title: Arthroscopic versus open distal clavicle excision: a comparative assessment at intermediate-term follow-up.
abstract: BACKGROUND
  While few comparative studies exist, it has been suggested that open distal clavicle excisions (DCEs) provide inferior results when compared with the all-arthroscopic technique.
  
  
  OBJECTIVE
  The purpose of this study was to compare the intermediate-term (5-year follow-up) results of patients undergoing arthroscopic versus open DCE for the treatment of recalcitrant acromioclavicular joint pain.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  All patients who underwent an arthroscopic or open DCE between January 1999 and September 2006 were reviewed. Forty-eight patients (49 shoulders; 32 arthroscopic, 17 open) following DCE without significant glenohumeral pathologic changes were included. The mean follow-up for group I (open) and group II (arthroscopic) was 5.3 years and 4.2 years, respectively. The American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) pain score, surgical time, and minimum radiographic acromioclavicular joint distance were calculated. Each patient completed a questionnaire assessing their scar satisfaction, percentage of normal shoulder function, and willingness to have the surgery again. Risk factors for poor outcomes were analyzed.
  
  
  RESULTS
  Arthroscopic patients had significantly less pain (P = .035) by VAS (0.61 ± 1.02) compared with open (1.59 ± 2.15) at final follow-up. There was no significant difference between group I and group II with regard to ASES (87.5 ± 17.6 vs 94.6 ± 8.6), percentage of normal shoulder function (89.7% ± 12.5 vs 92.9% ± 8.6), average operative time (53.1 minutes vs 48 minutes), or radiographic resection distance (12.8 ± 2.1 mm vs 9.5 ± 2.9 mm). In the open group, patients with 16 of 17 shoulders were satisfied with their scar and 100% would do it again. In the arthroscopic group, patients with 31 of 32 shoulders (97%) were both satisfied and would have the surgery again.
  
  
  CONCLUSIONS
  Open and arthroscopic DCE are both effective surgeries to treat recalcitrant acromioclavicular joint pain. At intermediate-term follow-up, they provide similarly good to excellent results with regard to patient satisfaction and shoulder function. Although both are effective treatments, less residual pain was found using the arthroscopic technique.
authors: UT Southwestern Medical Center at Dallas, 1801 Inwood Road, Dallas, TX 75390, USA. . robertsonwj@gmail.com
authors: William J
authors: WJ
authors: Robertson
authors: Matthew H
authors: MH
authors: Griffith
authors: Kaitlin
authors: K
authors: Carroll
authors: Thomas
authors: T
authors: O'Donnell
authors: Thomas J
authors: TJ
authors: Gill
mesh_terms: D000173:Acromioclavicular Joint / Q000601:surgery; D000328:Adult; D000368:Aged; D001182:Arthroscopy; D002921:Cicatrix / Q000523:psychology; D002968:Clavicle / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D011859:Radiography; D012189:Retrospective Studies; D012782:Shoulder / Q000502:physiology / Q000601:surgery; D020069:Shoulder Pain / Q000503:physiopathology / Q000601:surgery; D011795:Surveys and Questionnaires; D016896:Treatment Outcome