RESULTS OF ARTHROSCOPIC TREATMENT OF ISOLATED ACROMIOCLAVICULAR ARTHROPATHY: 27 CASES

Abstract

Purpose of the study: Resection of the lateral quarter of the clavicle is an effective treatment for painful acromio-clavicular arthropathy. An open procedure can create a disgraceful or painful scar or be associated with secondary instability and muscle weakness. Arthroscopic resection would avoid these complications.

Material and methods: Between 1992 and 2002, 35 patients were treated arthroscopically for isolated painful acromioclavicular arthropathy after failure of medical treatment. Twenty-seven patients (mean age 44 years) were reviewed clinically (Constant score, subjective outcome, stability) and radiographically (quality of resection, coraco-clavicular space, ossification) at more than two years follow-up. Acromioplasty was performed in all cases to improve exposure in 14 or because of an aggressive acromion (n=7). A scarf orthesis was worn to prevent pain. Self-controlled rehabilitation exercises were proposed.

Results: There were no postoperative complications excepting one case of retractile capsulitis in the context of an occupational accident. Excluding this case, mean sick-leave was five weeks (range 3–20). At mean follow-up of seven years, all scars were pain free and minimally visible. There was no problem with frontal or sagittal instability. The Constant score improved 24 points on average compared with the preoperative score with a significant gain for pain (+9 points). Two patients were disappointed: one retained a sequellar capsulitis and one persistent pain after insufficient resection. On average, the resection measured 10 mm (range 6–20 mm). Three patients had an insufficient posterosuperior resection. The coracoclavicular interval remained unchanged in all cases and four patients presented secondary ossification of the resection zone. Two patients were sensitive to acromioclavicular palpation with a positive cross arm test (one had an insufficient resection and the other ossifications at last follow-up).

Discussion and conclusion: Arthroscopic acromio-clavicular resection reduced operative morbidity. The operation does not destabilize the joint. The total joint surface area can be resected to avoid a residual pos-terosuperior impingement which would be a source of persistent pain. The presence of secondary ossifications in the zone of resection has led us to propose NSAID treatment although the prophylactic effect remains to be demonstrated.