title: Arthroscopic distal clavicle resection: a comparison of bursal and direct approaches.
abstract: OBJECTIVE
  To test the hypothesis that the direct (superior) approach to arthroscopic distal clavicle resection is as safe and effective as the bursal (subacromial) approach.
  
  
  METHODS
  All patients who had an arthroscopic distal clavicle resection in our institution between 1994 and 2002 were reviewed. Patients with a history of acromioclavicular joint (ACJ) instability, previous shoulder surgery, glenohumeral pathology, full-thickness rotator cuff tear, or other significant orthopaedic comorbidity were excluded. Outcome data were collected including the American Shoulder and Elbow Surgeons (ASES) score as well as subjective ratings of pain and instability.
  
  
  RESULTS
  Follow-up was completed on 66 shoulders of 60 patients. Twenty-four shoulders had a bursal approach (group I) and 42 had a direct approach (group II). There were 45 men and 15 women with an average age of 46 years (range, 21 to 78 years). Follow-up averaged 6.0 years (range, 2 to 11.5 years). The average ASES score was 90 (range, 53-100) in group I and 94 (range, 55-100) in group II. Four patients (10%) in group II required reoperation: 2 patients required ACJ stabilization at 6 and 9 months postoperatively because of anteroposterior instability, and 2 patients required resection again at 5 years because of recurrent symptoms.
  
  
  CONCLUSIONS
  Both the direct and bursal approaches lead to satisfactory outcomes in the majority of patients with ACJ arthrosis. However, the direct approach to the ACJ may damage the superior capsular ligaments, potentially leading to distal clavicle instability. Care should be taken when performing the direct ACJ resection to avoid disrupting the capsular restraints.
  
  
  METHODS
  Level IV therapeutic case series.
authors.affiliation: Center for Shoulder, Elbow and Sports Medicine, Columbia University, Columbia University Medical Center, New York, New York, USA. wnl1@columbia.edu
authors.forename: William N
authors.initials: WN
authors.lastname: Levine
authors.forename: Maximillian
authors.initials: M
authors.lastname: Soong
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ahmad
authors.forename: Theodore A
authors.initials: TA
authors.lastname: Blaine
authors.forename: Louis U
authors.initials: LU
authors.lastname: Bigliani
mesh_terms: D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000379:methods*; D002968:Clavicle / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D010147:Pain Measurement; D011183:Postoperative Complications; D012008:Recurrence