Arthroscopic Distal Clavicle Resection Research Articles

Arthroscopic distal clavicle resection versus conservation in patients with combined rotator cuff tears and acromioclavicular joint osteoarthritis.

The most common cause of shoulder pain originating from the acromioclavicular (AC) joint is osteoarthritis, causing pain and disability. Operative Management of AC arthritis includes arthroscopic distal clavicle resection (DCR) and open clavicle resection. This study was conducted to evaluate the outcomes of isolated rotator cuff repair with conservative treatment of ACJ arthritis versus the combined resection of the distal clavicle with the repair of a rotator cuff tear, in cases with acromioclavicular arthritis. A total of 46 patients with unilateral or bilateral combined rotator cuff tear and acromioclavicular arthritis were included, they were classified into 2 independent groups: Conservative group (23 patients), and DCR group (23 patients). All patients were subjected to full history taking, examination, pre and post-operative University of California at Los Angeles shoulder scoring scale (UCLA), Antero-Posterior and Zanca X-rays views, early and late complications. Mean age was (51 ± 9) years, males were predominant (56.5%). The average post-operative UCLA score was (31.1 ± 4.9), and the average time to return to work was (214 ± 22). (2.2%) of patients had early complications, (19.6%) had late complications, (32.6%) had > 24h till 1st post-operative analgesia, and (87%) needed MgSO4 Injection. We found a highly significant increase in UCLA score measurements in the Conservative group, and a highly significant increase in UCLA score measurements in the DCR group (p < 0.01). But there was no difference between the 2 groups. Conventional conservative approach with arthroscopic rotator cuff repair and subacromial decompression has proven to be as effective as arthroscopic rotator cuff repair and subacromial decompression with DCR, in terms of efficacy and safety profiles in short term, but with more risks of potential hazards and cost with the DCR.

Diagnostic value of a preoperative acromioclavicular injection for symptomatic acromioclavicular osteoarthritis: a retrospective study of cross-sectional midterm outcomes.

It is essential to distinguish between symptomatic- and asymptomatic radiographic acromioclavicular (AC) osteoarthritis (OA) because AC-targeted physical examinations are dubious. This study aimed to determine the diagnostic value of a preoperative AC injection in discriminating between symptomatic- and asymptomatic radiographic AC OA based on patient arthroscopic distal clavicle resection (aDCR) outcomes. Forty-eight patients who underwent aDCR for AC OA were included. Their satisfaction was objectified using a 5-point Likert scale and patient willingness to repeat the surgery. The Oxford Shoulder Score (OSS), the Subjective Shoulder Value (SSV), and the Numerical Rating Scale (NRS) were used to assess postoperative shoulder function and pain. Patients were subdivided into groups based on their good or minimal reaction to an AC injection (good reaction: ≥7 consecutive days of pain reduction, Minimal reaction: <7 consecutive days of pain reduction). Twenty-seven patients had a good reaction and 21 patients had a minimal reaction to the AC injection (median follow-up, 45.0 months; range, 31.0-52.8 months). No significant differences were found in level of satisfaction (P=0.234) or willingness to repeat the surgery (P=0.861). No significant differences were found in OSS (P=0.612), SSV (P=0.641), NRS at rest (P=0.684) or during activity (P=0.422). This study found no significant differences between patients with a good reaction or a minimal reaction to an AC injection after aDCR surgery. The outcomes of this study seem to suggest that a distinction between symptomatic and asymptomatic radiographic AC OA is unnecessary, as all patients were equally satisfied with the outcome. Level of evidence: IV.

Outcomes of Secondary Arthroscopic Distal Clavicle Resection for Shoulders With Symptomatic Acromioclavicular Joint Arthropathy After Isolated Rotator Cuff Repair With Complete Tendon Healing.

