Acromioclavicular Joint Excision Research Articles

Serious adverse event rates and reoperation after arthroscopic shoulder surgery: population based cohort study

ObjectiveTo provide clinicians and patients with accurate risk estimates of serious adverse events after common elective shoulder arthroscopic procedures, including reoperation within one year.DesignPopulation based cohort study.SettingHospital Episode Statistics for...

Acromioclavicular joint arthritis is not an indication for routine distal clavicle excision in arthroscopic rotator cuff repair.

To evaluate the significance of untreated primary acromioclavicular joint (ACJ) osteoarthritis, encountered during arthroscopic rotator cuff repair (RCR), as a cause of persistent symptomatology and need for revision surgery. In a cohort of 811 consecutive patients older than 55years who underwent RCR, the effect of primary ACJ osteoarthritis presence was prospectively examined. A total of 497 patients with mild/moderate and severe ACJ osteoarthritis based on preoperative MRI evaluation were allocated to Group A (n = 185, symptomatic ACJ) and Group B (n = 312, asymptomatic ACJ). Distal clavicle excision was not performed regardless of the presence of pain. The minimum follow-up was 28months (28-46). The visual analogue scale (VAS) pain scores were assessed for ACJ pain on palpation, the cross body adduction test, the Constant-Murley, and the American Shoulder and Elbow Surgeons (ASES). The overall loss to follow-up rate was 3.82% (19 patients: 11 in Group A and eight in Group B). The mean ASES score at the latest follow-up was 91.16 ± 9.3 and 92.37 ± 10.44 in Groups A and B, respectively, and the mean Constant-Murley score was 96.36 ± 5.7 and 95.76 ± 4.6 in Groups A and B, respectively. There was no statistical significance between regarding both scores. Localised ACJ pain on palpation and pain on cross body adduction were diminished in both the symptomatic and asymptomatic group. There were five cases (1%: two in Group A and three in Group B) with persistent ACJ pain who had failed the conservative treatment, and ACJ excision was necessary to alleviate the symptoms. All revision operations were uncomplicated with symptom resolution. Untreated ACJ osteoarthritis, symptomatic or not, encountered during arthroscopic RCR is associated with a low percentage of failure. Routine distal clavicle excision is not absolutely necessary, even in patients with symptomatic ACJ osteoarthritis. II, Prospective cohort study.

The changing incidence of arthroscopic subacromial decompression in Scotland.

The aim of this study was to examine the recent trend in delivery of arthroscopic subacromial decompression (ASD) in Scotland and to determine if this varies by geographical location. Scottish Morbidity Records were reviewed retrospectively between March 2014 and April 2018 to identify records for every admission to each NHS hospital. The Office of Population Censuses and Surveys (OPCS-4) surgical codes were used to identify patients undergoing primary ASD. Patients who underwent acromioclavicular joint excision (ACJE) and rotator cuff repair (RCR) were identified and grouped separately. Procedure rates were age and sex standardized against the European standard population. During the study period the number of ASDs fell by 649 cases (29%) from 2,217 in the first year to 1,568 in the final year. The standardized annual procedure rate fell from 41.6 (95% confidence interval (CI) 39.9 to 43.4) to 28.9 (95% CI 27.4 to 30.3) per 100,000. The greatest reduction occurred between 2017 and 2018. The number of ACJEs rose from 41 to 188 (a 3.59-fold increase). The number of RCRs fell from 655 to 560 (-15%). In the year 2017 to 2018 there were four (28.6%) Scottish NHS board areas where the ASD rate was greater than 3 standard deviations (SDs) from the national average, and two (14.3%) NHS boards where the rate was less than 3 SDs from the national average. There has been a clear decline in the rate of ASD in Scotland since 2014. Over the same period there has been an increase in the rate of ACJE. The greatest decline occurred between 2017 and 2018, corresponding to the publication of epidemiological studies demonstrating a rise in ASD, and awareness of studies which questioned the benefit of ASD. This paper demonstrates the potential impact of information from epidemiological studies, referral guidelines, and well-designed large multicentre randomized controlled trials on clinical practice. Cite this article: Bone Joint J 2020;102-B(3):360-364.

