title: Arthroscopic distal clavicle resection in athletes: a prospective comparison of the direct and indirect approach.
abstract: BACKGROUND
  The clinical success of arthroscopic distal clavicle resection for athletes has been well documented. There are, however, no published studies that prospectively compare the recovery rates in athletes as well as the outcomes of the indirect versus direct approaches.
  
  
  OBJECTIVE
  Both procedures are equally successful; however, the direct approach affords faster return to sports.
  
  
  METHODS
  Randomized controlled clinical trial; Level of evidence, 2.
  
  
  METHODS
  Thirty-eight consecutive athletes with osteolysis of the distal clavicle or isolated posttraumatic arthrosis of the acromioclavicular joint without instability underwent arthroscopic distal clavicle resection. The patients were randomized into 2 groups: a direct superior approach and an indirect subacromial approach. American Shoulder and Elbow Surgeons and Athletic Shoulder Scoring System scores were measurable outcomes.
  
  
  RESULTS
  Thirty-four athletes were available for a minimum 2-year follow-up. The 2 groups were similar, including preoperative American Shoulder and Elbow Surgeons and Athletic Shoulder Scoring System scores. Both groups demonstrated significant improvement in both scores at final follow-up when compared with preoperative scores (P < .001). The direct group demonstrated higher American Shoulder and Elbow Surgeons (82 vs 64) and Athletic Shoulder Scoring System (74 vs 56) scores at week 2 (P < .001) and week 6 (American Shoulder and Elbow Surgeons, 88 vs 77; Athletic Shoulder Scoring System, 87 vs 73) (P < .001). At final follow-up, both groups demonstrated excellent clinical outcomes, even though there was a statistical difference in scores, with the direct group scoring better (American Shoulder and Elbow Surgeons, 95.7 vs 91.2; Athletic Shoulder Scoring System -94.9 vs 88.3). The direct group demonstrated faster return to sports (mean, 21 days) than the indirect group (mean, 42 days) (P < .001). Radiographic analysis demonstrated an equivalent resection. One patient in each group had a clinically insignificant increase in coracoclavicular distance.
  
  
  CONCLUSIONS
  Both the direct superior approach and the indirect subacromial approach to the arthroscopic distal clavicle resection result in successful clinical outcome with clinically insignificant difference at final follow-up. Athletes treated with the direct superior approach improved faster clinically and returned to sports earlier.
authors.affiliation: Boston University Medical Center, Boston, MA 02118, USA.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Charron
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Schepsis
authors.forename: Ilya
authors.initials: I
authors.lastname: Voloshin
mesh_terms: D000173:Acromioclavicular Joint / Q000293:injuries / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001182:Arthroscopy / Q000379:methods*; D001265:Athletic Injuries / Q000601:surgery*; D002968:Clavicle / Q000293:injuries / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology; D016896:Treatment Outcome