Distal Clavicle Resection Using a Combined Anterior and Posterior Arthroscopic Approach

Distal clavicle resections are an effective treatment for subacromial impingement caused by clavicular pathologies. Causes include but are not limited to degenerative osteoarthritis, infection, malunion after trauma, and inflammatory arthritis. There are multiple variations of the procedure with different potential complications, including open and arthroscopic (direct, indirect).

In the setting of isolated acromioclavicular (AC) joint arthrosis, patients often have pain at the anterosuperior shoulder. Patients should be examined for tenderness to palpation at the AC joint in comparison to the unaffected side. This pain may increase with specific maneuvers to stress the AC joint, such as cross-body adduction, active compression, or maximal internal rotation. In addition to the standard 3 views of the shoulder, a Zanca view radiograph allows for optimal visualization of the AC joint.

The patient is placed upright in the beach-chair position, and the glenohumeral joint is accessed via the posterior and anterior portals. A soft tissue shaver and an ablation device are used to remove joint debris and capsule. Once the lateral clavicle is exposed, a bur is then introduced through the anterior portal. The proximal acromion and distal clavicle are then removed from anterior to posterior. A total of 6 to 7 mm of bone should be removed, which can be measured using the size of the bur. The camera is then switched to the anterior portal, and the resection can be completed with the bur in the posterior portal. This can accompany other subacromial decompression procedures or rotator cuff repair as needed.

The results of treating distal clavicle lesions via the above technique have been very successful in our patients. This is consistent with other studies in the literature, where patients with 20 years of follow-up were shown to have good outcomes after arthroscopic subacromial decompression. Patients who underwent arthroscopic rotator cuff repair with and without acromioplasty had a higher reoperation rate than those who did not undergo acromioplasty.

Distal clavicle resection is a safe and effective technique that can be easily employed as part of arthroscopic subacromial decompression.

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