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Hashem MH, Hegazy MO, Mohamed MKA, Mohamed MKA, Khater AH. Arthroscopic distal clavicle resection versus conservation in patients with combined rotator cuff tears and acromioclavicular joint osteoarthritis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1795-1801. [PMID: 38413435 DOI: 10.1007/s00590-023-03823-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/20/2023] [Indexed: 02/29/2024]
Abstract
PURPOSE 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. METHODS 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. RESULTS 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 > 24 h 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. CONCLUSION 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.
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Affiliation(s)
- Mohamed H Hashem
- Department of Orthopedic Surgery, Helwan University, Helwan, Egypt
| | | | | | | | - Ahmed Hany Khater
- Department of Orthopedic Surgery, Ain Shams University, Cairo, Egypt
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Zhang J, Li M, Yang Y, Liu W, Meng X, Fei W, Wang J. Bibliometric and visualized analysis of arthroscopic treatment of acromioclavicular joint injury. J Orthop Surg Res 2023; 18:728. [PMID: 37752567 PMCID: PMC10523771 DOI: 10.1186/s13018-023-04193-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Since arthroscopy was discovered to treat acromioclavicular joint injury, people have had great interest and attention to this beautiful and minimally invasive operation, and related research has been increasing worldwide. At present, there is no bibliometric and visualized analysis in this field. The purpose of this study is to explore the research hotspots and trends of arthroscopic treatment of acromioclavicular joint injury through bibliometric and visualized analysis and look forward to the future development direction of clinical practice. METHODS The publications on arthroscopic treatment of acromioclavicular joint injury diseases from its establishment to April 2023 were obtained from the Web of Science (WOS) Core Collection database. CiteSpace, VOSviewer, Scimago graphica and Origin were used for bibliometric and visualized analysis. RESULTS This study included a total of 330 publications. The number of publications tends to increase every year. The USA has the most significant number of publications and citations. Imhoff AB is the most relevant scholar with the largest number of publications in this field, and the scholar with the highest citation and average citations is Mazzocca AD. Tech Univ Munich, Rush University and Charite are the three institutions with the greatest contribution. Tech Univ Munich, Rush University and Charite are the three institutions with the greatest contribution. In addition, "Arthroscopy-the Journal of Arthroscopic and Related Surgery" and "American Journal of Sports Medicine" are the institutions with the most significant number of publications and average citations, respectively. The most common keywords are "acromioclavicular joint dislocation," "arthroscopic resection," "arthroscopic reconstruction" and "coracoclavicular ligament." CONCLUSION The number of publications shows a steady upward trend as a whole. However, there is still a lack of cooperation among countries, institutions and scholars around the world, so various countries, institutions and scholars need to strengthen academic exchanges and expand the field of cooperation, so as to promote further research and development in related fields. However, minimally invasive methods such as arthroscopy are still the hotspots and frontiers in the treatment of acromioclavicular joint injury in the future.
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Affiliation(s)
- Jian Zhang
- Department of Orthopedics, Medical College, Yangzhou University, Yangzhou, China
| | - Mingjun Li
- Department of Orthopedics, Northern Jiangsu People's Hospital, Dalian Medical University, Dalian, China
| | - Yuxia Yang
- Department of Orthopedics, Northern Jiangsu People's Hospital, Dalian Medical University, Dalian, China
| | - Wenkang Liu
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Xiangji Meng
- Department of Orthopedics, Northern Jiangsu People's Hospital, Dalian Medical University, Dalian, China
| | - Wenyong Fei
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China.
| | - Jingcheng Wang
- Department of Orthopedics, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China.
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Patient-reported outcomes of arthroscopic resection of the distal clavicle with concomitant ASD at two-years follow-up: a prospective study of 131 consecutive patients. JSES Int 2022; 6:999-1004. [DOI: 10.1016/j.jseint.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Yiannakopoulos CK, Vlastos I, Theotokatos G, Galanis N. Acromioclavicular joint arthritis is not an indication for routine distal clavicle excision in arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2021; 29:2090-2095. [PMID: 32556365 DOI: 10.1007/s00167-020-06098-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/10/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE 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. METHODS In a cohort of 811 consecutive patients older than 55 years 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 28 months (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). RESULTS 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. CONCLUSION 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. LEVEL OF EVIDENCE II, Prospective cohort study.
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Affiliation(s)
- Christos K Yiannakopoulos
- Metropolitan General Hospital, Athens, Greece. .,School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece.
| | - Iakovos Vlastos
- Metropolitan General Hospital, Athens, Greece.,School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Theotokatos
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikiforos Galanis
- Orthopaedic Department, Medical School, Papageorgiou General Hospital, Aristotle University, Thessaloniki, Greece
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Tang J, Zhao J. Arthroscopic Distal Clavicle Resection Through the Supraspinatus Fossa Portal. Arthrosc Tech 2020; 9:e2057-e2061. [PMID: 33381419 PMCID: PMC7768306 DOI: 10.1016/j.eats.2020.08.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/29/2020] [Indexed: 02/03/2023] Open
Abstract
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.
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Affiliation(s)
- Jin Tang
- Operating Theater, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China,Address correspondence to Jinzhong Zhao, M.D., Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai 200233, China.
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Frigg A, Song D, Willi J, Freiburghaus AU, Grehn H. Seven-year course of asymptomatic acromioclavicular osteoarthritis diagnosed by MRI. J Shoulder Elbow Surg 2019; 28:e344-e351. [PMID: 31279719 DOI: 10.1016/j.jse.2019.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/02/2019] [Accepted: 04/04/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Asymptomatic acromioclavicular osteoarthritis (AC-OA) is a frequent finding in shoulder magnetic resonance imaging (MRI). Its natural course is unknown. Therefore, the question arises whether a resection should be performed simultaneously with shoulder surgery for another reason to prevent future pain and reoperation. The purpose of this study was to investigate the mid-term course of asymptomatic AC-OA. METHODS Overall, 114 asymptomatic AC-OA diagnosed on MRI were followed for 7 years between 2011 and 2018. At baseline, MRI signal enhancement in the clavicle and acromion, OA grade, physical demand as well as the parameters (1) Constant Score Visual Analogue Scale, (2) pain on AC-joint compression, and (3) cross-body adduction test were measured. All patients were followed up after 7 years by interview, and in case of symptoms by clinical examination. The endpoint "deterioration" was reached if 2 of the 3 parameters turned worse. RESULTS Asymptomatic AC-OA remained asymptomatic in 83% of cases, 7% turned better, 10% turned worse. Physical demand and osteoarthritis grade increased the risk of deterioration, whereas MRI signal enhancement in the clavicle or acromion had no influence on outcome. During follow-up, the frequency of pain on AC-joint compression increased from 11% to 16% (P = .24), the frequency of a positive cross-body adduction test increased from 6% to 20% (P = .017), and the mean Constant Score Visual Analogue Scale increased from 10 to 13 points (P < .001) indicating less pain. CONCLUSIONS Asymptomatic AC-OA remained asymptomatic in 90% over 7 years. A simultaneous resection of an asymptomatic AC-OA during shoulder surgery for another reason is not indicated in every patient.
