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Percutaneous distal clavicle excision for acromioclavicular joint arthritis: our experience and early results of a novel surgical technique

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Abstract

Purpose

Symptomatic acromioclavicular joint (ACJ) osteoarthritis causes pain and limitations in activities of daily living. Open and arthroscopic distal clavicle excision techniques have been described with good outcomes. However, both techniques have their own sets of advantages and disadvantages. This study describes a novel technique of percutaneous distal clavicle excision for symptomatic ACJ osteoarthritis and our two-year results.

Methods

Fifteen consecutive patients underwent percutaneous distal clavicle excision for ACJ arthritis. These patients had failed a trial of conservative treatment. The ACJ was confirmed as the pain generator with an intraarticular steroid/lignocaine injection, and shoulder MRI was used to exclude alternative pain generators in the shoulder. They had a minimum of two years of follow-up.

Results

At a mean of 26.8 months postoperatively, the mean VAS pain score was 0, and the mean Constant score for the shoulder was 87.3 points (range 50–94), which corresponded to 1 good, 1 very good and 13 excellent results. The mean SF-36 score was 94.9 points (range 65–100). There were statistically significant improvements in the VAS scores, Constant shoulder scores and SF-36 scores at one year and two years of follow-up (p < 0.05). Three unique complications, namely subcutaneous emphysema, “missing” of the distal clavicle and thermal skin injury, were encountered. Our surgical technique has since been modified to circumvent these complications.

Conclusion

Our novel technique of percutaneous distal clavicle excision yields a 93.3% good-to-excellent results based on the Constant shoulder score and durable pain relief based on VAS at two years.

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References

  1. Shaffer BS (1999) Painful conditions of the acromioclavicular joint. J Am Acad Orthop Surg. 7(3):176–188

    Article  CAS  Google Scholar 

  2. Lee EW, Flatow EL (2005) The shoulder and arm: degenerative and painful conditions of the acromioclavicular joint. In: Weinstein SL, Buckwalter JA (eds) Turek's orthopaedics: principles and their application, 6 edn. Lippincott Williams & Wilkins, Philadelphia, pp 347–348.

  3. Nuber GW, Bowen MK (2003) Arthroscopic treatment of acromioclavicular joint injuries and results. Clin Sports Med 22:301–317

    Article  Google Scholar 

  4. Mumford EB (1941) Acromioclavicular dislocation: a new operative treatment. J Bone Joint Surg Am 23:799–802

    Google Scholar 

  5. Gurd FB (1941) The treatment of complete dislocation of the outer end of the clavicle: an hitherto undescribed operation. Ann Surg 113:1094–1098

    Article  CAS  Google Scholar 

  6. Tolin BS, Snyder SJ (1993) Our technique for the arthroscopic Mumford procedure. Orthop Clin North Am 24:143–151

    Article  CAS  Google Scholar 

  7. Flatow EL, Cordasco FA, Bigliani LU (1992) Arthroscopic resection of the outer end of the clavicle from a superior approach: a critical, quantitative, radiographic assessment of bone removal. Arthroscopy 8:55–64

    Article  CAS  Google Scholar 

  8. Veen EJD, Donders CM, Westerbeek RE, Derks RPH, Landman EBM, Koorevaar CT (2018) Predictive findings on magnetic resonance imaging in patients with symptomatic acromioclavicularosteoarthritis. J Shoulder Elbow Surg 27(8):e252–e258

    Article  Google Scholar 

  9. Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164

    Article  Google Scholar 

  10. Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form healthsurvey (SF-36): I. conceptual framework and item selection. Med Care 30:473–483

    Article  Google Scholar 

  11. Eskola A, Santavirta S, Viljakka HT, Wirta J, Partio TE, Hoikka V (1996) The results of operative resection of the lateral end of the clavicle. J Bone Joint Surg Am 78(4):584–587

    Article  CAS  Google Scholar 

  12. Rabalais RD, McCarty E (2007) Surgical treatment of symptomatic acromioclavicular joint problems: a systematic review. Clin Orthop Relat Res 455:30–37

    Article  Google Scholar 

  13. Hohmann E, Tetsworth K, Glatt V (2019) Open versus arthroscopic acromioclavicular joint resection: a systematic review and meta-analysis. Arch Orthop Trauma Surg 139(5):685–694

