How long should arthroscopic clavicular resection be in acromioclavicular arthropathy? A radiological-clinical study (with computed tomography) of 18 cases at a mean 4 years' follow-up.
BACKGROUND
Endoscopic clavicular resection is a common procedure, but few studies have analyzed predictive factors for outcome.


OBJECTIVE
1) Computed tomography (CT) of clavicular resection is reproductible; 2) Functional outcome correlates with resection length; 3) Other factors also influence outcome.


METHODS
Patients operated on between 2005 and 2010 were called back to establish functional scores (Constant, Simple Shoulder Test [SST], satisfaction) and undergo low-dose bilateral comparative computed tomography (CT) centered on the acromioclavicular joints. The assessment criteria were resection edge parallelism and resection length, measured using OsiriX software. Radiological and clinical data were correlated.


RESULTS
18 out of 21 patients (85%: 3 female, 15 male) were assessed. Mean age at surgery was 49 years (range, 40-62 yrs); mean follow-up was 4.2 years (1.6-7.2 yrs). Mean Constant score rose from 57.7 (25-85) to 70.2 (30-96); mean postoperative SST was 9.3 (3-12). 11 patients had very good and 4 poor results. CT resection length was reproducible, with intraclass, intra- and interobserver correlation coefficients >95%. There was no significant correlation between articular resection length on CT and functional scores (P=0.2). Functional scores were negatively influenced by an occupational pathologic context (P<0.01) and by associated tendinopathy.


CONCLUSIONS
Low-dose CT enabled reproducible analysis of clavicular resection. The hypothesized correlation between resection length and functional result was not confirmed. Work accidents and occupational disease emerged as risk factors.


METHODS
Single-center retrospective analytic cohort study. Level 4, guideline grade C.
Service de chirurgie orthopédique et réparatrice, CHU Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 09, France.
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Kim
Département de radiologie, CHU Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 09, France.
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Deniel
Service de chirurgie orthopédique et réparatrice, CHU Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 09, France.
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Ropars
Département de radiologie, CHU Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 09, France.
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Guillin
Service de chirurgie orthopédique et réparatrice, CHU Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 09, France.
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Fournier
Service de chirurgie orthopédique et réparatrice, CHU Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 09, France. Electronic address: herve.thomazeau@chu-rennes.fr.
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Thomazeau
D000173:Acromioclavicular Joint / Q000000981:diagnostic imaging* / Q000502:physiology / Q000601:surgery*; D000328:Adult; D001182:Arthroscopy / Q000379:methods*; D002968:Clavicle / Q000000981:diagnostic imaging / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007592:Joint Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D019637:Orthopedic Procedures / Q000379:methods*; D011379:Prognosis; D016059:Range of Motion, Articular / Q000502:physiology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
Acromioclavicular joints; Arthroscopy; CT scan