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

Park, Yong Bok; Koh, Kyoung Hwan; Shon, Min Soo; Park, Young Eun; Yoo, Jae Chul

doi:10.1177/0363546514563911

Cited by 38 publications

(48 citation statements)

References 41 publications

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“…While concomitant procedures currently have an unclear effect on the outcome of rotator cuff repairs, 1 , 5 , 17 , 22 , 29 , 33 these procedures are often performed with rotator cuff repairs to address additional aspects of shoulder pathology. We found that the incidence of subacromial decompression was high for both groups but greater in the arthroscopic rotator cuff repair group than in the open group (see Figure 2 ).…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of the Trends, Concomitant Procedures, and Complications With Open and Arthroscopic Rotator Cuff Repairs in the Medicare Population

Jensen

Peter

Devana

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Medicare insures the largest population of patients at risk for rotator cuff tears in the United States.Purpose:To evaluate the trends in incidence, concomitant procedures, and complications with open and arthroscopic rotator cuff repairs in Medicare patients.Study Design:Cohort study; Level of evidence, 3.Methods:All Medicare patients who had undergone open or arthroscopic rotator cuff repair from 2005 through 2011 were identified with a claims database. Annual incidence, concomitant procedures, and postoperative complications were compared between these 2 groups.Results:In total, 372,109 rotator cuff repairs were analyzed. The incidence of open repairs decreased (from 6.0 to 4.3 per 10,000 patients, P < .001) while the incidence of arthroscopic repairs increased (from 4.5 to 7.8 per 10,000 patients, P < .001) during the study period. Patients in the arthroscopic group were more likely to have undergone concomitant subacromial decompression than those in the open group (87% vs 35%, P < .001), and the annual incidence of concomitant biceps tenodesis increased for both groups (from 3.8% to 11% for open and 2.2% to 16% for arthroscopic, P < .001). While postoperative complications were infrequent, patients in the open group were more likely to be diagnosed with infection within 6 months (0.86% vs 0.37%, P < .001) but no more likely to undergo operative debridement (0.43% vs 0.26%, P = .08). Additionally, patients in the open group were more likely to undergo intervention for shoulder stiffness within 1 year (1.4% vs 1.1%, P = .01).Conclusion:In the Medicare population, arthroscopic rotator cuff repairs have increased in incidence and now represent the majority of rotator cuff repair surgery. Among concomitant procedures, subacromial decompression was most commonly performed despite evidence suggesting a lack of efficacy. Infections and stiffness were rare complications that were slightly but significantly more frequent in open rotator cuff repairs.

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Section: Discussionmentioning

confidence: 99%

“…We also assessed trends in concomitant procedures associated with rotator cuff repair surgery in Medicare patients, as 1 study suggested that the rates of these procedures have been increasing 31 despite there currently being a lack of evidence supporting their use. 1 , 17 , 22 , 29 , 33 …”

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confidence: 99%

Evaluation of the Trends, Concomitant Procedures, and Complications With Open and Arthroscopic Rotator Cuff Repairs in the Medicare Population

Jensen

Peter

Devana

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…Therefore, we judged that the amount of distal clavicle resection should be up to approximately 15 mm to avoid damage to the trapezoid ligament. Several authors have suggested that the critical resection length of the distal clavicle ranges from 5 to 15 mm, but there is still no consensus on the amount required to maintain AC joint stability and prevent contact between the distal clavicle and the acromion [15]. Gartsman et al [1] reported that 1.5 cm was an appropriate resection amount.…”

Section: Discussionmentioning

confidence: 99%

“…Because of this attachment morphology, we believe that an excision of less than 15 mm will not affect AC joint stability. The critical amount of resection remains controversial, with most authors recommending 5-15 mm of resection; however, there is a large variation in reported resection volumes [1,6,10,[12][13][14][15][16]. Arthroscopic resection of the distal clavicle has recently been developed as a less invasive alternative to open surgery that enables preservation of the clavicular attachments of the deltoid and trapezius muscles and faster return to normal activities.…”

Section: Introductionmentioning

confidence: 99%

“…However, reported disadvantages of this approach include a higher risk of inadequate resection compared with the open procedure because of technical challenges [1,14,20]. It was reported that postoperative pain can remain after distal clavicle resection due to residual small bone fragments, ectopic ossi cation, and the residual superior cortex at the distal clavicle after insu cient resection [15,17,[21][22][23]. Furthermore, Elhassan et al [17] and Levine et al [24] described that revision resections were required because of inadequate distal clavicular resection.…”

Section: Introductionmentioning

confidence: 99%

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

Minamikawa¹,

Shibata²,

Minokawa³

2020

Preprint

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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.

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Measures of Adult Shoulder Function

Buchbinder

Smolen

Huang

et al. 2020

Arthritis Care & Research

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

Abstract: 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.

Cited by 38 publications

References 41 publications

Evaluation of the Trends, Concomitant Procedures, and Complications With Open and Arthroscopic Rotator Cuff Repairs in the Medicare Population

Evaluation of the Trends, Concomitant Procedures, and Complications With Open and Arthroscopic Rotator Cuff Repairs in the Medicare Population

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

Measures of Adult Shoulder Function

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