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Affiliation(s)
- Arno Frigg
- Department of Orthopedic and Trauma Surgery, Kantonsspital Graubünden, Chur, Switzerland; Department of Orthopedic Surgery, University Hospital Basel, Basel, Switzerland; Private University of the Principality of Liechtenstein, Triesen, Liechtenstein.
| | - David Song
- Department of Orthopedic and Trauma Surgery, Kantonsspital Graubünden, Chur, Switzerland; Department of Orthopedic Surgery, University Hospital Basel, Basel, Switzerland
| | - Janick Willi
- Department of Orthopedic and Trauma Surgery, Kantonsspital Graubünden, Chur, Switzerland; Department of Orthopedic Surgery, University Hospital Basel, Basel, Switzerland
| | | | - Holger Grehn
- Department of Orthopedic and Trauma Surgery, Kantonsspital Graubünden, Chur, Switzerland
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Chalmers PN, Granger E, Ross H, Burks RT, Tashjian RZ. Preoperative Factors Associated With Subsequent Distal Clavicle Resection After Rotator Cuff Repair. Orthop J Sports Med 2019; 7:2325967119844295. [PMID: 31080842 PMCID: PMC6498781 DOI: 10.1177/2325967119844295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Acromioclavicular osteoarthritis and rotator cuff tears are commonly coincident. Purpose: To determine the rate of subsequent distal clavicle excision (DCE) when rotator cuff repair (RCR) is performed without DCE and the risk factors for subsequent DCE after RCR. Study Design: Case-control study; Level of evidence, 3. Methods: The operative logs of 2 surgeons from 2007 to 2016 were retrospectively reviewed for all patients who underwent RCR with or without DCE. Preoperative demographic data, symptoms, physical examination, and standardized outcomes (visual analog scale for pain, Simple Shoulder Test, and American Shoulder and Elbow Surgeons score) were noted. Acromioclavicular (AC) arthritis was classified on preoperative radiographs. The rate of subsequent surgery on the AC joint was determined via chart review, and univariate and multivariate analyses were conducted to determine risk factors for revision. Results: In total, 894 patients underwent isolated RCR, and 46 underwent concomitant RCR and DCE. On retrospective chart review, of those who underwent isolated RCR, the revision rate for any reason was 7.5% (67 patients), and the rate of subsequent AC surgery was 1.1% (10 patients). Preoperatively, 88% of the total cohort was considered to have a radiographically normal AC joint. On multivariate analysis of patients who underwent isolated RCR, the risk factors for subsequent AC surgery included preoperative tenderness to palpation at the AC joint (10% vs 63%, P < .001), female sex (35% vs 80%, P < .001), and surgery on the dominant side (60% vs 100%, P = .002). On multivariate analysis, these 3 factors explained 50% of the variance in revision AC surgery. When these 3 factors were present in combination, there was a 40% rate of revision AC surgery. Conclusion: This records review found that 10 of 894 (1.1%) rotator cuff repairs underwent subsequent distal clavicle resection. Risk factors for subsequent DCE included tenderness to palpation at the AC joint, female sex, and surgery on the dominant side, with subsequent DCE performed in 40% of cases with a combination of these 3 factors. Because the duration of follow-up was short and the number of reoperations small, some caution is recommended in interpreting these results, as the analyses may be underpowered.
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Affiliation(s)
- Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah Medical Center, Salt Lake City, Utah, USA
| | - Erin Granger
- Department of Orthopaedic Surgery, University of Utah Medical Center, Salt Lake City, Utah, USA
| | - Hunter Ross
- Department of Orthopaedic Surgery, University of Utah Medical Center, Salt Lake City, Utah, USA
| | - Robert T Burks
- Department of Orthopaedic Surgery, University of Utah Medical Center, Salt Lake City, Utah, USA
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah Medical Center, Salt Lake City, Utah, USA
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Livingstone A, Asaid R, Moaveni AK. Is routine distal clavicle resection necessary in rotator cuff repair surgery? A systematic review and meta-analysis. Shoulder Elbow 2019; 11:39-45. [PMID: 31019561 PMCID: PMC6463380 DOI: 10.1177/1758573217741124] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 10/14/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND The objective of the present study was to perform a systematic review and meta-analysis of randomized controlled trials looking at the effect of distal clavicle resection in patients undergoing rotator cuff repair (RCR). METHODS A systematic literature search was undertaken to identify randomized controlled trials looking at RCR +/- distal clavicle resection. Primary clinical outcome measures included in the meta-analysis were American Shoulder Elbow Society (ASES) score, pain on visual analogue scale and range of motion in forward elevation. RESULTS The systematic review identified three studies with a total of 203 participants. Those who underwent distal clavicle resection in conjunction with RCR had worse pain and acromioclavicular joint tenderness at 3-month follow-up. This difference, however, was not observed at the 24-month follow-up. The mean difference (95% confidence interval) for the ASES score was 0.45 (-3.67 to 4.58) and pain on visual analogue scale was - 0.27 (-0.70 to 0.16). CONCLUSIONS Routine distal clavicle resection in the setting of rotator cuff repair does not result in improved outcomes for patients with no difference being observed at 24 months post surgery. The results of our systematic review and meta-analysis do not support routine distal clavicle resection when performing RCR.
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Affiliation(s)
| | - Rafik Asaid
- Alfred Hospital, Melbourne, VIC, Australia,Rafik Asaid, Alfred Hospital, 55 Commercial Road, Melbourne, VIC 3004, Austrailia.
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Does Distal Clavicle Resection Decrease Pain or Improve Shoulder Function in Patients With Acromioclavicular Joint Arthritis and Rotator Cuff Tears? A Meta-analysis. Clin Orthop Relat Res 2018; 476:2402-2414. [PMID: 30334833 PMCID: PMC6259902 DOI: 10.1097/corr.0000000000000424] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND 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. QUESTIONS/PURPOSES 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. METHODS 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. RESULTS 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). CONCLUSIONS 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 OF EVIDENCE Level I, therapeutic study.