Continuing acromioclavicular joint pain after excision arthroplasty: is further surgery effective?

Little published evidence exists on the incidence of continuing acromioclavicular joint pain with no published outcomes for revision surgery. This study aimed to establish the incidence and outcomes of revision acromioclavicular joint excision surgery. A consecutive retrospective cohort of patients undergoing revision arthroscopic or open acromioclavicular joint excision was identified. Patients were identified from a prospectively collected database. Inclusion criteria were revision acromioclavicular joint excisions over a 14-year period between 2001 and 2015. Exclusion criteria were previous surgery for acromioclavicular joint instability or shoulder arthroplasty. Outcome measures were Oxford Shoulder scores and a satisfaction survey. Forty-three consecutive cases of revision acromioclavicular joint excision over 14 years (37 after arthroscopic excision with subacromial decompression, 5 after arthroscopic excision with rotator cuff repair, 1 after open excision). Continuing acromioclavicular joint pain was associated with incomplete resection from arthroscopic surgery, which was the primary indication for revision surgery. Revision occurred a mean 14.2 months after primary surgery (standard deviation 7.6 months). Mean Oxford Shoulder score was preoperatively 18 (standard deviation 8.1) and 23.4 (standard deviation 11.1) after primary surgery, which did not reach significance until after revision surgery with a mean 31.7 (standard deviation 13.6; P = 0.021). Median follow up was 15 months (interquartile range 4-31 months). A survey at a mean of 6 years (standard deviation 2.3) post-revision surgery found that 65% of patients felt improved, 77% would have their surgery again and 69% of patients felt satisfied. The incidence of postoperative frozen shoulder was 14.3%. Functional outcomes after revision surgery showed improvement from scores taken before primary surgery; however, long-term satisfaction rates were relatively low.

Magnetic resonance imaging scans are not a reliable tool for predicting symptomatic acromioclavicular arthritis.

We investigated whether magnetic resonance imaging (MRI) scans can accurately diagnose arthritis of the acromioclavicular joint (ACJ) because it has recently been suggested that bone marrow oedema on MRI scans is a predictive sign of symptomatic ACJ arthritis. The MRI scans of 43 patients (50 shoulders) who underwent ACJ excision for clinically symptomatic ACJ arthritis were compared to a control group of 43 age- and sex-matched patients (48 shoulders) who underwent an MRI scan for investigation of shoulder pain but did not have clinical symptoms or signs of ACJ arthritis. The scans were evaluated by an experienced musculoskeletal radiologist, who was blinded to the examination findings. Bone marrow oedema was present in only 15 (30%) shoulders in the ACJ excision group, although this was higher than the six shoulders in the asymptomatic group (p = 0.03). Forty-one (82%) shoulders in the symptomatic group had grade III/IV ACJ arthritis compared to 31 (65%) in the asymptomatic group (p = 0.05). However, 44 out of 48 (92%) shoulders in the asymptomatic group had signs of osteoarthritis on MRI scans. In contrast to recent reports, the present study shows that MRI is not helpful in making the diagnosis of ACJ arthritis. A focused history and clinical examination should remain the mainstay for surgical decision making. Level 3.

A Reproducible Technique for Arthroscopic Acromioclavicular Joint Excision.

Arthroscopic acromioclavicular joint excision is a commonly performed but technically demanding procedure. Incomplete excision can leave residual symptoms. We present a simple, reproducible technique ensuring satisfactory excision of the joint.

A simple method for identifying the acromioclavicular joint during arthroscopic procedures.

Arthroscopic acromioclavicular joint excision is performed via an anterior portal and is technically demanding. We present a simple method for identifying the acromioclavicular joint during arthroscopic procedures.

Arthroscopic Finding of an Extra-Articular Loose Body in the Subacromial Space: Case Report Presentation and Literature Review.

