title: Arthroscopic distal clavicle resection in symptomatic acromioclavicular joint arthritis combined with rotator cuff tear: a prospective randomized trial.
abstract: BACKGROUND
  The treatment of symptomatic acromioclavicular joint (ACJ) injury in the rotator cuff (RC) tear has not been well clarified.
  
  
  OBJECTIVE
  To compare the clinical results between patients who had distal clavicle resection (DCR) and those who did not during RC repair.
  
  
  METHODS
  Randomized controlled trial; Level of evidence, 1.
  
  
  METHODS
  From August 2008 to December 2009, a total of 56 consecutive patients (58 shoulders) were included. All patients had either a full-thickness or high-grade (>50%) RC tear, ACJ tenderness, arthritic change visible on plain radiographs, and a positive ACJ lidocaine injection test the day before surgery. Patients were randomized into 2 groups: DCR and RC repair (DCR+RCR group) and RC repair only (isolated RCR). Evaluation was performed preoperatively, at 6 months postoperatively, and at a final follow-up a minimum of 24 months postoperatively using the American Shoulder and Elbow Surgeons (ASES) score, the Constant shoulder score, range of motion examination, and pain visual analog scale (VAS).
  
  
  RESULTS
  After simple randomization, 26 shoulders were allocated in the DCR+RCR group, and 32 were placed in the isolated RCR group. Five shoulders in the DCR+RCR group and 6 in the isolated RCR group were excluded from analysis due to loss of follow-up. Therefore, the evaluation was performed for 21 shoulders in the DCR+RCR group and 26 shoulders in the isolated RCR group. The mean follow-up period was 44.2 months in the DCR+RCR group and 44.0 months in the isolated RCR group. There were no differences in age, sex, symptom duration, RC tear size, or preoperative ASES, Constant, and VAS scores between the 2 groups (P > .05). At final follow-up, the ASES, Constant, and VAS scores were significantly improved in both groups (P < .001). There were no differences in ASES, Constant, and VAS scores between the 2 groups at final follow-up (P > .05), and there was no difference in residual ACJ tenderness (7 in the DCR+RCR group and 5 in the isolated RCR group) between the 2 groups (P = .270).
  
  
  CONCLUSIONS
  There was no difference in the clinical evaluations between the combined arthroscopic DCR and RCR group and the isolated RCR group at a minimum 24-month follow-up. Arthroscopic DCR should be carefully considered in patients who have symptomatic ACJ arthritis with RC tears.
authors.affiliation: Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Yong Bok
authors.initials: YB
authors.lastname: Park
authors.affiliation: Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University, Goyang, Korea.
authors.forename: Kyoung Hwan
authors.initials: KH
authors.lastname: Koh
authors.affiliation: Department of Orthopaedic Surgery, National Medical Center, Seoul, Korea.
authors.forename: Min Soo
authors.initials: MS
authors.lastname: Shon
authors.affiliation: Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Young Eun
authors.initials: YE
authors.lastname: Park
authors.affiliation: Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea shoulderyoo@gmail.com.
authors.forename: Jae Chul
authors.initials: JC
authors.lastname: Yoo
mesh_terms: D000173:Acromioclavicular Joint / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000453:epidemiology; D001168:Arthritis / Q000473:pathology / Q000601:surgery; D001178:Arthroplasty / Q000379:methods; D001182:Arthroscopy / Q000379:methods*; D002968:Clavicle / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D010147:Pain Measurement; D011446:Prospective Studies; D016059:Range of Motion, Articular; D000070636:Rotator Cuff Injuries; D016896:Treatment Outcome
keywords: acromioclavicular joint; arthroscopic distal clavicle resection; rotator cuff; shoulder