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Gaillard J, Calò M, Nourissat G. Bipolar Acromioclavicular Joint Resection. Arthrosc Tech 2017; 6:e2229-e2233. [PMID: 29349023 PMCID: PMC5765814 DOI: 10.1016/j.eats.2017.08.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 08/08/2017] [Indexed: 02/03/2023] Open
Abstract
Acromioclavicular (AC) joint arthropathy remains one of the most common causes of shoulder pain. In the case of AC joint arthropathy resistant to conservative treatment, most authors have recognized distal clavicle resection as the gold-standard treatment. However, some challenges remain to be solved. One is the difficulty in visualization of the superior and posterior part of the distal clavicle from the midlateral portal, causing an incomplete resection of the distal clavicle. This could potentially lead to unresolved pain and therefore surgical failure. We propose a technique for arthroscopic resection of the distal clavicle and the medial portion of the acromion, without any added portal: bipolar AC joint resection. The term "bipolar" is used because both the acromion and the clavicle are resected, without injuring the superior capsule.
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Affiliation(s)
- Julien Gaillard
- Upper Extremity Unit, Department of Orthopaedics, Saint-Antoine Hospital, Paris, France
| | - Michel Calò
- Upper Extremity Unit, Department of Orthopaedics, Saint-Antoine Hospital, Paris, France
- Department of Orthopaedics and Traumatology, Ospedale San Luigi Gonzaga, Orbassano, Italy
| | - Geoffroy Nourissat
- Upper Extremity Unit, Department of Orthopaedics, Saint-Antoine Hospital, Paris, France
- Clinique des Maussins, Groupe Ramsay Generale de Santé, Paris, France
- Address correspondence to Geoffroy Nourissat, M.D., Ph.D., Clinique des Maussins, Groupe Ramsay Generale de Santé, 67 Rue de Romainville, Paris, France.Clinique des MaussinsGroupe Ramsay Generale de Santé67 Rue de RomainvilleParisFrance
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Lerch S, Elki S, Jaeger M, Berndt T. [Arthroscopic subacromial decompression]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2016; 28:373-91. [PMID: 27259482 DOI: 10.1007/s00064-016-0450-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/15/2016] [Accepted: 02/19/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Coracoacromial ligament release to widen the subacromial space, resection of the anterior undersurface of the acromion and, if needed, caudal exophytes at the acromioclavicular joint. INDICATIONS All types of outlet impingement after 3 months of conservative treatment. CONTRAINDICATIONS Impingement syndrome with instability/muscular imbalance, massive rotator cuff tear, unstable os acromionale, posterior-superior impingement, joint infection, freezing phase of a secondary frozen shoulder. SURGICAL TECHNIQUE Lateral decubitus position with traction device for the arm. Diagnostic arthroscopy of the glenohumeral joint via standard portals. With arthroscope moved to the subacromial space, bursectomy, electrosurgical release of coracoacromial ligament, resection of acromial hook through standard posterior portal. POSTOPERATIVE MANAGEMENT Physiotherapy or self-exercises on postoperative day 1, pain-adapted analgesia to avoid shoulder stiffness. RESULTS Several studies present positive long-term results compared to conservative treatment (and open acromioplasty) for partial rotator cuff tears and for elderly patients. With a 20-year follow-up, successful results have been achieved for all patients with isolated impingement syndrome.
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Affiliation(s)
- S Lerch
- Klinikum Agnes Karll Laatzen, Klinik für Orthopädie, Unfallchirurgie und Sportmedizin, Klinikum Region Hannover, Hildesheimer Straße 158, 30880, Laatzen, Deutschland.
| | - S Elki
- Klinikum Agnes Karll Laatzen, Klinik für Orthopädie, Unfallchirurgie und Sportmedizin, Klinikum Region Hannover, Hildesheimer Straße 158, 30880, Laatzen, Deutschland
| | - M Jaeger
- Klinikum Agnes Karll Laatzen, Klinik für Orthopädie, Unfallchirurgie und Sportmedizin, Klinikum Region Hannover, Hildesheimer Straße 158, 30880, Laatzen, Deutschland
| | - T Berndt
- Klinikum Agnes Karll Laatzen, Klinik für Orthopädie, Unfallchirurgie und Sportmedizin, Klinikum Region Hannover, Hildesheimer Straße 158, 30880, Laatzen, Deutschland
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Godinho GG, França FDO, Alves FJM, Watanabe FN, Nobre LO, De Almeida Neto MA, Mendes Da Silva MA. EVALUATION OF ANATOMICAL INTEGRITY USING ULTRASOUND EXAMINATION, AND FUNCTIONAL INTEGRITY USING THE CONSTANT & MURLEY SCORE, OF THE ROTATOR CUFF FOLLOWING ARTHROSCOPIC REPAIR. Rev Bras Ortop 2015; 45:174-80. [PMID: 27022538 PMCID: PMC4799143 DOI: 10.1016/s2255-4971(15)30289-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective: To evaluate the functional and anatomical results from surgical treatment via arthroscopy in cases of complete rupture of the rotator cuff, using ultrasound images and the Constant and Murley functional index to investigate the correlation between them. Methods: 100 patients (110 shoulders) were evaluated. The mean follow-up was 48.8 ± 33.28 months (12 to 141 months). The mean age was 60.25 ± 10.09 (36 to 81 years). Rupture of the supraspinal tendon alone occurred in 85 cases (77%), and in association with the infraspinatus in 20 cases (18%) and subscapularis in four shoulders (4%). An association of supraspinatus, infraspinatus and subscapularis lesions was found in one shoulder (1%). The lesions were classified according to DeOrio and Cofield scores as small/medium in 85 shoulders (77%) and large/extensive in 25 (23%). The clinical results were assessed in accordance with the Constant and Murley criteria. The ultrasound results relate to reports issued by different radiologists. Statistical analysis was carried out using the chi-square test, Fisher's exact test, Student's t test, Pearson's correlation, Kruskal-Wallis correlation and logistic regression (significance: p < 0.05). Results: The mean Constant evaluation was 85.3 ± 10.06 in the normal shoulders and 83.96 ± 8.67 in the operated shoulders (p = 0.224). Excellent and good results were found in 74 shoulders (67%), satisfactory and moderate results in 32 (29%) and poor results in four (4%). The ultrasound evaluation showed 38 shoulders with re-rupture (35%) and absence of rupture in 71 (65%). Among the 74 shoulders (67%) with excellent/good results, 22 (30%) presented re-rupture in the ultrasound report (p = 0.294). Among the four shoulders (4%) with poor results, two (50%) presented reports of intact tendons (p = 0.294). Conclusion: There was no statistically valid correlation between the ultrasound diagnosis and the clinical evaluation of results among the patients who underwent arthroscopic repair to treat full tear lesions of the rotator cuff. The clinical results from the complete rotator cuff repairs via arthroscopy presented a high level of functional recovery (Constant 83.96), compared with the contralateral shoulder. The postoperative ultrasound reports presented a high percentage of re-rupture (35%). Postoperative strength was greater among the patients aged under 60 years (p = 0.002) and in cases of lesions less than or equal to 3 cm (p = 0.003).
