 and group 2 were 92.5 ± 3.9 (range 88.3-98.3), 93.6 ± 4.0 (range 90-100), and 0.6 ± 0.6 (range 0-2) and 95 ± 3.3 (range 86.6-100), 96.2 ± 3.0 (range 88-100), and 0.4 ± 0.5 (range 0-1), respectively (P = .32, P = .15, and P = .59, respectively). At the final follow-up, acceptable reduction and bone healing were achieved in all patients. All patients in both groups were able to resume work as well as sports activities. Postoperative complications included 1 case of acromioclavicular joint arthritis and 1 case of screw penetration in group 1 and 2 cases of coracoid process fracture that did not require additional surgery in group 2. Five patients underwent hardware removal owing to skin irritation and dissatisfaction with the cosmetic appearance in group 1.ConclusionBoth distal anatomic locking plate fixation and arthroscopic coracoclavicular button fixation provide satisfactory functional and radiological outcomes. Both procedures can be used to treat distal clavicle fractures because they have a minimal risk of complications and present similar, high union rates.

Septic Arthritis of the Acromioclavicular Joint: A Single-Center, 11-Year Retrospective Review.

Septic arthritis of the smaller acromioclavicular joint is uncommon, with only a few reports and case series available in the literature. The aim of this outcomes analysis was to determine the prevalence of shoulder girdle septic arthritis within the authors' institution, with a particular focus on describing the authors' experience with acromioclavicular joint septic arthritis. A retrospective outcomes analysis was conducted of patients admitted to a single tertiary referral center from 2008 to 2018 with acromioclavicular joint septic arthritis. Demographic and clinical data were recorded for each patient; the modified Frailty Index score was calculated for each patient. Nine patients were identified as having acromioclavicular joint septic arthritis, making up 12% of shoulder girdle septic arthritis. Diabetes mellitus was the most prevalent comorbidity, present in 4 (44.4%) patients. Staphylococcus aureus was responsible in 55.6% and Streptococcus species in 44.4%. Seven patients were treated surgically. Mean (SD) length of antibiotic therapy was 6.2 (2.7) weeks. Mean (SD) length of stay was 6 (2.83) days (range, 4-8 days) for patients who received antibiotic therapy only and 12.7 (7.52) days for those who proceeded for operative management. Mean modified Frailty Index score was 1.1. Septic arthritis of the acromioclavicular joint is an uncommon infection that occurs both in patients with impaired immunity and in those with intact immune systems. Tailored antimicrobial therapy in conjunction with surgical intervention, when indicated, appears to result in successful suppression or eradication of infection in the majority of cases. [Orthopedics. 2021;44(4):e493-e497.].

Higher coracoacromial ligament thickness, critical shoulder angle and acromion index are associated with rotator cuff tears in patients who undergo arthroscopic rotator cuff repair

PurposeTo evaluate the effect of several shoulder anatomical parameters in the development of rotator cuff tear (RCT). MethodsBetween 2014 and 2018, all consecutive patients who underwent arthroscopic rotator cuff repair due to full-thickness rotator cuff tear with a minimum 2-year follow-up were identified. Inclusion criteria were (1) age>18 years, (2) patients with degenerative RCT, (3) full-thickness RCTs, (4) patients underwent arthroscopic RCR due to unresponsive conservative treatment, (5) minimum 2-year follow-up period. Exclusion criteria were traumatic RCT, history of previous shoulder surgery, shoulder deformity, neurologic or neuromuscular dysfunction, glenohumeral and/or acromioclavicular joint arthritis, cuff-tear arthropathy, history of fracture around shoulder and inadequate or low-quality magnetic resonance images (MRI). Acromion index (AI), Critical shoulder angle (CSA), Coracoacromial ligament (CAL) thickness, Subacromial space (SS) width, Acromiohumeral distance (AHD), CAL/SS ratio, Lateral acromial angle (LAA) and glenoid version angle (GVA) parameters were measured on MRI. Intra- and interobserver reliability were measured. Regression analysis was used to evaluate the association between anatomical parameters and RCT development. Receiver operating curves (ROC) were created for independent risk factors. The correlation between measurement parameters were evaluated. ResultsThere were 1029 patients met the inclusion criteria. After exclusions, 437 patients were included. Age- and sex matched 437 patients without any shoulder pathologies were selected as control group. There was almost perfect intra- (ICC>0.85) and interobserver (ICC> 0.81) reliability regarding all measurement parameters. There was significant difference between RCT group and control group regarding AI (0.67±0.07 vs. 0.61±0.08, p<0.001), CSA (33.58±3.93 vs. 31.50±4.01, p<0.001), CAL thickness (1.81±0.64 vs. 1.53±0.50, p<0.001), CAL/SS ratio (0.29±0.14 vs. 0.23±0.10, p<0.001) and GVA (-16.69±6.69 vs. -15.37±5.95, p=0.002) parameters. AI (OR: 1.998, P<0.001), CAL thickness (OR: 2.801, p<0.000) and CSA (OR: 3.055, p<0.001) were found to be independently associated with the increased risk of RCT development. Area under curve (AUC) of the AI, CSA, and CAL thickness were 71.4%, 71.3%, and 70.2%, respectively. Cut-off values for AI, CSA, and CAL thickness were 0.62, 36.4° and 1.47 mm, respectively. There was significantly positive strong correlation between AI and CSA (p<0.001, r=0.814). ConclusionHigher AI, CSA and CAL thickness independently associated with full-thickness RCT development. In clinical practice, these parameters may be useful in the prediction of rotator cuff rupture.