Loose bodies are pieces of soft tissue that run free within a body cavity, typically in the synovium; loose bodies outside of synovial cavities are very rare. This case study demonstrates such an instance occurring in the subacromial space, which is especially unusual. We report on it coupled with an analysis of the literature of known cases that have occurred previously. A 55-year old right-hand-dominant female patient presented with left shoulder pain. She had injured her left shoulder 7 yr previously and had achieved adequate pain and symptomatic control with physiotherapy. A magnetic resonance imaging scan demonstrated subacromial subdeltoid bursitis with a large subacromial spur, a bulky acromioclavicular (AC) joint, and a partial tear of the supraspinatous tendon. The patient subsequently underwent shoulder arthroscopy for subacromial decompression and AC joint excision. Arthroscopy demonstrated a suspected impingement of the rotator cuff in the subacromial space, bursitis, and a prominent acromion that limited the subacromial space (bigliani, type III), but during the procedure a detached white mass was discovered in the subacromial bursa. After histological analysis, the mass showed osteocartilagenous tissue, consistent with a loose body. Following the procedure, there were no complications, and the patient's symptoms gradually resolved. Extraarticular loose bodies are extremely rare, especially in the subacromial bursa. Reported cases have all been associated with either traumatic or degenerative shoulder pathology, and the diagnosis was commonly established incidentally on arthroscopy. Cases were managed with removal during the same procedure. Arthroscopic removal of loose bodies and bursa debridement, good options for treatment of loose bodies in the subacromial space, can result in good function.

Reverse Total Shoulder Replacement with Minimal ACJ Excision Arthroplasty for Management of Massive ACJ Cyst - A Case Report.

Massive acromioclavicular joint (ACJ) cysts are an extremely rare cause of shoulder impairment and with limited consensus in its management. We present the first published case report of a patient with a massive ACJ cyst treated with a reverse total shoulder replacement with minimal ACJ excision arthroplasty.

Acromioclavicular joint acceleration-deceleration injury as a cause of persistent shoulder pain: Outcome after arthroscopic resection.

Background:Shoulder pain in general and acromioclavicular joint (ACJ) pain specifically is common after acceleration-deceleration injury following road traffic accident (RTA). The outcome of surgical treatment in this condition is not described in the literature. The aim of the present study was to report the outcome of arthroscopic resection of the ACJ in these casesMaterials and Methods:Nine patients with localized ACJ pain, resistant to nonoperative treatment were referred on an average 18 months after the injury. There were 3 male and 6 females. The right shoulder was involved in seven patients and the left in two. The average age was 38.9 years (range 29-46 years). All presented with normal X-rays but with torn acromioclavicular joint disc and effusion on magnetic resonance imaging (MRI). Arthroscopic ACJ excision arthroplasty was performed in all patients.Results:At a mean followup of 18 month, all patients had marked improvement. The Constant score improved from 36 to 81, the pain score from 3/15 to 10/15 and the patient satisfaction improved from 3.5/10 to 9.3/10.Conclusion:Arthroscopic ACJ excision arthroplasty, gives good outcomes in patients not responding to conservative management in ACJ acceleration-deceleration injury.

Healing of Arthroscopic Portals in Shoulder Surgery: A Randomized Controlled Trial Comparing Different Methods of Closure

Background Suturing of portals following arthroscopic shoulder surgery is the standard method of closure, but may be unnecessary. We carried out a randomised controlled trial to compare patients whose arthroscopic portals were closed by suturing and those that were covered by a simple dressing. We randomised 60 patients undergoing diagnostic shoulder arthroscopy, arthroscopic subacromial decompression and arthroscopic acromioclavicular joint excision. Methods At 10 to 12 days following surgery, patients attended the GP surgery for a wound check and removal of sutures as required. At 3 weeks and 3 months every patient was reviewed by a designated, blinded, observer and the wounds assessed. The patients completed a questionnaire including visual analogue scores to determine their satisfaction with wound appearance and any complications such as infection. Results At 3 weeks and 3 months no patients had needed antibiotics with no wound erythema or signs of infection. The number of dressings needed was comparable in both groups (p=0.73). The difference in the level of patient satisfaction was not statistically significant in either group (p=0.46). The wound cosmesis score was not statistically different in either group (p=0.66). Conclusion We conclude that both closure techniques were equivalent but the non-suture technique is cheaper with lower morbidity. From our study there is no need to suture shoulder arthroscopy portal wounds.