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Affiliation(s)
- Glaydson Gomes Godinho
- MSc and PhD in Orthopedics. Head of the Shoulder Group at the Orthopedic Hospital and Belo Horizonte Hospital, Belo Horizonte, MG
| | - Flavio de Oliveira França
- Attending Surgeon in the Shoulder Group at the Orthopedic Hospital and Military Police Hospital of Minas Gerais, Belo Horizonte, MG
| | - Freitas José Marcio Alves
- Attending Surgeon in the Shoulder Group at the Orthopedic Hospital and Belo Horizonte Hospital, Belo Horizonte, MG
| | - Fábio Nagato Watanabe
- Residents in the Shoulder Group at the Orthopedic Hospital and Belo Horizonte Hospital, Belo Horizonte, MG
| | - Leonardo Oliveira Nobre
- Residents in the Shoulder Group at the Orthopedic Hospital and Belo Horizonte Hospital, Belo Horizonte, MG
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Park YB, Koh KH, Shon MS, Park YE, Yoo JC. Arthroscopic distal clavicle resection in symptomatic acromioclavicular joint arthritis combined with rotator cuff tear: a prospective randomized trial. Am J Sports Med 2015; 43:985-90. [PMID: 25583758 DOI: 10.1177/0363546514563911] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
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.
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Affiliation(s)
- Yong Bok Park
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung Hwan Koh
- Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University, Goyang, Korea
| | - Min Soo Shon
- Department of Orthopaedic Surgery, National Medical Center, Seoul, Korea
| | - Young Eun Park
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Chul Yoo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Bouchard A, Garret J, Favard L, Charles H, Ollat D. Failed subacromial decompression. Risk factors. Orthop Traumatol Surg Res 2014; 100:S365-9. [PMID: 25454330 DOI: 10.1016/j.otsr.2014.09.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 09/17/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Arthroscopic subacromial decompression (acromioplasty) is widely held to be effective, although pain may persist after the procedure. The objective of this study was to evaluate the proportion of patients with residual pain (i.e., the failure rate) after isolated subacromial decompression and to look for predictors of failure. MATERIAL AND METHOD We conducted a retrospective multicentre study of 108 patients managed with isolated arthroscopic subacromial decompression between 2007 and 2011, for any reason. We excluded patients in whom surgical procedures on the rotator cuff tendons were performed concomitantly. Data were collected from the medical records, a telephone questionnaire, and radiographs obtained before surgery and at last follow-up. Failure was defined as persistent pain (visual analogue scale score>3) more than 6 months after surgery and at last follow-up. RESULTS The failure rate was 29% (31/108). Two factors significantly predicted failure, namely, receiving workers' compensation benefits for the shoulder condition and co-planing. Heterogeneous calcific tendinopathy and deep partial-thickness rotator cuff tears were also associated with poorer outcomes, but the effect was not statistically significant. DISCUSSION Co-planing may predict failure of subacromial decompression, although whether this effect is due to an insufficient degree of co-planing or to the technique itself is unclear. Nevertheless, in patients with symptoms from the acromio-clavicular joint, acromio-clavicular resection is probably the best option. Receiving workers' compensation benefits was also associated with treatment failure, as a result of well-known parameters related to the social welfare system. CONCLUSION Isolated arthroscopic subacromial decompression is effective in 70% of cases. We recommend the utmost caution if co-planing is considered and/or the patient receives workers' compensation benefits for the shoulder condition, as these two factors are associated with a significant increase in the failure rate. LEVEL OF EVIDENCE IV (retrospective study).
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Affiliation(s)
- A Bouchard
- Hôpital d'Instruction des Armées Bégin Saint-Mandé, 69, avenue de Paris, 94160 Saint-Mandé, France.
| | - J Garret
- Clinique du Parc, 69000 Lyon, France
| | - L Favard
- Hôpital Trousseau, CHU de Tours, 37000 Tours, France
| | - H Charles
- 13, place Philippe Lebon, 59000 Lille, France
| | - D Ollat
- Hôpital d'Instruction des Armées Bégin Saint-Mandé, 69, avenue de Paris, 94160 Saint-Mandé, France
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Oh JH, Kim JY, Choi JH, Park SM. Is arthroscopic distal clavicle resection necessary for patients with radiological acromioclavicular joint arthritis and rotator cuff tears? A prospective randomized comparative study. Am J Sports Med 2014; 42:2567-73. [PMID: 25193889 DOI: 10.1177/0363546514547254] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
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.
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Affiliation(s)
- Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Yoon Kim
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jun Ha Choi
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Min Park
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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Kim W, Deniel A, Ropars M, Guillin R, Fournier A, Thomazeau H. How long should arthroscopic clavicular resection be in acromioclavicular arthropathy? A radiological-clinical study (with computed tomography) of 18 cases at a mean 4 years' follow-up. Orthop Traumatol Surg Res 2014; 100:S219-23. [PMID: 24703795 DOI: 10.1016/j.otsr.2014.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Endoscopic clavicular resection is a common procedure, but few studies have analyzed predictive factors for outcome. HYPOTHESES 1) Computed tomography (CT) of clavicular resection is reproductible; 2) Functional outcome correlates with resection length; 3) Other factors also influence outcome. MATERIAL AND METHODS Patients operated on between 2005 and 2010 were called back to establish functional scores (Constant, Simple Shoulder Test [SST], satisfaction) and undergo low-dose bilateral comparative computed tomography (CT) centered on the acromioclavicular joints. The assessment criteria were resection edge parallelism and resection length, measured using OsiriX software. Radiological and clinical data were correlated. RESULTS 18 out of 21 patients (85%: 3 female, 15 male) were assessed. Mean age at surgery was 49 years (range, 40-62 yrs); mean follow-up was 4.2 years (1.6-7.2 yrs). Mean Constant score rose from 57.7 (25-85) to 70.2 (30-96); mean postoperative SST was 9.3 (3-12). 11 patients had very good and 4 poor results. CT resection length was reproducible, with intraclass, intra- and interobserver correlation coefficients >95%. There was no significant correlation between articular resection length on CT and functional scores (P=0.2). Functional scores were negatively influenced by an occupational pathologic context (P<0.01) and by associated tendinopathy. DISCUSSION AND CONCLUSION Low-dose CT enabled reproducible analysis of clavicular resection. The hypothesized correlation between resection length and functional result was not confirmed. Work accidents and occupational disease emerged as risk factors. LEVEL OF EVIDENCE Single-center retrospective analytic cohort study. Level 4, guideline grade C.
