Incidence of acromioclavicular joint complications after arthroscopic subacromial decompression

We performed a chart and radiograph review of 173 patients (183 shoulders) who underwent arthroscopic subacromial decompression between 1991 and 1994 and had preoperative and postoperative radiographs. The study focused on the presence of preoperative acromioclavicular joint pathology, intraoperative violation of the acromioclavicular joint, extent of distal clavicle excision, and subsequent development of acromioclavicular joint symptoms. The 183 surgical procedures were divided into three groups: shoulders with subacromial decompression without acromioclavicular joint violation (103 of 183; 56%; group A); shoulders with subacromial decompression with acromioclavicular joint violation and partial distal clavicle resection (36 of 183; 20%; group B); and shoulders with subacromial decompression with complete distal clavicle resection (44 of 183; 24%; group C). Groups A and C had no postoperative sequelae in reference to the acromioclavicular joint. In contrast, 14 of the 36 shoulders (39%) in group B with a documented acromioclavicular joint violation and a partial distal clavicle resection developed acromioclavicular joint symptoms at an average of 8.4 months (range, 1.8 to 19 months) after surgery. This finding was statistically significant (P=.0001). The results of this study suggest that any violation of the acromioclavicular joint in the course of an arthroscopic subacromial decompression may jeopardize the result. The degree of violation is not helpful in predicting outcome. As a result of this study, we suggest an all-or-none surgical approach to the acromioclavicular joint and distal clavicle resection.