Recent meta-analyses have advised against distal clavicle resection (DCR) as an adjuvant procedure during rotator cuff repair (RCR), whether performed routinely or in shoulders diagnosed with symptomatic acromioclavicular joint (ACJ) arthropathy. However, the efficacy of DCR as a secondary procedure in patients with persistent pain attributed to symptomatic ACJ arthropathy remains unknown. To evaluate outcomes of secondary DCR in patients with failed nonoperative treatment of symptomatic ACJ arthropathy after isolated RCR with complete tendon healing. Case series; Level of evidence, 4. 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 ≥12 months after the 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 the Subjective Shoulder Value (SSV) and pain at rest. Clinical assessment at >12 months after DCR included the SSV, pain at rest, Constant-Murley score, range of motion, and satisfaction. Pre- and post-DCR SSV and pain scores were compared. Of the initial cohort, 5 patients did not consent to the use of their data, leaving 18 patients aged 53.3 ± 7.6 years (mean ± SD; range, 39-68 years) for outcome assessment. At a mean follow-up of 7.0 ± 3.1 years after DCR, the SSV significantly improved from 58.7 ± 17.2 to 76.1 ± 20.2 (P < .001), and the pain at rest significantly decreased from 4.7 ± 1.5 to 2.8 ± 1.9 (P < .001). At final follow-up, the Constant-Murley score was 70.2 ± 21.0. Of 18 patients, 15 had none or mild residual pain (0-2; 83%), while 3 had substantial residual pain (5 or 6; 17%). Only 1 of the 3 patients with substantial residual pain had a poor SSV score (20 points) and was against opting for DCR in retrospect. No patient had infections or gross ACJ instability after DCR. Secondary DCR for cases of symptomatic ACJ arthropathy after isolated RCR with complete tendon healing reduced pain in 83% of patients, and 94% were satisfied and would undergo secondary DCR again.

Patient-reported outcomes for arthroscopic resection of the distal clavicle with concomitant arthroscopic subacromial decompression at a 2-year follow-up: a prospective study of 131 consecutive patients.

Arthroscopic distal clavicle resection (DCR) can be offered to patients with persistent acromioclavicular (AC) joint pain who do not benefit from conservative treatment. The aim of this study was to evaluate the outcome of combined arthroscopic DCR and concomitant arthroscopic subacromial decompression in a large consecutive and prospective cohort using patient-reported outcomes. Consecutive patients were identified from our online database and included based on their primary treatment code. All patients had a diagnosis of shoulder impingement syndrome and persistent AC joint pain resistant to at least six months of conservative treatment. The outcomes from the combined intervention were evaluated by patients through the Oxford Shoulder Score (OSS) questionnaire and EuroQol 5-Dimension 3-Level questionnaire, including a EuroQol visual analog scale score collected preoperatively and at a 2-year follow-up. Patient-reported satisfaction with the procedure was reported at the follow-up. Subgroups were formed to further evaluate outcome based on preoperative OSS (low, moderate, high) and age. 131 patients (75%) were available for analysis at the 2-year follow-up. Sixty seven patients (51%) were female and the mean age was 51 years (range 19-82). A mean OSS change of 12.1 (95% confidence interval, 10.3-14.0; P<.001) was observed within the entire study group. In both the low and moderate preoperative-OSS (pre-OSS) groups, a mean change of 14 was found with no difference between groups (P=.971). A mean change of 7 was found in the high pre-OSS group, which differed from both the moderate (P<.001) and low (P=.036) pre-OSS groups. A significant change in EuroQol 5-Dimension and EuroQol visual analog scale was observed within all the pre-OSS groups, and 107 patients (82%) replied that they were satisfied or very satisfied with their outcome of surgery at the follow-up. Patients who suffer from persistent AC joint pain largely benefit from arthroscopic DCR with arthroscopic subacromial decompression through relief of symptoms and improved quality of life, including those with a high self-reported and preoperative level of shoulder function.

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.

Nanoscopic Distal Clavicle Resection

Acromioclavicular joint pathology such as osteoarthritis has historically been treated with either an open or arthroscopic distal clavicle resection. Over the years the trend has been toward more minimally invasive treatment options with the arthroscope. In this article we highlight the use of the nanoscope to visualize the resection which can be performed through a small percutaneous incision. The advantages of this technique include the use of smaller portals, which should lead to improved earlier outcomes, and less iatrogenic damage to the shoulder.

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.

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.

Arthroscopic Distal Clavicle Resection Through the Supraspinatus Fossa Portal

Disorders of the acromioclavicular (AC) joint quite often necessitate distal clavicle resection (DCR). Arthroscopic DCR is favored because of it is mini-invasive and convenient to treat concomitant intraarticular or subacromial lesions. In previous reports, arthroscopic DCR was performed through the anterior portal with the patient in beach chair position. However, when the patient is in the lateral decubitus position, it is inconvenient to perform DCR through the anterior portal. Thus, we introduce a special DCR technique through the supraspinatus fossa (SSF) portal. The critical point of this technique is viewing the acromioclavicular joint through the routine posterior portal, creating the SSF portal at the anterior edge of the scapular spine and the same medial-to-lateral level to the AC joint, and enough removal of the posterior edge of the distal clavicle. We believe the introduction of this technique will provide a special technical option when DCR is needed.

