Modified technique of Indirect arthroscopic distal clavicle resection

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

Technique for Arthroscopic Resection of the Distal Clavicle in Patients with Symptomatic Acromioclavicular Joint Osteoarthritis: A Retrospective Study

Background: Arthroscopic resection of the distal clavicle has the potential risk of inadequate resection that may be associated with residual postoperative pain. We propose a new arthroscopic technique to excise the distal clavicle precisely and reproducibly without causing impingement or instability of the acromioclavicular (AC) joint. The purpose of this study was to evaluate the clinical and radiological results of arthroscopic distal clavicle resection in patients with symptomatic AC joint osteoarthritis.Methods: We retrospectively evaluated 26 patients (mean age, 55.3 ± 16.0 years) who underwent arthroscopic distal clavicle resection between April 2010 and September 2017 with a minimum 1-year follow-up (mean follow-up, 25.3 ± 11.1 months). Nine of these patients also underwent rotator cuff repair. Clinical evaluations performed preoperatively and at final follow-up included subjective pain scores according to a visual analogue scale (VAS), range-of-motion examinations, UCLA scores, and Shoulder-36 scores. Shoulder muscle strengths were measured with a handheld dynamometer. The amount of distal clavicle resection was measured on plain radiographs. Results: No patients had AC joint tenderness. There were significant differences between the preoperative and postoperative VAS, UCLA, and Shoulder-36 scores (P < 0.05). Muscle strengths were measured preoperatively and at final follow-up in 14 patients. Elevation and internal rotation strengths were significantly greater postoperatively, but there was no significant difference in external rotation strength. The mean amount of distal clavicle resection was 14.1 ± 2.1 mm. The mean coracoclavicular distance was 8.4 ± 1.6 mm preoperatively and 8.6 ± 1.8 mm at final follow-up, with no significant difference. Conclusions: Our arthroscopic technique of distal clavicle resection for AC joint osteoarthritis resulted in successful clinical outcomes at final follow-up. Bone resection was performed according to the amount planned, as confirmed on postoperative radiographs. The technique allows resection of the distal clavicle with accurate shape and amount as planned preoperatively with no postoperative instability of the AC joint.

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

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.

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

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.

Incidence of accompanying intraarticular lesions in patients treated with arthtroscopic surgery for acromioclavicular degeneration

Purpose: Acromioclavicular joint degeneration is a common disease that causes antero-superior shoulder pain. İn physical examination regional pain at acromioclavicular joint can occur with cross-body adduction or internal rotation. Surgery should be planned if the patient has not relieved with minimum 6 months of nonoperative treatment, and has no infection or instability. In this study, we aimed the incidence of accompanying intraarticular conditions in patients applied arthroscopic distal clavicula resection. Method: Documents and intraoperative videos of 128 patients undergone artroscopic distal clavicula resection between 2005-2014 has been analyzed restospectively. The incidence of other intraarticular conditions accompanying acromioclavicular arthritis. Results: The average of the age of the 128 patients was 56,9(18-70). 43 of them were male (%33,6) and 85 were female (66,4). 3 (%2,3) patients had anterior instability and treated with Bankart repairment. 50 patients had Superior Labrum Anterior Posterior (SLAP) lesion (39,1) (SLAP1:12, SLAP2:36, SLAP4:1, SLAP5:2). 37 of the were treated with SLAP repairment. Bufford complex had been spotted in one patient. 19 (%14,8) patients had accompanying biceps lesions. 2 patients had biceps brachii long head rupture. 10 patients had been treated with biceps tenotomy, 3 atients had been treated with biceps tenodesis. 7 (%5,5) patients had accompanying subscapularis lesion and treated with repairment. 58(%45,3) patients had accompanying rotator cuff tears (12 partial, 45 total, 1 massive) and48 treated with repairment. In conclusion; 100 (%78,1) 128 patients had accompanying intraarticular lesions needed surgical intervention Outcomes: The most common complication of distal clavicle resection is pain as a result of insufficient resection and instability due to aggressive resection. İndications sould be chosen carefully to avoid complications and for patient satisfaction. After evaluation of the accompanying lesions that require operative treatment, acromioclavicular lesion should be evaluated again. In our study accompanying lesions can be unnoticed using open surgery, as a consequence incomplete treatment and low patien satisfaction. In radographic imaging, if acromioclavicular arthritis is not compatible with clinical symptoms it is essential to evaluate accompanying lesions, on the other hand it should not be forgotten that acromioclavicular arthritis can imitate other lesions