Arthroscopic Versus Open Distal Clavicle Excision

Abstract

Open and arthroscopic DCE are both effective surgeries to treat recalcitrant acromioclavicular joint pain. At intermediate-term follow-up, they provide similarly good to excellent results with regard to patient satisfaction and shoulder function. Although both are effective treatments, less residual pain was found using the arthroscopic technique.

Comparison between open and arthroscopic procedures for lateral clavicle resection

“…Four comparative studies were found in the literature, which found no difference in shoulder function at final follow-up between LCR by an open and arthroscopic approach, although different questionnaires were used [5][6][7][8]. The data in the present study support these findings.…”

“…For VAS pain score, no difference was found in most studies [5][6][7]. Only one of these studies did correct for concomitant pathology; with the exclusion of adjuvant procedures, Robertson et al [8] found a lower VAS score for the arthroscopic group, in contrast with the results of the present study. However, they did not perform analyses for a correlation between resection length and residual pain.…”

“…The large difference in bone removal compared to the present study may be partly explained by the year in which the study was performed (1992)-older reports recommend a minimum resection of 2 cm [17][18][19], whereas newer studies show that even resections of 5 mm can still impair joint stability [4,10,12,20]. Several studies show an equal amount of resection between the approaches, but it might be harder to estimate the resected amount in arthroscopy [5,8,14].…”

“…Few studies have compared complications between both approaches and different complications have been mentioned [5,6,8,14,17]. In general, both approaches give few complications, with surgical site infection (SSI) rates of 0.0-4.3 %, and stiffness of the shoulder in 0-33 % of the patients [3].…”

“…Although one study found a better pain score outcome in favour of an arthroscopic approach [8], no relevant differences were found in other studies [5][6][7]9]. Thus, a preferable approach based on patient-related outcome measures can, so far, not be determined [5][6][7][8]. When both surgical interventions prove to have similar outcome, a future shift towards the least expensive procedure can be expected, because in times of economic recession, budget cuts are demanded while quality of treatment must be maintained.…”