Bony Edema and Clinical Examination Findings Predict the Need for Distal Clavicle Excision at the Time of Shoulder Arthroscopy.

Background: Deciding to perform a distal clavicle excision for acromioclavicular joint arthritis, especially in conjunction with other arthroscopic shoulder procedures, is challenging for surgeons. Studies have reported mixed results on the value of magnetic resonance imaging (MRI) in decision making. Purpose: We sought to correlate MRI findings with clinical symptoms and the surgeon's decision to perform a distal clavicle excision. Methods: We compared MRI, clinical examination, and MRI findings of 200 patients who underwent distal clavicle excision for symptomatic acromioclavicular joint arthritis with 200 patients who underwent arthroscopic shoulder procedures for other reasons. Univariate statistics were used to determine correlations between physical examination findings, MRI findings, and the decision to perform distal clavicle excision. A binary logistic regression model was used to determine independent predictors of need for distal clavicle excision. Results: There was no difference in mean age, sex, and race between groups. Advanced acromioclavicular joint osteoarthritis was strongly correlated with positive physical examination findings. Bony edema correlated strongly with tenderness at the acromioclavicular joint but not pain with cross-body adduction testing. There was no association between higher MRI grade of osteoarthritis and the need for distal clavicle excision. Regression analysis identified both physical examination findings and bony edema on MRI as independent predictors of the need for distal clavicle excision. Conclusion: In the setting of positive clinical examination findings and bony edema of the distal clavicle, surgeons should feel reassured that distal clavicle excision is likely indicated.

Percutaneous distal clavicle excision for acromioclavicular joint arthritis: our experience and early results of a novel surgical technique.

Symptomatic acromioclavicular joint (ACJ) osteoarthritis causes pain and limitations in activities of daily living. Open and arthroscopic distal clavicle excision techniques have been described with good outcomes. However, both techniques have their own sets of advantages and disadvantages. This study describes a novel technique of percutaneous distal clavicle excision for symptomatic ACJ osteoarthritis and our two-year results. Fifteen consecutive patients underwent percutaneous distal clavicle excision for ACJ arthritis. These patients had failed a trial of conservative treatment. The ACJ was confirmed as the pain generator with an intraarticular steroid/lignocaine injection, and shoulder MRI was used to exclude alternative pain generators in the shoulder. They had a minimum of two years of follow-up. At a mean of 26.8months postoperatively, the mean VAS pain score was 0, and the mean Constant score for the shoulder was 87.3 points (range 50-94), which corresponded to 1 good, 1 very good and 13 excellent results. The mean SF-36 score was 94.9 points (range 65-100). There were statistically significant improvements in the VAS scores, Constant shoulder scores and SF-36 scores at one year and two years of follow-up (p < 0.05). Three unique complications, namely subcutaneous emphysema, "missing" of the distal clavicle and thermal skin injury, were encountered. Our surgical technique has since been modified to circumvent these complications. Our novel technique of percutaneous distal clavicle excision yields a 93.3% good-to-excellent results based on the Constant shoulder score and durable pain relief based on VAS at two years.

Indirect Arthroscopic Distal Clavicle Resection: an Institutional Experience with Midterm Functional Outcome

Acromioclavicular joint arthritis is a relatively common source of shoulder pain. The treatment options consist of conservative management and operative intervention depending on the severity and duration of the disease. Distal clavicle excision is the standard operative treatment and can be performed through either open or arthroscopic techniques. The purpose of this study was to evaluate the functional outcome of arthroscopic resection of the distal clavicle. This was a prospective study, conducted in a group of 50 patients in the Post-Gra-duate Department of Orthopaedics, Govt. Medical College Srinagar, from July 2015 to July 2019 with cases followed for a minimum of 3 years. The mean UCLA score improved from 13.2 preoperatively to 29.56 at final follow-up. An excellent result was seen in 10 patients (20%), good in 34 (68%), fair in 3 (6%) and poor in 3 (6%) patients. Overall 88% of the patients achieved excellent or good results and 94% were satisfied. Persistent pain and excessive intraoperative bleeding were the most common complications in our study. 1. Distal clavicle excision through an indirect or subacromial approach is a safe and effective procedure with very few complications. 2. The subacromial approach gives the added advantage of evaluating any glenohumeral joint and subacromial pathology. 3. This procedure is associated with less pain and improved cosmesis in comparison to open procedures.