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Affiliation(s)
- W Kim
- Service de chirurgie orthopédique et réparatrice, CHU Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 09, France
| | - A Deniel
- Département de radiologie, CHU Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 09, France
| | - M Ropars
- Service de chirurgie orthopédique et réparatrice, CHU Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 09, France
| | - R Guillin
- Département de radiologie, CHU Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 09, France
| | - A Fournier
- Service de chirurgie orthopédique et réparatrice, CHU Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 09, France
| | - H Thomazeau
- Service de chirurgie orthopédique et réparatrice, CHU Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 09, France.
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Abstract
Shoulder arthroscopic procedures have become common in today's orthopedic practice. The safety of shoulder arthroscopy though well established, is not without complications both minor and significant. The true incidence of complications is difficult to identify in the current literature. However, as with all procedures, complications associated with shoulder arthroscopy do occur. General complications (ie, infection), those specific to shoulder arthroscopy (ie, positioning) and those associated with specific procedures (ie, failure) all have been recognized. The purpose of this article is to review the current literature regarding complications in shoulder arthroscopy, provide insight into the risk factors and types of complications and to provide guidelines on the prevention and management of complications if and when they occur.
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Abstract
Rotator cuff repair is a common orthopedic procedure. Techniques have evolved from open procedures to an arthroscopic (assisted) procedure in many patients. Tendon healing is anticipated, but complications may occur. There is approximately 90% patient satisfaction with index surgery, but imaging studies reveal defect recurrence in approximately one-third of the larger tears. For patients who are limited by pain, revision surgery is considered. Newer techniques of stabilizing the damaged structures, combined with delay in rehabilitation, improved the number of successful surgeries. Revision surgery for pain relief is promising when causes of persistent pain have been identified. Strength deficits may persist, particularly if permanent atrophy and fatty infiltration within the cuff muscles are demonstrated preoperatively.
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21
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Acromioclavicular Joint Disorders. Curr Sports Med Rep 2007. [DOI: 10.1097/01.csmr.0000306492.61271.e0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Acromioclavicular joint reoperation after arthroscopic subacromial decompression with and without concomitant acromioclavicular surgery. Arthroscopy 2007; 23:804-8. [PMID: 17681199 DOI: 10.1016/j.arthro.2007.02.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Revised: 01/17/2007] [Accepted: 02/05/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to examine the reoperation rate on the acromioclavicular (AC) joint after arthroscopic subacromial decompression (ASAD) with and without concomitant AC joint surgery and to identify factors related to continued AC joint symptoms. METHODS We conducted a retrospective review of 1,482 cases without concomitant shoulder pathology that were followed up by physical examination, phone interview, questionnaire, or chart review. Group A, patients who underwent ASAD alone, consisted of 1,091 cases. Group B, patients who underwent ASAD with concomitant AC joint surgery consisting of either co-planing or arthroscopic distal clavicle resection (ADCR), consisted of 391 cases. RESULTS A total of 22 patients underwent reoperation on the AC joint. The overall reoperation rate was 1.5%, or 22 of 1,482 patients. The index procedure failed in 16 patients from the ASAD group (group A), yielding a reoperation rate of 1.5%. The index procedure failed in 6 patients from the group undergoing ASAD with concomitant AC joint surgery (group B), for a reoperation rate of 1.5%. Reoperation occurred at a mean of 22 months and 8 months for group A and group B, respectively. Overall, 17 of 22 patients (77%) who required AC joint reoperation were either Workers' Compensation (WC) or litigation cases. The reoperation rate was 2.4% for WC patients and 0.8% for non-WC patients. WC status was found to be a statistically significant factor in the rate of reoperation for AC joint symptoms (P < .05). Of the 22 patients, 10 continued to have pain at a mean of 25.9 months (range, 9 to 53 months) after reoperation. Given the similar rates of reoperation, routine AC joint violation by co-planing or ADCR is not recommended during ASAD. Reoperation for continued AC joint symptoms was associated with a nearly 50% rate of continued symptoms. CONCLUSIONS The results of the study show that the incidence of reoperation on the AC joint after ASAD with or without concomitant AC joint surgery is small for both groups with a 1.5% rate of reoperation for each group. The incidence of reoperation is lower, at 0.8%, for non-WC cases. In addition, there was a high rate of continued symptoms, with 45% of patients having continued pain after reoperation. Violation of the AC joint during the initial surgery by co-planing or ADCR did not alter the reoperation rate for AC joint symptoms. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Clavert P, Leconiat Y, Dagher E, Kempf JF. [Arthroscopic surgery of the acromioclavicular joint.]. CHIRURGIE DE LA MAIN 2007; 25S1:S36-S42. [PMID: 17349408 DOI: 10.1016/j.main.2006.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Lesion of the acromioclavicular joint is a usual clinical condition because of it superficial situation. It is often involved in trauma of the shoulder girdle. Moreover, degenerative changes are quite always observed for patients over 40. Distal clavicle resection as a treatment of acromioclavicular joint disease had been first described in 1941. Clinical results in term of mobility and shoulder pain are good and durable in time. Referring to the expansion arthroscopic techniques, distal clavicle resection lead to same middle and long term results as open surgery. Arthroscopic procedures have the theoretical advantages of no deltoid disruption and may help the surgeon to diagnose and treat associated lesions such as rotator cuff ruptures. More recently, arthroscopic surgeries for fresh and/or chronic acromioclavicular disjunctions were proposed. These procedures remain in development and need further evaluations.
