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Outcome of distal clavicle resection in patients with acromioclavicular joint osteoarthritis and full-thickness rotator cuff tear

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to examine the impact of distal clavicle resection (DCR) on subjective and objective outcome measures in patients with acromioclavicular (AC) joint osteoarthritis (OA) and rotator cuff tear.

Methods

Prospectively collected data of consecutive patients with arthroscopic evidence of OA of the ACJ with complete data at 2 years were used for the data analysis. Patients with moderate-to-severe OA of the AC joint underwent a DCR in conjunction with rotator cuff repair, while patients with mild OA of the ACJ underwent surgery related to concomitant rotator cuff tear without a DCR.

Results

Data of 184 (72 females, 112 males, mean age: 62) patients with rotator cuff tear and varying degrees of OA of the AC joint were used for the analysis. Of 184 patients, 144 (78 %) had a resection of distal clavicle (resection group) and 40 (22 %) did not have a resection (no-resection group). Both groups showed a statistically significant (p < 0.0001) improvement in the American Shoulder and Elbow Surgeons (ASES) scores, Constant Murley score, and strength. Multivariable analysis showed that lower pre-operative ASES scores (higher disability), having a larger tear, an active compensation claim, and not having a DCR, had a negative impact on post-operative ASES scores.

Conclusion

When untreated surgically, even mild arthroscopic findings of AC joint OA may lead to a poorer outcome after rotator cuff repair. Further characterisation of patients in whom mild arthroscopic findings of OA of AC joint are clinically significant and warrant resection is needed.

Level of evidence

Retrospective outcome study, Level II.

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References

  1. Blasiak A, Mojzesz M, Brzoska R, Solecki W, Binkowska A (2013) Results of arthroscopic treatment of rotator cuff tear with the resection of symptomatic acromioclavicular joint with degenerative changes. Pol Orthop Traumatol 78:229–234

    PubMed  Google Scholar 

  2. Bonsell S, Pearsall AW IV, Heitman RJ, Helms CA, Major NM, Speer KP (2000) The relationship of age, gender, and degenerative changes observed on radiographs of the shoulder in asymptomatic individuals. J Bone Joint Surg Br 82:1135–1139

    Article  CAS  PubMed  Google Scholar 

  3. Chen AL, Rokito AS, Zuckerman JD (2003) The role of the acromioclavicular joint in impingement syndrome. Clin Sports Med 22:343–357

    Article  PubMed  Google Scholar 

  4. Collins DH (1950) The pathology of articular and spinal diseases. The Williams and Wilkins Co., Baltimore

    Google Scholar 

  5. Constant CR (1997) An evaluation of the Constant-Murley shoulder assessment. J Bone Joint Surg Br 79:695–696

    CAS  PubMed  Google Scholar 

  6. Cook FF, Tibone JE (1988) The Mumford procedure in athletes. An objective analysis of function. Am J Sports Med 16:97–100

    Article  CAS  PubMed  Google Scholar 

  7. Cuomo F, Kummer FJ, Zuckerman JD, Lyon T, Blair B, Olsen T (1998) The influence of acromioclavicular joint morphology on rotator cuff tears. J Shoulder Elbow Surg 7:555–559

    Article  CAS  PubMed  Google Scholar 

  8. Daluga DJ, Dobozi W (1989) The influence of distal clavicle resection and rotator cuff repair on the effectiveness of anterior acromioplasty. Clin Orthop Relat Res 247:117–123

    PubMed  Google Scholar 

  9. DePalma AF (2008) The classic. Surgical anatomy of the rotator cuff and the natural history of degenerative periarthritis. Clin Orthop Relat Res 466:543–551

    Article  PubMed  Google Scholar 

  10. 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 78:584–587

    CAS  PubMed  Google Scholar 

  11. Frieman BG, Fenlin JM Jr (1995) Anterior acromioplasty: effect of litigation and workers’ compensation. J Shoulder Elbow Surg 4:175–181

    Article  CAS  PubMed  Google Scholar 

  12. Gartsman GM (1993) Arthroscopic resection of the acromioclavicular joint. Am J Sports Med 21:71–77

    Article  CAS  PubMed  Google Scholar 

  13. Gurbuz H, Unalan H, Sarisaltik H, Sekhavat H, Candan L (1998) The role of acromioclavicular arthritis in impingement syndromes. Yonsei Med J 39:97–102

    Article  CAS  PubMed  Google Scholar 

  14. Holtby R, Razmjou H (2010) Impact of work-related compensation claims on surgical outcome of patients with rotator cuff related pathologies: a matched case–control study. J Shoulder Elbow Surg 19:452–460

    Article  PubMed  Google Scholar 

  15. Holtby R, Razmjou H (2004) Validity of the supraspinatus test as a single clinical test in diagnosing patients with rotator cuff pathology. J Orthop Sports Phys Ther 34:194–200

    Article  PubMed  Google Scholar 

  16. Kay SP, Dragoo JL, Lee R (2003) Long-term results of arthroscopic resection of the distal clavicle with concomitant subacromial decompression. Arthroscopy 19:805–809

    Article  PubMed  Google Scholar 

  17. Kemp KA, Sheps DM, Luciak-Corea C, Styles-Tripp F, Buckingham J, Beaupre LA (2011) Systematic review of rotator cuff tears in worker’s compensation patients. Occup Med (Lond) 61:556–562

    Article  CAS  Google Scholar 

  18. Kim J, Chung J, Ok H (2011) Asymptomatic acromioclavicular joint arthritis in arthroscopic rotator cuff tendon repair: a prospective randomized comparison study. Arch Orthop Trauma Surg 131:363–369

    Article  PubMed  Google Scholar 

  19. Leavitt F (1992) The physical exertion factor in compensable work injuries. A hidden flaw in previous research. Spine 17:307–310

    Article  CAS  PubMed  Google Scholar 

  20. Levine WN, Soong M, Ahmad CS, Blaine TA, Bigliani LU (2006) Arthroscopic distal clavicle resection: a comparison of bursal and direct approaches. Arthroscopy 22:516–520

    Article  PubMed  Google Scholar 

  21. Lozman PR, Hechtman KS, Uribe JW (1995) Combined arthroscopic management of impingement syndrome and acromioclavicular joint arthritis. J South Orthop Assoc 4:177–181

    CAS  PubMed  Google Scholar 

  22. Luyckx L, Luyckx T, Donceel P, Debeer P (2011) Return to work after arthroscopic subacromial decompression. Acta Orthop Belg 77:737–742

    PubMed  Google Scholar 

  23. MacDermid JC, Drosdowech D, Faber K (2006) Responsiveness of self-report scales in patients recovering from rotator cuff surgery. J Shoulder Elbow Surg 15:407–414

    Article  PubMed  Google Scholar 

  24. Martin SD, Baumgarten TE, Andrews JR (2001) Arthroscopic resection of the distal aspect of the clavicle with concomitant subacromial decompression. J Bone Joint Surg Am 83-A:328–335

    CAS  PubMed  Google Scholar 

  25. McRae S, Leiter J, Walmsley C, Rehsia S, Macdonald P (2011) Relationship between self-reported shoulder function/quality of life, body mass index, and other contributing factors in patients awaiting rotator cuff repair surgery. J Shoulder Elbow Surg 20:57–61

    Article  PubMed  Google Scholar 

  26. Michener LA, McClure PW, Sennett BJ (2002) American shoulder and elbow surgeons standardized shoulder assessment form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow Surg 11:587–594

    Article  PubMed  Google Scholar 

  27. Nordt WE III, Garretson RB III, Plotkin E (1999) The measurement of subacromial contact pressure in patients with impingement syndrome. Arthroscopy 15:121–125

    Article  PubMed  Google Scholar 

  28. Novak PJ, Bach BR Jr, Romeo AA, Hager CA (1995) Surgical resection of the distal clavicle. J Shoulder Elbow Surg 4:35–40

    Article  CAS  PubMed  Google Scholar 

  29. Pennington RG, Bottomley NJ, Neen D, Brownlow HC (2008) Radiological features of osteoarthritis of the acromiclavicular joint and its association with clinical symptoms. J Orthop Surg (Hong Kong) 16:300–302

    CAS  Google Scholar 

  30. Petchell JF, Sonnabend DH, Hughes JS (1995) Distal clavicular excision: a detailed functional assessment. Aust N Z J Surg 65:262–266

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  32. Razmjou H, Bean A, MacDermid JC, van Osnabrugge V, Travers N, Holtby R (2008) Convergent validity of the Constant-Murley outcome measure in patients with rotator cuff disease. Physiother Can 60:72–79

    Article  PubMed Central  PubMed  Google Scholar 

  33. Razmjou H, Davis AM, Jaglal SB, Holtby R, Richards RR (2011) Disability and satisfaction after rotator cuff decompression or repair: a sex and gender analysis. BMC Musculoskelet Disord 12:66

    Article  PubMed Central  PubMed  Google Scholar 

  34. Razmjou H, Lincoln S, Axelrod T, Holtby R (2008) Factors contributing to failure of rotator cuff surgery in persons with work-related injuries. Physiother Can 60:125–133

    Article  PubMed Central  PubMed  Google Scholar 

  35. Razmjou H, Bean A, van Osnabrugge V, MacDermid JC, Holtby R (2006) Cross-sectional and longitudinal construct validity of two rotator cuff disease-specific outcome measures. BMC Musculoskelet Disord 7:26

    Article  PubMed Central  PubMed  Google Scholar 

  36. Richards RR, An K, Bigliani LU, Friedman R, Gartsman GM, Gristina AG, Iannotti JP, Mow VC, Sidles JA, Zuckerman JD (1994) A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg 3:347–352

    Article  CAS  PubMed  Google Scholar 

  37. Snyder SJ, Banas MP, Karzel RP (1995) The arthroscopic Mumford procedure: an analysis of results. Arthroscopy 11:157–164

    Article  CAS  PubMed  Google Scholar 

  38. Stein BE, Wiater JM, Pfaff HC, Bigliani LU, Levine WN (2001) Detection of acromioclavicular joint pathology in asymptomatic shoulders with magnetic resonance imaging. J Shoulder Elbow Surg 10:204–208

    Article  CAS  PubMed  Google Scholar 

  39. Stenlund B, Marions O, Engstrom KF, Goldie I (1988) Correlation of macroscopic osteoarthrotic changes and radiographic findings in the acromioclavicular joint. Acta Radiol 29:571–576

    Article  CAS  PubMed  Google Scholar 

  40. Wuelker N, Plitz W, Roetman B (1994) Biomechanical data concerning the shoulder impingement syndrome. Clin Orthop Relat Res 303:242–249

    PubMed  Google Scholar 

  41. Wuelker N, Plitz W, Roetman B, Wirth CJ (1994) Function of the supraspinatus muscle. Abduction of the humerus studied in cadavers. Acta Orthop Scand 65:442–446

    Article  CAS  PubMed  Google Scholar 

  42. Wuelker N, Schmotzer H, Thren K, Korell M (1994) Translation of the glenohumeral joint with simulated active elevation. Clin Orthop Relat Res 309:193–200

    PubMed  Google Scholar 

  43. Zawadsky M, Marra G, Wiater JM, Levine WN, Pollock RG, Flatow EL, Bigliani LU (2000) Osteolysis of the distal clavicle: long-term results of arthroscopic resection. Arthroscopy 16:600–605

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Helen Razmjou & Richard Holtby

  2. Department of Physical Therapy, University of Toronto, Toronto, Canada

    Helen Razmjou & Moira Devereaux

  3. Department of Orthopaedic Surgery, St. Joseph’s Health Centre, Toronto, Canada

    Amr ElMaraghy

  4. Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada

    Amr ElMaraghy, Tim Dwyer & Richard Holtby

  5. Department of Orthopaedic Surgery, Women’s College and Mount Sinai Hospital, Toronto, Canada

    Tim Dwyer

  6. Centre de Santé et de Services Sociaux d’Arthabaska-et-de-l’Érable, Affilié Universitaire, Université de Sherbrooke, Québec, Canada

    Simon Fournier-Gosselin

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  1. Helen Razmjou
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  2. Amr ElMaraghy
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  5. Moira Devereaux
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  6. Richard Holtby
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Correspondence to Helen Razmjou.

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Razmjou, H., ElMaraghy, A., Dwyer, T. et al. Outcome of distal clavicle resection in patients with acromioclavicular joint osteoarthritis and full-thickness rotator cuff tear. Knee Surg Sports Traumatol Arthrosc 23, 585–590 (2015). https://doi.org/10.1007/s00167-014-3114-2

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  • DOI: https://doi.org/10.1007/s00167-014-3114-2

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