Do intra-articular pathologies accompanying symptomatic acromioclavicular joint degeneration vary across age groups?

This study aims to evaluate the accompanying intra-articular pathologies in patients who underwent arthroscopic distal clavicle resection (DCR) for symptomatic acromioclavicular (AC) joint degeneration based on age groups and to reveal which additional pathologies should be considered across different age groups during physical examination of patients suspected of AC joint degeneration. The study included 156 patients (55 males, 101 females; mean age 57.2±10.0 years; range, 35 to 80 years) who underwent arthroscopic DCR between January 2006 and December 2017 and had at least one clinical positive test for AC joint degeneration during the preoperative physical examination. The patients were divided into three groups as those aged <50 years (group 1), between 50-65 years (group 2), and >65 years (group 3). The concomitant intra-articular pathologies were evaluated across different age groups and compared between the groups. Concomitant intra-articular pathologies were detected in 117 (75%) of a total of 156 patients. Additional pathology rate increased with increasing age (p=0.002). More than one concomitant intra-articular pathologies were detected in 37 patients (23.7%). This rate increased with increasing age (p=0.002). The number of patients with superior labrum anterior posterior (SLAP) lesion as the only additional pathology was 33 (21.2%). This rate decreased with increasing age (p=0.015). In group 1, the rate of concomitant SLAP lesion was 44.1%. The high incidence of intra-articular pathologies accompanying symptomatic AC joint degeneration raises the importance of careful physical examination, detailed imaging, and arthroscopic surgery to obtain good results in patients scheduled for DCR. The frequency of AC joint degeneration and concomitant SLAP lesions, particularly in younger patients, should be considered during clinical examinations.

Does Distal Clavicle Resection Decrease Pain or Improve Shoulder Function in Patients With Acromioclavicular Joint Arthritis and Rotator Cuff Tears? A Meta-analysis.

Acromioclavicular joint arthritis is a common, painful, and often missed diagnosis, and it often accompanies other shoulder conditions such as rotator cuff disease. Whether distal clavicle resection is important to perform in patients undergoing surgery for rotator cuff tears and concomitant acromioclavicular joint arthritis is controversial. The purpose of this study was to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of distal clavicle resection on (1) outcome scores; (2) shoulder ROM, joint pain or tenderness, and joint instability; and (3) risk of reoperation among patients treated surgically for rotator cuff tears who had concomitant acromioclavicular joint arthritis. We systematically searched the PubMed, EMBASE, and Cochrane databases to find RCTs that met our eligibility criteria, which, in summary, (1) compared rotator cuff repair plus distal clavicle resection with isolated rotator cuff repair for patients who sustained a full- or partial-thickness rotator cuff tear and concomitant acromioclavicular joint arthritis; and (2) the followup period was at least 2 years. Two reviewers screened the studies, extracted the data and evaluated the methodological quality, and performed data analysis. Statistical heterogeneity among studies was quantitatively evaluated with the I index. No heterogeneity was detected (I = 0%; p = 0.75) in terms of acromioclavicular joint pain or tenderness, Constant score, forward flexion, external rotation, and risk of reoperation, so fixed-effect models were used in these endpoints. Heterogeneity was moderate for the American Shoulder and Elbow Surgeons (ASES) score (I = 53%; p = 0.12) and low for the visual analog scale (VAS) score (I = 35%; p = 0.22), so random-effect models were used in these endpoints. Subgroup analysis was stratified by the symptom of acromioclavicular joint arthritis. Three RCTs with 208 patients were included. We evaluated the risk of bias using the Cochrane risk-of-bias tool; in aggregate, the three RCTs included showed low to intermediate risk, although not all parameters of the Cochrane tool could be assessed for all studies. There was no difference between the distal clavicle resection plus rotator cuff repair group and the isolated rotator cuff repair group in ASES score (mean difference =1.41; 95% confidence interval [CI], -3.37 to 6.18; p = 0.56) nor in terms of the VAS score and Constant score. Likewise, we found no difference in ROM of the shoulder (forward flexion, internal rotation, and external rotation) or acromioclavicular joint pain or tenderness between the groups (pooled results of acromioclavicular joint pain or tenderness: risk ratio [RR], 1.59; 95% CI, 0.67-3.78; p = 0.30). Acromioclavicular joint instability was only detected in the rotator cuff repair plus distal clavicle resection group. Finally, we found no difference in the proportion of patients undergoing repeat surgery between the study groups (pooled results of risk of reoperation for the rotator cuff repair plus distal clavicle resection and isolated rotator cuff repair: one of 52 versus two of 78; RR, 0.86; 95% CI, 0.11-6.48; p = 0.88). Distal clavicle resection in patients with rotator cuff tears did not result in better clinical outcome scores or shoulder ROM and was not associated with a lower risk of reoperation. Distal clavicle resection might cause acromioclavicular joint instability in patients with rotator cuff tears and concomitant asymptomatic acromioclavicular joint arthritis. Arthroscopic distal clavicle resection is not recommended in patients with rotator cuff tears and concomitant acromioclavicular joint arthritis. Additional well-designed RCTs with more participants, long-term followup, and data on patient-reported outcomes are needed. Level I, therapeutic study.