Return to Work and Driving following Arthroscopic Subacromial Decompression and Acromioclavicular Joint Excision

Background Arthroscopic subacromial decompression and acromio-clavicular joint excision are two of the most commonly performed arthroscopic shoulder procedures. Methods In the present study, we prospectively evaluated the timing of return to work and driving following these procedures in a British population. Results Median time of returning to work was 22 days (range 2 days to 72 days). Median time of returning to driving was 14 days (range 2 days to 70 days). Ninety percent of patients returned to work by 6 weeks and to driving by 4 weeks. Discussion The results obtained suggest that most patients having arthroscopic subacromial decompression or acromio-clavicular joint excision will return to work and driving by 6 weeks post surgery.

Radiological Features of Osteoarthritis of the Acromiclavicular Joint and its Association with Clinical Symptoms

To determine whether increasing age is associated with increased radiological features of osteoarthritis of the acromioclavicular joint (ACJ) in a general population, and whether clinical symptoms correlate with radiological features. Anteroposterior and axillary shoulder radiographs of 240 patients aged 20 to 80 years were randomly selected. The presence of stigmata of osteoarthritis of the ACJ including sclerosis, cysts, lysis, and osteophytes were recorded, and the width of the ACJ was measured. To determine the correlation between clinical symptoms and radiological features, the same radiological features were assessed for 100 further patients who had undergone either arthroscopic subacromial decompression (ASD) alone (n=50) or ASD plus ACJ excision (n=50, age-matched controls) based on clinical examination. Radiological features of osteoarthritis of the ACJ increased significantly with increasing age but were not related to gender or the side affected. Of the 10 features, only medial acromial sclerosis and superior clavicular osteophytes were more prevalent in patients with ASD plus ACJ excision than in those with ASD alone (p=0.016). The sensitivity, specificity, positive and negative predictive values of these features were poor. Therefore, clinical symptoms were not associated with radiological features of osteoarthritis of the ACJ. Radiological features should only be used as an adjunct in the decision to excise the ACJ. A thorough clinical examination is crucial in the assessment of ACJ pathology.

Rate of return to work and driving following arthroscopic subacromial decompression

The aim of the present paper was to evaluate the return to work and return to driving of a cohort of patients undergoing arthroscopic subacromial decompressions +/- arthroscopic acromioclavicular joint excision. Arthroscopic subacromial decompressions +/- arthroscopic acromioclavicular joint excision were performed in 68 patients between February 2000 and November 2000. All patients had symptoms of subacromial impingement +/- acromioclavicular joint arthrosis for more than 6 months that had not settled with conservative treatment. All had positive local anaesthetic injection tests. All patients were followed up at 3 weeks and 3 months postoperatively. Their Constant-Murley score was measured preoperatively and at 3 weeks and 3 months postoperatively. Patients were asked to record when they had returned to work and when they had returned to driving. Only one non-manual worker did not return to work within 6 weeks. Eighty-five per cent of manual workers returned to manual work within 3 months. Fifty-one patients held driving licences. The average time to return to driving was 28.9 days. Average preoperative Constant-Murley scores were 47.5 (20-67). At 3 weeks postoperation average Constant-Murley scores were 66.8 (40-92), and at 3 months 76.5 (48-99).

Combined Arthroscopic Capsular Release, Acromioclavicular Joint Excision, and Acromioplasty for End-Stage Glenohumeral Joint Arthritis

Combined Arthroscopic Capsular Release, Acromioclavicular Joint Excision, and Acromioplasty for End-Stage Glenohumeral Joint Arthritis