Continuing acromioclavicular joint pain after excision arthroplasty: is further surgery effective?

Abstract

Background Little published evidence exists on the incidence of continuing acromioclavicular joint pain with no published outcomes for revision surgery. This study aimed to establish the incidence and outcomes of revision acromioclavicular joint excision surgery. Materials and methods A consecutive retrospective cohort of patients undergoing revision arthroscopic or open acromioclavicular joint excision was identified. Patients were identified from a prospectively collected database. Inclusion criteria were revision acromioclavicular joint excisions over a 14-year period between 2001 and 2015. Exclusion criteria were previous surgery for acromioclavicular joint instability or shoulder arthroplasty. Outcome measures were Oxford Shoulder scores and a satisfaction survey. Results Forty-three consecutive cases of revision acromioclavicular joint excision over 14 years (37 after arthroscopic excision with subacromial decompression, 5 after arthroscopic excision with rotator cuff repair, 1 after open excision). Continuing acromioclavicular joint pain was associated with incomplete resection from arthroscopic surgery, which was the primary indication for revision surgery. Revision occurred a mean 14.2 months after primary surgery (standard deviation 7.6 months). Mean Oxford Shoulder score was preoperatively 18 (standard deviation 8.1) and 23.4 (standard deviation 11.1) after primary surgery, which did not reach significance until after revision surgery with a mean 31.7 (standard deviation 13.6; P = 0.021). Median follow up was 15 months (interquartile range 4–31 months). A survey at a mean of 6 years (standard deviation 2.3) post-revision surgery found that 65% of patients felt improved, 77% would have their surgery again and 69% of patients felt satisfied. The incidence of postoperative frozen shoulder was 14.3%. Conclusion Functional outcomes after revision surgery showed improvement from scores taken before primary surgery; however, long-term satisfaction rates were relatively low.

A systematic review of the treatment of primary acromioclavicular joint osteoarthritis

“…Sabeti-Aschraf et al 24,25 conversely found no difference between palpation and ultrasound-guided injections, as well as no difference between ultrasound-guided intra- or peri-articular injection at relatively short (3 weeks) follow-up. Another study 57 proved joint entry in 96% using ultrasound and that the anterior superior aspect of the joint was the widest target even in advanced degeneration. Cadaveric studies have shown image guidance to improve needle aim and joint penetration.…”

“…The UK study looking at revision 54 of DCE found that incomplete excision was the primary reason for revision ACJ excision, followed by heterotopic ossification. It also found that functional outcomes did not significantly improve, and satisfaction scores remained low in revision participants.…”

Failed suspension button acromioclavicular joint reconstruction revised with double-loop suture cerclage: a case report and review of the literature

“… 10 Additionally, the literature is sparse in regards to outlining the most effective salvage technique for secondary AC joint reconstruction and whether salvage surgery is indicated. 8 AC joint salvage procedures require careful preoperative planning and identification of the cause of reinjury for proper surgical planning and appropriate patient education on postoperative protocols as patient noncompliance can be detrimental in terms of surgical success. 12 …”

Outcomes of Secondary Arthroscopic Distal Clavicle Resection for Shoulders With Symptomatic Acromioclavicular Joint Arthropathy After Isolated Rotator Cuff Repair With Complete Tendon Healing

“… 8 , 11 , 12 Routine DCR is not always recommended, however, as it can lead to complications such as pain, stiffness, instability, or infection. 2 , 4 , 7 , 9 , 13 , 15 Moreover, up to 90% of patients with asymptomatic ACJ arthropathy may remain pain-free at 7-year follow-up. 6 Recent meta-analyses 10 , 18 have advised against DCR as an adjuvant procedure during RCR, whether performed routinely or in shoulders diagnosed with symptomatic ACJ arthropathy.…”