Critical Findings on Magnetic Resonance Arthrograms in Posterior Shoulder Instability Compared With an Age-Matched Controlled Cohort

Background: Posterior shoulder instability is less common and potentially more difficult to diagnose clinically and radiographically compared with anterior shoulder instability. Radiographic findings including posterior labral tears, increased retroversion, presence of glenoid dysplasia, and increased capsular area are associated with symptomatic recurrent posterior shoulder instability. Purpose: This study aimed to determine the prevalence and severity of associated radiographic parameters found on magnetic resonance arthrograms (MRAs) in patients with arthroscopically confirmed isolated posterior labral tears and symptomatic recurrent posterior shoulder instability, compared with an age-matched cohort of patients without posterior instability or labral injury confirmed with shoulder arthroscopy. Study Design: Cross-sectional study, Level of evidence, 3. Methods: Patients who received a preoperative standard shoulder MRA at an academic institution over a 5-year period and had symptomatic posterior instability and received a repair of an arthroscopically confirmed posterior labral tear (n = 63) were identified. These patients were compared with an age-matched control group of patients without posterior instability (n = 49) who underwent an isolated arthroscopic distal clavicle resection that included an arthroscopic glenohumeral joint evaluation. Glenoid version, posterior humeral head subluxation, glenoid dysplasia, and linear and capsular area measurements were evaluated between the 2 groups. Interobserver reliability for continuous and categorical variables was assessed for all measurements. Results: Multivariate logistic regression revealed that the presence of increased glenoid retroversion (P = .0018), glenoid dysplasia (P = .03), and increased axial posterior capsular cross-sectional area (P = .05) were significantly associated with posterior labral tears and symptomatic posterior shoulder instability compared with the age-matched control group. Posterior humeral head subluxation was found to be a statistically significant variable with univariate analysis (P = .001) for posterior shoulder instability but not with multivariate logistic regression (P = .53). Interobserver reliability was good to very good for all measurements (intraclass correlation coefficient [ICC] = 0.74-0.85; κ = 0.64) but was moderate for total capsular area and sagittal capsular area measurements (ICC = 0.43-0.56). Conclusion: The presence of increased glenoid retroversion, glenoid dysplasia, and increased posterior capsular area on MRA are significantly associated with posterior labral tears and symptomatic posterior shoulder instability. Identification of these critical radiographic variables on magnetic resonance arthrography assists in the accurate diagnosis and management of clinically significant posterior shoulder instability.

Arthroscopic Distal Clavical Resection Using “Vis-à-Vis” Portal

Arthroscopic distal clavicle resection has become an increasingly popular procedure in orthopaedics, and various techniques have been published. Many of the arthroscopic distal clavicle resection techniques that have been reported require visualization from the lateral portal with an anterior working portal to perform the resection. While these techniques have reported high success rates, there is often difficulty in viewing the entire acromioclavicular joint from the 2 standard arthroscopic portals (lateral and anterior). This is due to the medial edge of the acromion blocking the ability to visualize the most superior and posterior portions of the distal clavicle. We propose a technique for arthroscopic distal clavicle resection using an accessory anterior portal.

