INFLUENCE OF ACROMIOCLAVICULAR OSTEOARTHRITIS ON OUTCOME OF ARTHROSCOPIC ACROMIOPLASTY

Abstract

Purpose: Failure is still observed after 20% of acromioplasties which can be explained by acromioclavicular osteoarthritis. The purpose of this study was to demonstrate the deleterious effect of this degeneration on outcome.

Material and methods: We reviewed 103 arthroscopic acromioplasties performed in 100 patients who presented non-torn non-calcified tenopathies. Seven patients were excluded so 96 patients, 63 women and 33 men were retained for analysis. Mean age at operation was 48.2 years and mean follow-up was 3.8 years. Patients were divided into two groups on the basis of the sonographic findings: group 1 had no computed tomography (CT) signs of acromioclavicular osteoarthritis (66 patients), such signs were found in group 2 (30 patients). Each patient was reviewed clinically and CT-scan was used to diagnosis osteoarthritis classed as stage 0 to 3. Subjective outcome was assessed in terms of patient satisfaction and objectively with the Constant score.

Results: Subjectively, three-quarters of the patients in group 1 were satisfied versus one-third in group 2. The Constant score confirmed this finding with a mean 76 points in group 1 versus 68 in group 2 (the weighted score was 93.5% and 83% respectively). The weighted score showed that good or excellent results were achieved in 84.84% of the patients in group 1 and in 43% in group 2.

Discussion: Our results are in agreement with data in the literature and provide scientific evidence of the influence of acromioclavicular osteoarthritis on the failure of acromioplasty. The results in group 1 were clearly better than in group 2, proving statistically a widely accepted notion: acromioclavicular osteoarthritis compromises significantly outcome of acromioplasty. Furthermore, it is interesting to note that among the seven cases excluded (for resection of the articulation), six had satisfactory outcomes.

Conclusion: These results confirm the unfavourable influence of acromioclavicular osteoarthritis on the outcome of acromioplasty. A prospective study designed to determine the effect of simultaneous acromioclavicular resection would be useful to propose a coherent therapeutic approach.