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Affiliation(s)
- P Clavert
- Service d'orthopédie et d'arthroscopie de l'appareil locomoteur, CHRU de Hautepierre, avenue Molière, 67091 Strasbourg cedex, France
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Rabalais RD, McCarty E. Surgical treatment of symptomatic acromioclavicular joint problems: a systematic review. Clin Orthop Relat Res 2007; 455:30-7. [PMID: 17159577 DOI: 10.1097/blo.0b013e31802f5450] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Excision of the distal clavicle has become the mainstay of surgical treatment for acromioclavicular joint arthritis and osteolysis refractory to nonoperative management. Surgical options for symptomatic acromioclavicular joint abnormalities refractory to nonoperative treatment are the classic open distal clavicle excision, direct (superior) arthroscopic excision, and indirect (bursal) arthroscopic distal clavicle excision. We asked whether any of these three procedures provided a better result. We systematically reviewed the medical literature (Medline, EMBASE), assigned a level of evidence for available studies, and critically identified the flaws and biases in the studies to provide comparisons between the published reports. We limited the literature review to clinical reports in the English language published in peer-reviewed journals. The literature supports surgical excision, but the reports are all Level III or IV evidence consisting largely of retrospective case series. Arthroscopic distal clavicle resection has provided more "good or excellent" results than has the open procedure, but is comprised of low-level evidence. Distal clavicle resection has provided satisfactory results when combined with other procedures. Simple distal clavicle resection may have worse outcomes when performed after preceding trauma. The published reports of the removal of medial acromial and inferior distal clavicle osteophytes when performing subacromial decompression are conflicting and may increase post-operative acromioclavicular symptoms.
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Affiliation(s)
- R David Rabalais
- Department of Orthopaedics, CU Sports Medicine, University of Colorado Health Sciences Center, Boulder, CO 80304, USA.
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Abstract
Acromioclavicular joint injuries and, more specifically, separations are commonplace both in general practice and during athletic participation. This article reviews the traditional classification as well as the clinical evaluation of patients with acute and chronic acromioclavicular joint separations. It also highlights many recent advances, principally in the anatomy and biomechanics of the acromioclavicular joint ligamentous complex. The concept of increases in superior translation as well as disturbances in horizontal translation with injuries to this joint and ligaments are discussed. This information, coupled with the unpredictable long-term results with the Weaver-Dunn procedure and its modifications, have prompted many recent biomechanical studies evaluating potential improvements in the surgical management of acute and chronic injuries. The authors present these recent works investigating cyclic loading and ultimate failure of traditional reconstructions, augmentations, use of free graft, and the more recent anatomic reconstruction of the conoid and trapezoid ligaments. The clinical results (largely retrospective), including acromioclavicular joint repair, reconstruction and augmentation with the coracoclavicular ligament, supplemental sutures, and the use of free autogenous grafts, are summarized. Finally, complications and the concept of the failed distal clavicle resection and reconstruction are addressed. The intent is to provide a current, in-depth treatise on all aspects of acromioclavicular joint complex injuries to include anatomy, biomechanics, benchmark studies on instability and reconstruction, clinical and radiographic evaluation, and to present the most recent clinical research on surgical outcomes.
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Affiliation(s)
- Augustus D Mazzocca
- Department of Orthopaedics, University of Connecticut Health Center, Farmington, CT 06034, USA
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Brislin KJ, Field LD, Savoie FH. Complications after arthroscopic rotator cuff repair. Arthroscopy 2007; 23:124-8. [PMID: 17276218 DOI: 10.1016/j.arthro.2006.09.001] [Citation(s) in RCA: 219] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2005] [Revised: 03/26/2006] [Accepted: 09/05/2006] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine the complication rate of a consecutive series of patients undergoing arthroscopic rotator cuff repair. METHODS From January 2003 to June 2003, all patients undergoing primary arthroscopic rotator cuff repair were identified. A total of 263 patients were identified. Medical records were reviewed to identify complications in the study patients. RESULTS A total of 28 patients (10.6%) sustained a complication. Complications included shoulder stiffness, failure of healing, infection, reflex sympathetic dystrophy, deep venous thrombosis, and death. CONCLUSIONS The most common complication was recognized as persistent stiffness that usually responded to extensive physical therapy. Complications after arthroscopic rotator cuff repair are similar to results published for open rotator cuff repair. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Kenneth J Brislin
- Orthopaedic Associates of Allentown, Allentown, Pennsylvania 18103, USA.
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Levine WN, Soong M, Ahmad CS, Blaine TA, Bigliani LU. Arthroscopic distal clavicle resection: a comparison of bursal and direct approaches. Arthroscopy 2006; 22:516-20. [PMID: 16651161 DOI: 10.1016/j.arthro.2006.01.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To test the hypothesis that the direct (superior) approach to arthroscopic distal clavicle resection is as safe and effective as the bursal (subacromial) approach. METHODS All patients who had an arthroscopic distal clavicle resection in our institution between 1994 and 2002 were reviewed. Patients with a history of acromioclavicular joint (ACJ) instability, previous shoulder surgery, glenohumeral pathology, full-thickness rotator cuff tear, or other significant orthopaedic comorbidity were excluded. Outcome data were collected including the American Shoulder and Elbow Surgeons (ASES) score as well as subjective ratings of pain and instability. RESULTS Follow-up was completed on 66 shoulders of 60 patients. Twenty-four shoulders had a bursal approach (group I) and 42 had a direct approach (group II). There were 45 men and 15 women with an average age of 46 years (range, 21 to 78 years). Follow-up averaged 6.0 years (range, 2 to 11.5 years). The average ASES score was 90 (range, 53-100) in group I and 94 (range, 55-100) in group II. Four patients (10%) in group II required reoperation: 2 patients required ACJ stabilization at 6 and 9 months postoperatively because of anteroposterior instability, and 2 patients required resection again at 5 years because of recurrent symptoms. CONCLUSIONS Both the direct and bursal approaches lead to satisfactory outcomes in the majority of patients with ACJ arthrosis. However, the direct approach to the ACJ may damage the superior capsular ligaments, potentially leading to distal clavicle instability. Care should be taken when performing the direct ACJ resection to avoid disrupting the capsular restraints. LEVEL OF EVIDENCE Level IV therapeutic case series.
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Affiliation(s)
- William N Levine
- Center for Shoulder, Elbow and Sports Medicine, Columbia University, Columbia University Medical Center, New York, New York, USA.