Arthroscopic Distal Clavicle Resection of Symptomatic Acromioclavicular Joint Arthritis Combined with Rotator Cuff Tear. Prospective Randomized Trial

Arthroscopic Distal Clavicle Resection of Symptomatic Acromioclavicular Joint Arthritis Combined with Rotator Cuff Tear. Prospective Randomized Trial

Arthroscopic Distal Clavicle Resection in Symptomatic Acromioclavicular Joint Arthritis Combined With Rotator Cuff Tear

Background: The treatment of symptomatic acromioclavicular joint (ACJ) injury in the rotator cuff (RC) tear has not been well clarified. Purpose: To compare the clinical results between patients who had distal clavicle resection (DCR) and those who did not during RC repair. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: From August 2008 to December 2009, a total of 56 consecutive patients (58 shoulders) were included. All patients had either a full-thickness or high-grade (>50%) RC tear, ACJ tenderness, arthritic change visible on plain radiographs, and a positive ACJ lidocaine injection test the day before surgery. Patients were randomized into 2 groups: DCR and RC repair (DCR+RCR group) and RC repair only (isolated RCR). Evaluation was performed preoperatively, at 6 months postoperatively, and at a final follow-up a minimum of 24 months postoperatively using the American Shoulder and Elbow Surgeons (ASES) score, the Constant shoulder score, range of motion examination, and pain visual analog scale (VAS). Results: After simple randomization, 26 shoulders were allocated in the DCR+RCR group, and 32 were placed in the isolated RCR group. Five shoulders in the DCR+RCR group and 6 in the isolated RCR group were excluded from analysis due to loss of follow-up. Therefore, the evaluation was performed for 21 shoulders in the DCR+RCR group and 26 shoulders in the isolated RCR group. The mean follow-up period was 44.2 months in the DCR+RCR group and 44.0 months in the isolated RCR group. There were no differences in age, sex, symptom duration, RC tear size, or preoperative ASES, Constant, and VAS scores between the 2 groups (P > .05). At final follow-up, the ASES, Constant, and VAS scores were significantly improved in both groups (P < .001). There were no differences in ASES, Constant, and VAS scores between the 2 groups at final follow-up (P > .05), and there was no difference in residual ACJ tenderness (7 in the DCR+RCR group and 5 in the isolated RCR group) between the 2 groups (P = .270). Conclusion: There was no difference in the clinical evaluations between the combined arthroscopic DCR and RCR group and the isolated RCR group at a minimum 24-month follow-up. Arthroscopic DCR should be carefully considered in patients who have symptomatic ACJ arthritis with RC tears.

A Novel and Reproducible Anterior Portal for Arthroscopic Distal Clavicle Excision

Acromioclavicular (AC) joint pathology is a common cause of shoulder pain, and arthroscopic distal clavicle resection is a frequently performed procedure for this problem. Here we describe a portal that is directly in line with the AC joint such that the surgeon can easily access the posterosuperior distal clavicle, as this is the region that is most frequently neglected or incompletely resected region with a “standard” or uncontrolled portal. This research provides an anatomic description for creating this anterior portal that preserves local anatomy and is both safe and effective for glenohumeral and AC joint access using reproducible anatomic landmarks. The technique was validated using cadaveric dissection and yields a method of establishing the anterior portal for distal clavicle excision with a safe corridor for placement of instruments in a reliable manner that does not disrupt the important stabilizers of the glenohumeral or AC joints. Level of Evidence: Level IV.

Is Arthroscopic Distal Clavicle Resection Necessary for Patients With Radiological Acromioclavicular Joint Arthritis and Rotator Cuff Tears?

