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Two Surgical Methods of Acromioclavicular Resection Compared

Over the top of the shoulder a bony projection from the shoulder blade (acromion) meets up with the collarbone (clavicle). This joint is called the acromioclavicular joint (ACJ). The ACJ can become very painful when there is arthritis or impingement. Impingement occurs when tendons from the rotator cuff get pinched as they pass through the space below this joint.

In this study, surgeons from Columbia University Medical Center in New York compare the results of two different ways to surgically repair the problem. The first, more common method is the bursal or indirect approach. The second is the direct approach. In both methods, the end of the clavicle is cut and taken out where it meets the acromion.

Sixty-six shoulders in 60 patients were divided into two groups based on the method used to resect the clavicle. Each procedure is described by the surgeon. All operations were done with minimal incisions or openings using an arthroscope. Results were measured by level of pain, shoulder instability, and function.

The authors report the direct approach gives the surgeon a better view of the entire joint and easier access to the ACJ compared to the bursa approach. However, the direct method may damage the capsular ligaments above the joint. The patient can be left with instability of the remaining clavicle.

In this study everyone was followed for at least two years. Measures of function reported after the operation were equal in both groups. Ten percent of the direct group needed a second operation for instability or return of painful symptoms.

The authors conclude both ways to treat problems at the ACJ work well. The direct approach may be a little more risky because of the potential for damage to the joint capsule and ligaments. They advise surgeons who use the direct approach to repair any damage done to these structures right away. The supporting and ligamentous tissues must be protected during surgery in order to maintain ACJ stability.

References: William N. Levine, MD, et al. Arthroscopic Distal Clavicle Resection: A Comparison of Bursal and Direct Approaches. In The Journal of Arthroscopic and Related Surgery. May 2006. Vol. 22. No. 5. Pp. 516-520.

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