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Barber FA. Long-term results of acromioclavicular joint coplaning. Arthroscopy 2006; 22:125-9. [PMID: 16458796 DOI: 10.1016/j.arthro.2005.08.046] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2005] [Revised: 06/18/2005] [Accepted: 08/22/2005] [Indexed: 02/02/2023]
Abstract
PURPOSE Coplaning removes medial acromial spurs and portions of the distal clavicle with an arthroscopic subacromial decompression (ASD). Concerns exist that this violates inferior acromioclavicular (AC) ligaments and increases AC joint mobility, resulting in long-term problems. The purpose of this study was to re-evaluate 3 cohorts of patients who underwent ASD with various degrees of coplaning and to determine if late AC joint tenderness or reoperation had occurred. TYPE OF STUDY Nonrandomized control study. METHODS Eighty-one patients undergoing ASD were divided into 3 groups. Group 1 (24) underwent removal of inferior clavicle osteophytes, group 2 (34) had a distal clavicle hemiresection with up to 50% of the articular cartilage removed, and group 3 (23) had complete distal clavicle resection. Radiographs, charts, and arthroscopic videotapes were reviewed to determine the amount of clavicle removed. Follow-up evaluations included Constant-Murley, American Shoulder and Elbow Surgeons (ASES), SANE, and Rowe shoulder scores with special attention given to AC joint pain and additional procedures. RESULTS The average patient age was 46 years (range, 19 to 81 years) and follow-up was 73 months. At follow-up, the average Constant, ASES, Row, and SANE scores were: for group 1, 97.1, 97.5, 96.9, and 95.8, respectively; for group 2, 95.1, 97.4, 96, and 92.8, respectively; and for group 3, 96.3, 98.3, 96.1, and 95.7. No patient required additional shoulder surgery. CONCLUSIONS Coplaning did not increase AC joint symptoms, compromise clinical results, or lead to additional surgery at an average follow-up of 6 years. LEVEL OF EVIDENCE Level IV, therapeutic case series study.
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Affiliation(s)
- F Alan Barber
- Plano Orthopedic and Sports Medicine Center, Plano, Texas 75093, USA
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29
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Abstract
This article deals with the diagnosis and treatment of shoulder impingement syndrome.
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Affiliation(s)
- Jeremy Henrichs
- University of Pittsburgh Medical Center for Sports Medicine, 3200 South Water Street, Pittsburgh, PA 15203, USA.
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30
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Kay SP, Dragoo JL, Lee R. Long-term results of arthroscopic resection of the distal clavicle with concomitant subacromial decompression. Arthroscopy 2003; 19:805-9. [PMID: 14551540 DOI: 10.1016/s0749-8063(03)00682-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE The goal of the study was to evaluate the long-term outcome of combined arthroscopic distal clavicle excision and subacromial decompression. TYPE OF STUDY Retrospective, long-term cohort evaluation. METHODS Twenty patients with an average follow-up of 6 years (range, 3.9 to 9 years) were reviewed. All patients had ipsilateral impingement syndrome and acromioclavicular joint disease at the time of surgery and underwent arthroscopic subacromial decompression combined with arthroscopic distal clavicle excision. All patients returned for evaluation in person, in addition to filling out a questionnaire incorporating the University of California, Los Angeles (UCLA), and Constant scoring systems. Preoperative and postoperative radiographs were available for all patients. RESULTS Postoperatively, all patients had pain relief and were satisfied with the result. The average postoperative UCLA Shoulder score was 29.8 +/- 0.6, compared with 17.5 +/- 3.0 before surgery (P =.001). The Constant Shoulder score averaged 98.5 +/- 2.1 postoperatively, compared with 70.5 +/- 11.2 preoperatively (P =.001). There was 100% good to excellent results using both scoring systems. Individual components of the UCLA scoring system (pain, function, and power) all showed significant postoperative improvement (P =.001). Constant categories of pain, activities of daily living, range of motion, and power also improved. Follow-up radiographs showed maintenance of the resected distal clavicle in 19 patients. Five patients (25%) had radiographic evidence of calcific density distal to the resected clavicle but were asymptomatic. CONCLUSIONS The long-term results of arthroscopic resection of the distal clavicle with concomitant subacromial decompression are uniformly good or excellent. Impingement and acromioclavicular joint disease frequently coexist and should be identified and treated concurrently.
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Affiliation(s)
- Stephen P Kay
- The Shoulder Institute, Century City, California, USA.
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31
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Abstract
Although AC pathology usually represents a late manifestation of outlet impingement, it typically presents as a cause of pain that is resistant to nonoperative and operative measures designed to treat purely anterior acromial pathology. The bursitis that occurs with AC joint impingement may be indistinguishable from anterior acromial impingement on clinical presentation; however, physical examination, diagnostic injection, and radiographic evaluation are generally sufficient to establish the diagnosis of AC joint impingement. Nonoperative measures are indicated for the treatment of acute bursitis, although operative intervention may be necessary in cases of large, distally projecting osteophytes in the presence of AC joint degeneration. Acromioclavicular pathology, when present, should be addressed at the time of subacromial decompression, and may involve distal clavicular resection, beveling of the AC joint, or excision of marginal osteophytes. The results of surgery to address the AC contribution to impingement are generally favorable; future investigation may further clarify the role of coplaning and its potential contribution to continued postoperative AC pain and symptomatic instability.
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Affiliation(s)
- Andrew L Chen
- New York University-Hospital for Joint Diseases, 305 Second Avenue, Suite #4, New York, NY 10003, USA
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32
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Abstract
We review the literature on complication of arthroscopic shoulder surgery and their management. Computer data based searches were used to identify articles regarding complications of shoulder arthroscopy, as well as hand searches of Arthroscopy and Journal of Shoulder and Elbow Surgery over the last decade. Arthroscopic shoulder surgery has become a popular therapeutic and diagnostic procedure during the past two decades. As with all interventions complications can occur which require recognition and management by the orthopedic surgeon. While the literature is helpful with identifying types of complications, establishing the rate of these complications remains elusive. These complications can be divided into general complications, complications generic to all shoulder procedures, and complications specific to the type of procedure performed. General complications such as infection and anesthesia problems continue to show low incidences. Shoulder arthroscopy presents increased risk of complications over knee arthroscopy in regard to vascular and neurologic injury, fluid extravasation, stiffness, iatrogenic tendon injury, and equipment failure. New techniques of increased complexity for subacromial surgery, rotator cuff repair, and arthroscopic instability present new problems related to implant failure, nerve injury, iatrogenic fracture, and capsular necrosis. While the rate of complications especially with newer procedures remain elusive, most studies suggest that the rate is low, 5.8-9.5% in all recent review studies published. Underreporting complications makes assessment of incidence rates of complication difficult. Proper patient selection, attention to operative detail, and careful post-operative monitoring can minimize the morbidity associated with these complications.
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Affiliation(s)
- Stephen C Weber
- Sacramento Knee and Sports Medicine, Sacramento, California, USA.
