The Influence of Distal Clavicle Resection and Rotator Cuff Repair on the Effectiveness of Anterior Acromioplasty

1989 ◽  
Vol &NA; (247) ◽  
pp. 117???123 ◽  
Author(s):  
DANIEL J. DALUGA ◽  
WILLIAM DOBOZI
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Distal Clavicle ◽  
Cuff Repair ◽  
Distal Clavicle Resection

scholarly journals Is routine distal clavicle resection necessary in rotator cuff repair surgery? A systematic review and meta-analysis

2017 ◽  
Vol 11 (1_suppl) ◽  
pp. 39-45 ◽  
Author(s):  
Ann Livingstone ◽  
Rafik Asaid ◽  
Afshin Kamali Moaveni
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Analogue Scale ◽  
Meta Analysis ◽  
Distal Clavicle ◽  
Randomized Controlled ◽  
Cuff Repair ◽  
Distal Clavicle Resection

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.

scholarly journals Preoperative Factors Associated With Subsequent Distal Clavicle Resection After Rotator Cuff Repair

2019 ◽  
Vol 7 (5) ◽  
pp. 232596711984429 ◽  
Author(s):  
Peter N. Chalmers ◽  
Erin Granger ◽  
Hunter Ross ◽  
Robert T. Burks ◽  
Robert Z. Tashjian
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Chart Review ◽  
Distal Clavicle ◽  
Ac Joint ◽  
Cuff Repair ◽  
Distal Clavicle Resection ◽  
Dominant Side

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.

How to Perform a Distal Clavicle Resection During Rotator Cuff Repair Surgery

2015 ◽  
Vol 16 (2) ◽  
pp. 63-67
Author(s):  
Chris R. Mellano ◽  
Michael Khair ◽  
Jason J. Shin ◽  
Tibor Warganich ◽  
Anthony A. Romeo ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Distal Clavicle ◽  
Cuff Repair ◽  
Distal Clavicle Resection

scholarly journals Benefits of distal clavicle resection during rotator cuff repair: Prospective randomized single-blind study

2020 ◽  
Vol 106 (8) ◽  
pp. S207-S211
Author(s):  
David Gallinet ◽  
Johannes Barth ◽  
Ludovic Labattut ◽  
Philippe Collin ◽  
Pierre Metais ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Blind Study ◽  
Distal Clavicle ◽  
Cuff Repair ◽  
Distal Clavicle Resection ◽  
Single Blind

scholarly journals Disparities in Cost and Access by Caseload for Arthroscopic Rotator Cuff Repair: An Analysis of 18,616 Cases

2019 ◽  
Vol 7 (6) ◽  
pp. 232596711985050 ◽  
Author(s):  
Lambert Li ◽  
Steven L. Bokshan ◽  
Shayna R. Mehta ◽  
Brett D. Owens
Keyword(s):  
Rotator Cuff ◽  
Low Income ◽  
Rotator Cuff Repair ◽  
Univariate Analysis ◽  
High Volume ◽  
Arthroscopic Rotator Cuff Repair ◽  
Distal Clavicle ◽  
Low Volume ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: Surgeon caseload has been shown to affect both health and economic outcomes in arthroscopic rotator cuff repair. Although previous studies have investigated disparities in access to care, little is known about disparities between low- and high-volume surgeons and facilities. Purpose: To identify where disparities may exist regarding access to high-volume surgeons and facilities. Study Design: Cross-sectional study. Methods: Univariate analysis was performed to analyze differences in the caseload between low- and high-volume surgeons and facilities. Cutoff values were set at 50 cases per year for high-volume surgeons and 125 cases annually for high-volume facilities. Multiple linear regression was then used to develop a cost model incorporating all variables significant under univariate analysis. We collected 18,616 cases with Current Procedural Terminology code 29827 (“arthroscopic rotator cuff repair”) from the 2014 Florida State Ambulatory Surgery and Services Databases. Results: A greater proportion of the caseload for low-volume surgeons and facilities was composed of patients who were of lower socioeconomic status, had government-subsidized insurance, or lived in areas with low-income ZIP codes. Low-volume surgeons and facilities also had higher total charges, higher postoperative admission rates, and lower distal clavicle excision rates ( P < .001). In our cost model, a low facility volume significantly increased costs. Subacromial decompression, postoperative admission, distal clavicle excision, male sex, and government-subsidized insurance were all significant factors for increased costs in multivariate cost analysis. Conclusion: There are disparities in access to high-volume surgeons and facilities for patients undergoing arthroscopic rotator cuff repair in Florida. Patients with a lower socioeconomic status, government-subsidized insurance, and low income all faced decreased access to these high-volume groups. High-volume surgeons and facilities were associated with lower total charges, higher rates of distal clavicle excision, and lower readmission rates. Low-volume facilities added a significant amount of cost, even when controlling for all other significant variables. It is important for providers to be aware of these disparities and work to address them in their own practices.

scholarly journals Increased T2 signal intensity in the distal clavicle does not justify acromioclavicular resection arthroplasty during rotator cuff repair

2020 ◽  
Vol 106 (8) ◽  
pp. S217-S222
Author(s):  
Pierre Métais ◽  
David Gallinet ◽  
Ludovic Labattut ◽  
Arnaud Godenèche ◽  
Johannes Barth ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Signal Intensity ◽  
Rotator Cuff Repair ◽  
Resection Arthroplasty ◽  
Distal Clavicle ◽  
Cuff Repair