    Article  Google Scholar 

  14. Freedman BA, Javernick MA, O’Brien FP, Ross AE, Doukas WC (2007) Arthroscopic versus open distal clavicle excision: comparative results at six months and one year from a randomized, prospective clinical trial. J Shoulder Elbow Surg Jul-Aug 16(4):413–418

    Article  Google Scholar 

  15. Jerosch J, Steinbeck J, Schröder M, Castro WH (1993) Arthroscopic resection of the acromioclavicular joint (ARAC). Knee Surg Sports Traumatol Arthrosc 1(3–4):209–215

    Article  CAS  Google Scholar 

  16. Shaffer BS, Tibone JE (2003) Complications in shoulder arthroscopy. In: Tibone JE, Savoie FH, Shaffer BS (eds) shoulder arthroscopy. Springer, New York, p 232

    Google Scholar 

  17. Saseendar S, Tan SH, Vijayan S, Pawaskar A, Kumar VP (2016) Extensive subcutaneous emphysema complicating a percutaneous Mumford procedure. Knee Surg Sports Traumatol Arthrosc 24(6):1907–1910

    Article  Google Scholar 

  18. Calvisi V, Lupparelli S, Rossetti S (2009) Subcutaneous emphysema and pneumomediastinum following shoulder arthroscopy with brachial plexus block: a case report and review of the literature. Arch Orthop Trauma Surg 129:349–352

    Article  Google Scholar 

  19. Shames IH (2002) Mechanics of fluid, 4th edn. McGraw-Hill Higher Education, New York

    Google Scholar 

  20. Neer CS (1983) Impingement lesions. Clin Orthop 173:70–77

    Article  Google Scholar 

  21. Rockwood CA, Young DC (1983) Disorders of the acromioclavicular joint. In: Rockwood CA, Matsen FA (eds) The shoulder. WB Saunders Co, Philadelphia, pp 413–476

    Google Scholar 

  22. Rowe CR (1984) Trends in treatment of complete acromioclavicular dislocations. In: Bateman JE, Walsh RP (eds) Surgery of the shoulder. RC Decker, Toronto, pp 73–78

    Google Scholar 

  23. Lervick GN (2005) Direct arthroscopic distal clavicle resection: a technical review. Iowa Orthop J 25:149–156

    PubMed  PubMed Central  Google Scholar 

  24. Matthews P et al (1999) Arthroscopic versus open distal clavicle resection: a biomechanical analysis on a cadaveric model. Arthroscopy 15(3):237–240

    Article  CAS  Google Scholar 

  25. Auge WK, Fischer RA (1998) Arthroscopic distal clavicle resection for isolated atraumatic osteolysis in weight lifters. Am J Sports Med 26(2):189–192

    Article  Google Scholar 

  26. Gokkus K, Saylik M, Atmaca H, Sagtas E, Aydin AT (2016) Limited distal clavicle excision of acromioclavicular joint osteoarthritis. Orthop Traumatol Surg Res 102(3):311–318

    Article  CAS  Google Scholar 

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Funding

No funding was received to assist with the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore

    Y. H. Ng, C. C. Hong, D. Z. Ng & V. P. Kumar

Authors
  1. Y. H. Ng
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  2. C. C. Hong
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  3. D. Z. Ng
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  4. V. P. Kumar
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Yau Hong, Ng and Choon Chiet, Hong. The first draft of the manuscript was written by Yau Hong, Ng and Choon Chiet, Hong. All authors commented on previous versions of the manuscript including the revised versions. Dennis Zhaowen, Ng and V Prem Kumar supervised and reviewed the final manuscript. All authors read and approved the final manuscript.

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Correspondence to C. C. Hong.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

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This study was approved by our local institutional review board.

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Ng, Y.H., Hong, C.C., Ng, D.Z. et al. Percutaneous distal clavicle excision for acromioclavicular joint arthritis: our experience and early results of a novel surgical technique. Musculoskelet Surg 106, 247–255 (2022). https://doi.org/10.1007/s12306-021-00708-9

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  • DOI: https://doi.org/10.1007/s12306-021-00708-9

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