Little has been written about the results of isolated acromioclavicular joint (ACJ) resection using the superior approach. We report the results of our large series.

Between June 1994 and October 2003, a single surgeon performed 155 isolated ACJ resections, using the direct superior approach. Exclusion criteria were previous ipsilateral shoulder surgery, simultaneous arthroscopic procedures and OA. We asked 90 of the patients (94 shoulders) to complete the Simple Shoulder Test questionnaire by telephone. The median age of the 72 males and 18 females was 38 years (16 to 62). The dominant shoulder was involved in 54 patients. There was a history of trauma in 44 patients, with 11 rugby injuries. The median follow-up period was 29 months (6 to 118).

One portal infection resolved with debridement and antibiotics. Five revision procedures were done, four open revision Mumfords and one subacromial decompression. The mean postoperative Simple Shoulder score was 11.5 (6 to 12). Patients rated outcome as excellent in 63 shoulders, good in 22, moderate in five and poor in four.

The technique provides consistently good or excellent results (90%) and allows rapid return to normal function. There was complete resolution of pain in 73 of the 94 shoulders. All rugby players returned to the same level of play.

We reviewed 36 patients (39 shoulders) who had undergone arthroscopic Mumford procedure via a two superior portal technique for isolated acromioclavicular joint pain, using the Simple Shoulder Score (SSS) and a subjective outcome questionnaire, which included views about the cosmesis of the scars. The mean age of the 32 men and four women was 36 years (19 to 57) and 14 shoulders were on the dominant side. The mean follow-up was 22.7 months (14 to 47). Twenty-five patients reported a history of trauma, including six rugby injuries and five repetitive injuries sustained while bodybuilding.

The mean SSS was 11.5 out of 12. Subjectively 25 shoulders were rated excellent, eight good, two moderate and four poor. In 31 shoulders (79.5%) pain resolved completely. Twenty-five patients considered small scars either very important or extremely important and 33 were either extremely happy or very happy with their scars.

Arthroscopic excision of the distal clavicle via superior portals preserves the capsule-ligamentous structures stabilising the acromioclavicular joint. The procedure gives an excellent subjective outcome. Those patients with a poorer subjective outcome were older, with an increased possibility of occult shoulder pathology.