Background: The failure of subacromial decompression may be attributed to persistent symptoms of acromioclavicular joint (ACJ) arthritis, while inferior clavicular spurs of the ACJ may be associated with failed healing of repaired rotator cuffs. Purpose: To evaluate the clinical effectiveness of arthroscopic distal clavicle resection (DCR) in patients with rotator cuff tears and concomitant asymptomatic radiological ACJ arthritis. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 78 patients with rotator cuff tears in addition to radiological and asymptomatic ACJ arthritis who were scheduled for arthroscopic rotator cuff repair were prospectively randomized into 2 groups. Patients underwent arthroscopic rotator cuff repair with acromioplasty. Patients in group 1 (39 patients) underwent additional arthroscopic DCR, while patients in group 2 (39 patients) did not. Clinical outcomes of the 2 groups were compared using the visual analog scale (VAS) for pain, range of motion, Constant score, and American Shoulder and Elbow Surgeons (ASES) score up to at least 24 months. The structural integrity of repaired rotator cuffs was assessed using ultrasonography, computed tomography arthrography, or MRI at least 6 months after surgery. To evaluate ACJ instability, weighted stress radiography of the ACJ was studied at 6 and 12 months postoperatively. Results: Patients in both groups showed significant improvement in the VAS score and all functional scores at final follow-up (mean, 29.2 months; range, 24-46 months) without significant differences between the 2 groups (P > .05). Results (mean ± SD) for preoperative group 1/group 2 and postoperative group 1/group 2 were as follows, respectively: 7.2 ± 1.8/6.1 ± 1.9 (P = .02) and 0.6 ± 1.8/0.6 ± 0.9 (P = .97) for the VAS score, 74.1 ± 5.7/73.8 ± 8.0 (P = .87) and 96.3 ± 5.7/95.7 ± 4.6 (P = .77) for the Constant score, and 47.0 ± 10.3/50.8 ± 14.1 (P = .22) and 91.5 ± 15.5/94.5 ± 11.8 (P = .55) for the ASES score. Failed cuff healing occurred in 9 patients (23%) in group 1 and 10 patients (26%) in group 2, with no significant difference (P = .95). In group 1, there were 2 patients (5.0%) with ACJ subluxation on weighted stress radiography at 6 months postoperatively. These patients complained of gross protrusion and ACJ tenderness. Conclusion: Preventive arthroscopic DCR in patients with rotator cuff tears and concomitant asymptomatic radiological ACJ arthritis did not result in better clinical or structural outcomes, and it did lead to symptomatic ACJ instability in some patients. Preventive arthroscopic DCR is not recommended in patients with radiological but asymptomatic ACJ arthritis. Further long-term follow-up is needed to confirm the development of symptoms in ACJ arthritis.

Symptomatic residual instability with grade II acromioclavicular injury

PurposeOur objective was to evaluate the effectiveness of arthroscopic distal clavicle resection in cases presenting with pain and subtle instability after neglected grade II acromioclavicular (AC) joint dislocation. MethodsFrom February 1998 to May 2006, 17 patients with symptomatic AC instability following chronic grade II AC joint injury were studied. Sixteen patients were male and one female, with a mean age of 48years. An all-arthroscopic procedure comprising disk removal and distal clavicle resection was performed in all cases. All patients were reviewed clinically, preoperatively and at final follow-up (mean 38months) using the pain score on a visual analog scale and the Constant score. Strength was measured using an Isobex digital strength analyzer. Patient's personal satisfaction after the procedure was documented as excellent, good or poor. Postoperative AC joint radiographs were routinely obtained in all patients to measure the amount of clavicle resection. ResultsTwo patients underwent additional reconstructive surgery for disabling pain and dysfunction even after the arthroscopic resection procedure. The remaining 15 patients were analyzed. The pain scores improved significantly (p = 0.03). The mean pain score was 5.8 (range 5–9) before treatment and 1.6 (range 0–3) at follow-up. The Constant scores had improved significantly at the final follow-up (p = 0.001). The median Constant score increased from 46 (range 36–69) preoperatively to 71 (range 48–84) postoperatively. Strength had improved at the last follow-up. Eleven patients were satisfied and six were not satisfied with this procedure at the final follow-up. ConclusionsArthroscopic distal clavicle resection statistically improved the pain score, Constant score and strength for grade II AC injury with subtle distal clavicle instability. However, six patients (33.5 %) were not satisfied subjectively. This procedure seemed to be a reasonable initial treatment option with lower morbidity.

Medium Term Clinical Results of Arthroscopic Distal Clavicle Resection for the Treatment of Acromioclavicular Joint Osteoarthritis

Medium Term Clinical Results of Arthroscopic Distal Clavicle Resection for the Treatment of Acromioclavicular Joint Osteoarthritis

Acromioclavicular dislocation after arthroscopic distal clavicle resection: a case report

Acromioclavicular dislocation after arthroscopic distal clavicle resection: a case report