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Acromioclavicular joint arthritis is not an indication for routine distal clavicle excision in arthroscopic rotator cuff repair



To evaluate the significance of untreated primary acromioclavicular joint (ACJ) osteoarthritis, encountered during arthroscopic rotator cuff repair (RCR), as a cause of persistent symptomatology and need for revision surgery.


In a cohort of 811 consecutive patients older than 55 years who underwent RCR, the effect of primary ACJ osteoarthritis presence was prospectively examined. A total of 497 patients with mild/moderate and severe ACJ osteoarthritis based on preoperative MRI evaluation were allocated to Group A (n = 185, symptomatic ACJ) and Group B (n = 312, asymptomatic ACJ). Distal clavicle excision was not performed regardless of the presence of pain. The minimum follow-up was 28 months (28–46). The visual analogue scale (VAS) pain scores were assessed for ACJ pain on palpation, the cross body adduction test, the Constant-Murley, and the American Shoulder and Elbow Surgeons (ASES).


The overall loss to follow-up rate was 3.82% (19 patients: 11 in Group A and eight in Group B). The mean ASES score at the latest follow-up was 91.16 ± 9.3 and 92.37 ± 10.44 in Groups A and B, respectively, and the mean Constant-Murley score was 96.36 ± 5.7 and 95.76 ± 4.6 in Groups A and B, respectively. There was no statistical significance between regarding both scores. Localised ACJ pain on palpation and pain on cross body adduction were diminished in both the symptomatic and asymptomatic group. There were five cases (1%: two in Group A and three in Group B) with persistent ACJ pain who had failed the conservative treatment, and ACJ excision was necessary to alleviate the symptoms. All revision operations were uncomplicated with symptom resolution.


Untreated ACJ osteoarthritis, symptomatic or not, encountered during arthroscopic RCR is associated with a low percentage of failure. Routine distal clavicle excision is not absolutely necessary, even in patients with symptomatic ACJ osteoarthritis.

Level of evidence

II, Prospective cohort study.

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Fig. 1
Fig. 2



Acromioclavicular joint


Bone marrow edema


Rotator cuff


Rotator cuff repair


Magnetic resonance imaging


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There was no external source of funding for this study.

Author information




CKY performed the surgeries and the patient follow-up, IV and GT were in charge of the patient follow-up and performed data analysis, NG participated in the design of the study and helped draft the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Christos K. Yiannakopoulos.

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The authors of this study declare that they have no conflicts of interest related to this study. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Ethical approval

Prior to the start of the study, approval was obtained from the Institutional Review Board in accordance with the ethical standards of the Declaration of Helsinki (1964) and its later amendments (PRO15060142).

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Yiannakopoulos, C.K., Vlastos, I., Theotokatos, G. et al. Acromioclavicular joint arthritis is not an indication for routine distal clavicle excision in arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 29, 2090–2095 (2021).

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  • Acromioclavicular joint
  • Osteoarthritis
  • Rotator cuff
  • Rotator cuff repair
  • Shoulder