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33
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Abstract
PURPOSE Coplaning removes inferior spurs or portions of the distal clavicle to decrease injury to the rotator cuff. This study sought to determine if the presence or degree of coplaning influenced the results and if reoperations for distal clavicle symptoms were needed. TYPE OF STUDY Nonrandomized control study. METHODS A total of 76 patients undergoing arthroscopic subacromial decompression (ASD) followed for at least 25 months were divided into 3 groups. Group 1 included 28 patients who underwent ASD with removal of only an inferior clavicular osteophyte. Group 2 included 27 patients with resection of any inferior clavicle spur, violation of the inferior joint capsule, and removal of articular cartilage to a level adjacent with the resected acromion. As much as 50% of the articular cartilage was removed in some cases. Group 3 included 21 patients who underwent a complete distal clavicle excision. Radiographs, charts, and arthroscopic videotapes were reviewed and the degree of claviculectomy exactly determined. Follow-up evaluations included the Constant-Murley, American Shoulder and Elbow Surgeons (ASES), SANE, and Rowe shoulder scores, with special attention given to acromioclavicular (AC) joint pain and additional operations. RESULTS The average age of the patients was 49 years (range, 19 to 81 years) and follow-up averaged 40 months (range, 25 to 68 months). Follow-up Constant, ASES, Rowe, and SANE scores for the various groups were calculated. Group 1 scores were 99.4, 98.7, 98.6, and 98.1, respectively; group 2 scores were 96.8, 98.7, 98.5, and 95.7, respectively; and group 3 scores were 98.4, 99.4, 99.3, and 98.6, respectively. No patient required any additional AC joint surgery. CONCLUSIONS Violation of the AC joint capsule and partial distal clavicle resection to make it confluent with the resected acromion (coplaning), does not cause increased AC joint symptoms, compromise the results, or lead to additional surgery at an average 40-month follow-up.
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Affiliation(s)
- F A Barber
- Plano Orthopedic and Sports Medicine Center, Plano, Texas, USA.
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34
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Tytherleigh-Strong G, Gill J, Sforza G, Copeland S, Levy O. Reossification and fusion across the acromioclavicular joint after arthroscopic acromioplasty and distal clavicle resection. Arthroscopy 2001; 17:E36. [PMID: 11694940 DOI: 10.1053/jars.2001.26861] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Arthroscopic acromioplasty and distal clavicle resection has now become an accepted method of treatment for acromioclavicular (AC) joint arthritis. Complications following arthroscopic acromioplasty are relatively uncommon and include instrument breakage, hematoma, traction neuropathy, infection, acromial fracture, reflex sympathetic dystrophy, and recurrence of symptoms. Although heterotopic ossification within the soft tissues has also been reported, complete reossification of the resected clavicle has not. We report a case of reossification of the clavicle and fusion across the AC joint following arthroscopic acromioplasty and distal clavicle resection.
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Affiliation(s)
- G Tytherleigh-Strong
- Reading Shoulder Surgery Unit, Department of Orthopaedics, The Royal Berkshire Hospital, Reading, England
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35
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Shubin Stein BE, Wiater JM, Pfaff HC, Bigliani LU, Levine WN. Detection of acromioclavicular joint pathology in asymptomatic shoulders with magnetic resonance imaging. J Shoulder Elbow Surg 2001; 10:204-208. [PMID: 11408899 DOI: 10.1067/mse.2001.113498] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The purpose of this study was to determine the prevalence of acromioclavicular joint (ACJ) arthritis with magnetic resonance imaging (MRI) evaluation in asymptomatic patients. Fifty shoulders in 42 patients were evaluated with the use of standard MRI techniques. There were 18 men and 24 women with an average age of 35 years (range, 19 to 72). ACJ arthritic changes were graded on a scale from 1 to 4 (none, mild, moderate, and severe), based on the amount of subacromial fat effacement, joint space narrowing, irregularity, capsular distension, and osteophyte formation. Forty-one (82%) of 50 shoulders had abnormalities consistent with arthritis on MRI. Patients were divided into two groups according to age: those older than 30 years and those 30 years old or younger. In the 30-and-under age group, 68% of the shoulders had arthritic changes, whereas in the over-30 age group, 93% had arthritic changes. Furthermore, in a comparison of the two groups, more advanced arthritic changes were found in the over-30 age group (P <.05). Clinical decisions to resect the ACJ should correlate the physical examination with the MRI findings because many patients may be clinically asymptomatic.
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Affiliation(s)
- Beth E Shubin Stein
- Shoulder Service, New York Orthopaedic Hospital, New York Presbyterian Medical Center, New York, NY
| | - J Michael Wiater
- Shoulder Service, New York Orthopaedic Hospital, New York Presbyterian Medical Center, New York, NY
| | - H Charles Pfaff
- Shoulder Service, New York Orthopaedic Hospital, New York Presbyterian Medical Center, New York, NY
| | - Louis U Bigliani
- Shoulder Service, New York Orthopaedic Hospital, New York Presbyterian Medical Center, New York, NY
| | - William N Levine
- Shoulder Service, New York Orthopaedic Hospital, New York Presbyterian Medical Center, New York, NY
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36
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Buford D, Mologne T, McGrath S, Heinen G, Snyder S. Midterm results of arthroscopic co-planing of the acromioclavicular joint. J Shoulder Elbow Surg 2000; 9:498-501. [PMID: 11229322 DOI: 10.1067/mse.2000.109560] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There has been recent concern about long-term morbidity associated with arthroscopic co-planing of the acromioclavicular joint in the treatment of impingement syndrome. OBJECTIVE The purpose of this study was to assess the results of the co-planing procedure, special attention being paid to acromioclavicular joint morbidity. METHODS The study included 56 patients who were operated on by the senior author. Outcomes were evaluated both objectively and subjectively through physical examinations and telephone surveying. Each patient had subacromial decompression at the time of the index surgery. Other concomitant arthroscopic procedures included rotator cuff repair and labral debridement or repair. RESULTS Average follow-up was 4 years (range, 2-7 years). Thirty-five (95%) of 37 patients had no subjective pain and no objective tenderness to direct palpation or compression of the acromioclavicular joint. The joint was not clinically hypermobile in comparison with that on the opposite side in any patient. In all, 95% of patients had good or excellent results in terms of the University of California at Los Angeles Shoulder Score. Of the 2 patients who did have pain and tenderness at the acromioclavicular joint, both had had multiple operations on their shoulders before the index procedure. Nineteen patients were not examined clinically but did complete a telephone survey; these 19 patients were not symptomatic at the acromioclavicular joint. CONCLUSIONS To fully treat impingement syndrome, the surgeon should remove osteophytes under the lateral clavicle and medial acromion. With good technique, the surgeon can leave the anterior, posterior, and superior acromioclavicular joint capsule intact. We conclude that for appropriate clinical indications, beveling the inferior 20% to 25% of the clavicle to make it co-planar with the decompressed acromion is safe and is not an etiologic factor in acromioclavicular joint pain or instability.
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Affiliation(s)
- D Buford
- Southern California Orthopedic Institute, Van Nuys, Calif., USA
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