PRP in acromio-clavicular joint arthritis – A prospective analysis

Background: The acromioclavicular joint pathologies are one of the common causes of shoulder pain. The most common of these is the acromioclavicular joint arthritis. The management can be conservative or surgical. The conservative measures include activity modification, physiotherapy, Non-Steroidal Anti- Inflammatory Drugs (NSAIDs), and Intra-articular Steroid Injections (ISI). ISI has been used with variable success rates and the long-term effects are doubtful. Materials and Methods: Patients with clinical and radiological evidence of ACJ arthritis and not responding to exercise and NSAIDs for 2 months were enrolled for PRP injection. 1 mL of PRP prepared by the manual double spin method was injected into the ACJ and patients were followed for a minimum period of 6 months. Constant Score was used to measure the functional recovery at 1, 3, and 6 months post-injection therapy. Results: 13 patients including 16 shoulders were followed up for an average of 8 months (6 to 14 months).3 patients had bilateral ACJ involvement. 4 had left ACJ involvement and the rest had right side involvement. The mean pre-injection constant score was 45 (range 28-70). The mean score at the end of 1 month follow up was 69 (range 56-89). At the end of 3 months, the mean score was 81 range (63-93). Both were statistically significant improvements when compared to the pre-injection score (P=0.003,0.0021 respectively). At the end of 6 months, the score was 89 range (58–94). This sequential improvement was not however statistically significant. Conclusion: ACJ arthritis is one of the common causes of shoulder pain. In our pilot study, PRP has been a promising option to treat primary ACJ arthritis. Future RCTs are needed to establish it as a superior option in the management of ACJ arthritis. Keywords: Acromioclavicular joint (ACJ) NSAIDs.

Modified technique of Indirect arthroscopic distal clavicle resection

Distal clavicle resection is an accepted surgical treatment option for unremitting acromioclavicular joint arthritis. Indirect arthroscopic approach is preferred when an additional subacromial or glenohumeral diagnostic or therapeutic procedure is contemplated. However, concomitant subacromial decompression and acromial overhang removal, which is integral to indirect approach vis-a-vis direct approach, have additional risks of stiffness and acromial fracture. A modification in indirect approach technique is demonstrated which not only reduces these risks but also improves accuracy and safety of distal clavicle resection. The pros and cons are discussed in detail with reference to relevant literature.

Arthroscopically Assisted Acute Acromioclavicular Joint Reconstruction Using the Infinity-Lock Button System

Acromioclavicular (AC) joint injuries are the most common shoulder injuries in the athletic population. The literature is rife with various surgical techniques and implants as well as opinion on proper timing of surgical options. Patient outcomes are generally similar across fixation method. Complications are common following reconstruction, and the specific type of complication may depend on the technique used. Fracture and graft elongation are associated with use of allograft, whereas button cutout and skin irritation can occur with cortical suture-fixation methods. This technical paper describes an arthroscopically assisted acute AC joint reconstruction technique using the Infinity-Lock Button System. This technique provides a minimally invasive, low-profile reconstruction that may minimize risk of clavicle and coracoid fracture as well as overlying skin irritation. Acute reconstruction may permit healing of the native coracoclavicular and AC ligaments and mitigate risk of future AC joint arthritis.

Epidemiology of Acromioclavicular Joint Injuries in Professional Baseball

Objectives:Shoulder injuries account for a large portion of all recorded injures in professional baseball. Much is known about other shoulder pathologies in the overhead athlete, but the incidence and impact of acromioclavicular (AC) joint injuries in this population is unknown. The purpose of this study was to examine the incidence, rates, and characteristics of AC joint injuries in professional baseball, and determine the impact on time missed.Methods:The Major League Baseball Health and Injury Tracking System (HITS) was used to compile records of all major and minor league player from 2011-2017 with documented AC joint injuries. These injuries were classified as acute (sprain or separation) or chronic (AC joint arthritis or distal clavicular osteolysis), and associated data included laterality, date of injury, player position, activity, mechanism of injury, length of return to play (RTP), and need for surgical intervention.Results:A total of 312 AC joint injuries (183 MiLB, 129 MLB; range 39-60 per year) were recorded (acute n=201, 64.4%; chronic n=111, 35.6%). A total of 81% of acute injuries resulted in time missed with an average RTP of 22.8 days whereas 59% of chronic injuries resulted in days missed with an average RTP of 32.2 days (p<0.001). Acute injuries occurred most commonly in outfielders (42.7%), followed by infielders (27.3%). Chronic injuries were seen in higher proportions among pitchers and catchers (45.5-56.4% chronic injuries). Acute AC injuries occurred most often while playing defense (n=100; 49.8%) in the infield or outfield (n=138; 68.7%), with 63.2% the result of a contact injury. Chronic AC joint injuries were most commonly with throwing or pitching (n=48; 43.2%) and non-contact injuries (n=79; 71.2%).Conclusion:Acute AC joint injuries are contact injuries occurring most commonly among infielders and outfielders that result in more than 3 weeks missed before return to play whereas chronic AC joint injuries occur more commonly in pitchers and catchers from repetitive overhead activity. Knowledge of these data can better guide expectation management in this elite population to better elucidate the prevalence of two common injury patterns in the acromioclavicular joint.