Arthroscopic treatment of acromioclavicualr joint arthritis, a modified approach in the distal clavicle excision with preservation of the superior A.C.J ligament

ABSTRACT

The acromioclavicular [AC] joint arthritis is a common and sometimes under-looked source of shoulder problems. The procedure of subacromial decompression with distal clavicular end resection [either open or arthroscopic] was the usual treatment proposed. With the increasing popular usage of this technique, some failure rates were reported after either open or arthroscopic techniques. This was attributed to Inadequate resection, or partial ACJ instability due to injury or resection of the superior ligament during the ACJ resection, and underlying muscle injury due to lack of experience or difficult portals handling. Our Aim was to assess the results of arthoscopic management of A.C.J arthritis, by distal clavicle resection using a modified arthroscopic portals and technique. Thirty two patients were managed arthroscopicaly, after proper diagnosis of A.C arthritis. A modified arthroscopic approach through anterior working portal -instead of the classical anterosuperior portal-and posterior viewing portal were used with the resection of acromial side [osteophytes] preceding the clavicular side instead of resection the clavicular side directly. This approach brings better handling of the joint and easier in preserving the superior AC ligament as widening of the ACJ is less than 1.5cm from both acromial and clavicular ends. All patients were followed up for six months using the UCLA shoulder scale in analysis of the results. This modified approach proved successful results, and comparable with the classical anterosuperior, and posterosuperior approach, showed earlier recovery. In this series 90.6% of patients showed excellent results after an average of 3.7 months, while 6.4% of patients showed good results, and only 3% showed poor results. The Meticulous preoperative evaluation, and this modified approach using the anterior portal instead of the classical anterosuperior one, with the resection of less than 1.5cm of the clavicle, preserve the superior A.C ligament, and consequent the horizontal stability of the joint. Moreover the adequate subacromial decompression that may accomplish the procedure could be easier and better. Both- viewing and working at the joint using the modified portals decreased the long learning curve, and achieved better final results: