Arthroscopic Distal Clavicle and Medial Border of Acromion Resection for Symptomatic Acromioclavicular Joint Osteoarthritis

Reconstruction of Coracoclavicular Ligaments with Semitendinosus Autograft and Temporary Kirschner Wires is a good option for Chronic Acromioclavicular Joint Instability

Introduction

This study reports the results of surgical anatomic reconstruction of torn coracoclavicular ligaments with an autogenous semitendinosus graft and temporary Kirschner wires (K-wires) in chronic acromioclavicular (AC) joint dislocations.

Materials and methods

Nineteen shoulders underwent surgical anatomic reconstruction of torn coracoclavicular (CC) ligaments with an autogenous semitendinosus tendon graft and temporary K-wires for Rockwood grade III, IV and V chronic AC joint dislocations. Pre-operative data included patients' demographic characteristics, injury characteristics and surgical histories. The primary outcome measures were the University of California Los Angeles (UCLA) shoulder rating scale and visual analogue pain scoring (VAS), and the complications were noted for each patient.

Results

Surgical anatomic reconstruction of torn CC ligaments was performed in 19 patients with a mean age of 41.6±16 years (range 21-72 years). All of the patients were satisfied and felt better after CC ligament reconstruction. The average UCLA shoulder rating scale score was good/excellent: 29.4 (range 23-34) out of 35 points. The average pre-operative VAS score was 7.7 points out of 10 and improved to 1.1 points post-operatively (p<0.05). None of the patients experienced failure during the follow-up. One patient had a mild subluxation, but the patient was satisfied with the result.

Conclusions

This technique is simple, reliable, and biologic without major complications. It is also a cost-effective procedure since it can be performed with Kirschner wires and autogenous grafts. It has a major advantage of leaving no implants inside the joint, which can lead to hardware complications, and it can be performed in basic operating room settings.

Iatrogenic Excessive Clavicle Resection as a Complication of Arthroscopic Distal Clavicle Excision

Arthroscopic distal clavicle excision (DCE) is a reliable procedure to treat acromioclavicular joint arthritis. Typically, only 1 to 2 cm of distal clavicle should be removed. Resection of too much bone can lead to instability of the joint or lack of support to the shoulder. We describe 2 patients who had excessive clavicular bone removed arthroscopically, leading to irreparable clavicular pain and dysfunction. The 2 female patients, ages 56 and 60 years, presented to our clinic with continued pain after DCE. Both had pain intractable with nonoperative treatment and loss of range of motion of the shoulder. Radiographs revealed a distal clavicle defect of 7.5 cm in 1 patient. The second patient had a 2-cm distal clavicular defect with an adjacent 2-cm clavicle bone fragment between the defect and residual clavicle shaft. Both underwent surgery with subtotal claviculectomy for pain control. During surgery, 1 patient had a subclavian vein requiring vascular repair. After 1 year of follow-up, both patients had reduced but residual pain and restricted range of motion. Only 1 patient could rejoin her preinjury occupation. Neither patient could continue with preinjury recreational sports. Excessive removal of the distal clavicle during DCE can result in continued pain and disability of the shoulder. Methods to visualize the anatomy of the distal clavicle and its articulation to the acromion should be considered when performing this operation arthroscopically. Reoperation to remove subtotal clavicle has good clinical outcomes but may lead to serious complications due to the proximity to major neurovascular structures. [Orthopedics. 2024;47(1):e57-e60.].

Usefulness of the acromioclavicular joint cross-sectional area as a diagnostic image parameter of acromioclavicular osteoarthritis

BACKGROUND

Acromioclavicular joint (ACJ) space narrowing has been considered to be an important diagnostic image parameter of ACJ osteoarthritis (ACJO). However, the morphology of the ACJ space is irregular because of osteophyte formation, subchondral irregularity, capsular distention, sclerosis, and erosion. Therefore, we created the ACJ cross-sectional area (ACJCSA) as a new diagnostic image parameter to assess the irregular morphologic changes of the ACJ.

AIM

To hypothesize that the ACJCSA is a new diagnostic image parameter for ACJO.

METHODS

ACJ samples were obtained from 35 patients with ACJO and 30 healthy individuals who underwent shoulder magnetic resonance (S-MR) imaging that revealed no evidence of ACJO. Oblique coronal, T2-weighted, fat-suppressed S-MR images were acquired at the ACJ level from the two groups. We measured the ACJCSA and the ACJ space width (ACJSW) at the ACJ on the S-MR images using our imaging analysis program. The ACJCSA was measured as the cross-sectional area of the ACJ. The ACJSW was measured as the narrowest point between the acromion and the clavicle.

RESULTS

The average ACJCSA was 39.88 ± 10.60 mm² in the normal group and 18.80 ± 5.13 mm² in the ACJO group. The mean ACJSW was 3.51 ± 0.58 mm in the normal group and 2.02 ± 0.48 mm in the ACJO group. ACJO individuals had significantly lower ACJCSA and ACJSW than the healthy individuals. Receiver operating characteristic curve analyses demonstrated that the most suitable ACJCSA cutoff score was 26.14 mm², with 91.4% sensitivity and 90.0% specificity.

CONCLUSION

The optimal ACJSW cutoff score was 2.37 mm, with 88.6% sensitivity and 96.7% specificity. Even though both the ACJCSA and ACJSW were significantly associated with ACJO, the ACJCSA was a more sensitive diagnostic image parameter.

Efficacy of postoperative drainage after arthroscopic rotator cuff repair: a randomized controlled trial

Background

Arthroscopic rotator cuff repair is the standard treatment in patients with symptomatic reparable rotator cuff tear. It brings good to excellent postoperative outcomes. Postoperative suction drainage is the method to theoretically reduce postoperative shoulder swelling and hematoma formation, which is still commonly used in clinical practice, yet its efficacy remains unproven.

Methods

This is a nonblinded prospective randomized controlled study. A sample of 43 shoulders were simply randomized without replacement across drain and nondrain groups, allocated by sealed envelope before skin closures. The preoperative, intraoperative, and postoperative data were analyzed. The difference of oblique (O) and horizontal (H) shoulder circumference between before and after operation is the primary parameter indicating swelling and hematoma formation. The preoperative reliability of O and H dimensions were evaluated by 2 independent evaluators. The visual analog scale, estimated blood loss, and Disabilities of Arm, Shoulder, and Hand score were analyzed.

Results

There was no significant difference of circumference between drain and nondrain groups in both O and H methods. For method O, the mean difference between drain and nondrain groups at 24 hours was -0.25 (95% CI: -2.09 to 1.59, P = .783), at 1 week was -0.54 (95% CI: -2.05 to 0.96, P = .470), at 1 month was -0.39 (95% CI: -2.06 to 1.28, P = .639) and at 3 months was -0.01 (95% CI: -1.49 to 1.46, P = .987). Method H: Mean difference between groups at 24 hours was 0.29 (95% confidence interval [CI]: -0.61 to 1.20, P = .520), at 1 week was 0.004 (95% CI: -0.99 to 1.002, P = .993), at 1 month was -0.53 (95% CI: -1.62 to 0.56, P = .333), and at 3 months was -0.07 (95% CI: -0.91 to 0.77, P = .862). The preoperative O and H parameters showed strong to almost perfect agreement (intraclass correlation coefficient for A = 0.858 [95% CI: 0.738 to 0.923, P < .001], intraclass correlation coefficient for B = 0.955 [95% CI: 0.918 to 0.976, P < .001]). No significant difference of visual analog scale, estimated blood loss, and Disabilities of Arm, Shoulder, and Hand score was recorded between groups.

Conclusion

No difference was found between drain and nondrain placement for shoulder swelling, visual analog scale, estimated blood loss, and functional outcome in 3 months after surgery. Drain placement after arthroscopic rotator cuff repair is of unproven benefit in routine clinical practice.

Arthroscopic Distal Clavicle Resection Through the Supraspinatus Fossa Portal

Disorders of the acromioclavicular (AC) joint quite often necessitate distal clavicle resection (DCR). Arthroscopic DCR is favored because of it is mini-invasive and convenient to treat concomitant intraarticular or subacromial lesions. In previous reports, arthroscopic DCR was performed through the anterior portal with the patient in beach chair position. However, when the patient is in the lateral decubitus position, it is inconvenient to perform DCR through the anterior portal. Thus, we introduce a special DCR technique through the supraspinatus fossa (SSF) portal. The critical point of this technique is viewing the acromioclavicular joint through the routine posterior portal, creating the SSF portal at the anterior edge of the scapular spine and the same medial-to-lateral level to the AC joint, and enough removal of the posterior edge of the distal clavicle. We believe the introduction of this technique will provide a special technical option when DCR is needed.

Surgical techniques for management of acromioclavicular joint separations: review and update for radiologists

Imaging plays a central role in the postoperative management of acromioclavicular (AC) joint separations. There are more than 150 described techniques for the surgical management of AC joint injuries. These procedures can be categorized as varying combinations of the following basic techniques: a) soft-tissue repair, b) trans-articular AC joint fixation, c) coracoclavicular (CC) fixation, d) non-anatomic reconstruction of the CC ligaments, e) anatomic reconstruction of the CC ligaments, f) distal clavicle resection, and g) dynamic muscle transfer. The goals of this article are to describe the basic techniques for the surgical management of AC joint separations with an emphasis on technique-specific complications and postoperative imaging assessment.