Background: Arthroscopic subacromial decompression
and arthroscopic resection of the acromioclavicular joint as separate
procedures have been well documented. However, there is little information
on the success rate of resection with concomitant decompression.
In this study, we retrospectively evaluated the results of a consecutive
group of patients who underwent arthroscopic resection of the acromioclavicular
joint with concomitant subacromial decompression.
Methods: We evaluated the surgical results in thirty-one
consecutive patients (thirty-two shoulders) with acromioclavicular
pathology with concomitant subacromial impingement. The mean age
of the patients at the time of surgery was thirty-six years (range,
eighteen to sixty-seven years). Twenty-five patients, including
four professional athletes, were actively involved in sports activities.
The mean duration of follow-up was four years and ten months (range,
three to eight years). The follow-up examination included clinical
evaluation, chart review, radiographic analysis, and isokinetic
testing of both upper extremities.
Results: Of the twenty-five patients who participated
in sports, twenty-two (including the four professional athletes)
returned to their previous level of sports activity. Twenty-six
patients had no pain, three reported mild pain on strenuous repetitive
overhead activity, two (both weight-lifters) had occasional pain
in the acromioclavicular joint and the lateral aspect of the shoulder
with bench-pressing, and two (both baseball players) had mild pain
in the posterior aspect of the shoulder with throwing. All of the patients
were satisfied with the results. In the absence of a complete rotator
cuff tear, isokinetic strength-testing of both upper extremities
failed to demonstrate any weakness of the involved shoulder. The
mean functional score for individual activities was 2.7 points (range,
2.1 to 3.0 points) preoperatively and 3.9 points (range, 3.6 to
4.0 points) postoperatively (p = 0.0001).
No patient had superior migration of the clavicle. The amount
of distal clavicular resection averaged 9 mm (range, 7 to 15 mm).
One patient had heterotopic ossification at the resection site,
with mild pain on direct palpation of the acromioclavicular joint
and on strenuous overhead activity. Five patients had calcification
at the anterior deltoid insertion into the acromion that was asymptomatic, with
no impingement on overhead activity and no pain on direct palpation.
Conclusions: We found excellent results with arthroscopic
resection of the acromioclavicular joint and concomitant subacromial
decompression. When this procedure is performed on properly selected
patients, the results are similar to those of an open approach.