These authors performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of distal clavicle resection on (1) outcome scores; (2) shoulder ROM, joint pain or tenderness, and joint instability; and (3) risk of reoperation among patients treated surgically for rotator cuff tears who had concomitant acromioclavicular joint arthritis.
They found no difference between the distal clavicleresection plus rotator cuff repair group and the isolated rotator cuff repair group in ASES score, the VAS score, the Constant score, the range of motion the shoulder, acromioclavicular joint pain or tenderness between the groups.
Acromioclavicular joint instability was only detected in the rotator cuff repair plus distal clavicle resection group. Finally, they found no difference in the proportion of patients undergoing repeat surgery between the study groups.
The authors concluded that distal clavicle resection in patients with rotator cuff tears did not result in better clinical outcome scores or shoulder ROM and was not associated with a lower risk of reoperation. Distal clavicle resection might cause acromioclavicular joint instability in patients with rotator cuff tears and concomitant asymptomatic acromioclavicular joint arthritis.
Thus they do not recommend arthroscopic distal clavicle resection in patients with rotator cuff tears and concomitant acromioclavicular joint arthritis.
The authors concluded that distal clavicle resection in patients with rotator cuff tears did not result in better clinical outcome scores or shoulder ROM and was not associated with a lower risk of reoperation. Distal clavicle resection might cause acromioclavicular joint instability in patients with rotator cuff tears and concomitant asymptomatic acromioclavicular joint arthritis.
Thus they do not recommend arthroscopic distal clavicle resection in patients with rotator cuff tears and concomitant acromioclavicular joint arthritis.
Comment: A discussion of this paper can be found at this link.
In our experience, most patients with cuff tears have x-ray changes at the AC joint. However, on physical exam these patients rarely have findings attributable to the AC joint. As a result, we rarely add AC joint surgery to our surgical treatment of patients having rotator cuff surgery. This article supports this practice.
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