Time Required to Achieve Clinically Significant Outcomes After Arthroscopic Rotator Cuff Repair

2020 ◽  
Vol 48 (14) ◽  
pp. 3447-3453
Author(s):  
Brandon J. Manderle ◽  
Anirudh K. Gowd ◽  
Joseph N. Liu ◽  
Alexander Beletsky ◽  
Benedict U. Nwachukwu ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Outcome Measures ◽  
Rotator Cuff Repair ◽  
Workers Compensation ◽  
Biceps Tenodesis ◽  
Distal Clavicle ◽  
Compensation Status ◽  
Clinically Significant ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: Recent literature has focused on correlating statistically significant changes in outcome measures with clinically significant outcomes (CSOs). CSO benchmarks are being established for arthroscopic rotator cuff repair (RCR), but more remains to be defined about them. Purpose: To define the time-dependent nature of the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and Patient Acceptable Symptomatic State (PASS) after RCR and to define what factors affect this time to CSO achievement. Study Design: Case series; Level of evidence, 4. Methods: An institutional registry was queried for patients who underwent arthroscopic RCR between 2014 and 2016 and completed preoperative, 6-month, 1-year, and 2-year patient-reported outcome measures (PROMs). Threshold values for MCID, SCB, and PASS were obtained from previous literature for the American Shoulder and Elbow Surgeons score (ASES), Single Assessment Numeric Evaluation (SANE), and subjective Constant score. The time in which patients achieved MCID, SCB, and PASS was calculated using Kaplan-Meier analysis. A Cox multivariate regression model was used to identify variables correlated with earlier or later achievement of CSOs. Results: A total of 203 patients with an average age of 56.19 ± 9.96 years and average body mass index was 30.29 ± 6.49 were included. The time of mean achievement of MCID, SCB, and PASS for ASES was 5.77 ± 1.79 months, 6.22 ± 2.85 months, and 7.23 ± 3.81 months, respectively. The time of mean achievement of MCID, SCB, and PASS for SANE was 6.25 ± 2.42 months, 7.05 ± 4.10 months, and 9.26 ± 5.89 months, respectively. The time of mean achievement of MCID, SCB, and PASS for Constant was 6.94 ± 3.85 months, 7.13 ± 4.13 months, and 8.66 ± 5.46 months, respectively. Patients with dominant-sided surgery (hazard ratio [HR], 1.363; 95% CI, 1.065-1.745; P = .014) achieved CSOs earlier on ASES, while patients with workers’ compensation status (HR, 0.752; 95% CI, 0.592-0.955; P = .019), who were current smokers (HR, 0.323; 95% CI, 0.119-0.882; P = .028), and with concomitant biceps tenodesis (HR, 0.763; 95% CI, 0.607-0.959; P = .021) achieved CSOs on ASES at later timepoints. Patients with distal clavicle excision (HR, 1.484; 95% CI, 1.028-2.143; P = .035) achieved CSOs earlier on SANE. Patients with distal clavicle excision (HR, 1.689; 95% CI, 1.183-2.411, P = .004) achieved CSOs earlier on Constant, while patients with workers’ compensation insurance status (HR, 0.671; 95% CI, 0.506-0.891; P = .006) and partial-thickness tears (HR, 0.410; 95% CI, 0.250-0.671; P < .001) achieved CSOs later on Constant. Greater preoperative score was associated with delayed achievement of CSOs for ASES, SANE (HR, 0.993; 95% CI, 0.987-0.999; P = .020), and Constant (HR, 0.941; 95% CI, 0.928-0.962; P < .001). Conclusion: A majority of patients achieved MCID by 6 months after surgery. Dominant-sided surgery and concomitant distal clavicle excision resulted in faster CSO achievement, while workers’ compensation status, concomitant biceps tenodesis, current smoking, partial-thickness rotator cuff tears, and higher preoperative PROMs resulted in delayed CSO achievement.

Sleep Impairment

2009 ◽  
Vol 14 (3) ◽  
pp. 7-10
Author(s):  
Craig Uejo ◽  
Stephen Demeter
Keyword(s):  
Rotator Cuff ◽  
Distal Clavicle ◽  
Rotator Cuff Disease ◽  
Degenerative Arthritis ◽  
Sixth Edition ◽  
Cuff Tear ◽  
Shoulder Region ◽  
Illness Causation ◽  
Traumatic Rotator Cuff Tear ◽  
Distal Clavicle Resection

Abstract In the AMAGuides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, distal clavicle resection (resection arthroplasty of the acromioclavicular joint [ACJ]) results in ratable impairment, but only a single diagnosis within a region may be rated. Therefore, if another impairing condition is present in the shoulder region (eg, impingement syndrome or rotator cuff disease) only that resulting in the greatest causally related impairment is rated. In the setting of an occupational or other compensable injury or illness, causation of the impairment often is a key issue because, typically, only impairment that is causally related to the injury can be rated. For example, assume that a lifting injury at work caused a tear in a rotator cuff tendon that was already attenuated by repetitive impingement on inferiorly projecting spurs from longstanding degenerative arthritis of the ACJ. If surgery was performed for a traumatic rotator cuff tear and the distal clavicle also was resected due to preexisting ACJ arthritis, the latter surgery is not considered to be related to the injury. In other words, because the ACJ arthritis was neither caused nor worsened by the injury, this condition is not rated. The distal clavicular resection may have been warranted to diminish pain due to ACJ arthritis and/or eliminate the distal clavicle as a source of impingement.

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