Clinical outcomes and predictors of dissatisfaction following revision surgery after distal clavicle excision

Distal clavicle excision (DCE) is a well-established treatment for acromioclavicular (AC) joint pain and osteoarthritis, with generally favorable outcomes after primary surgery. However, persistent pain or instability may require revision surgery. The literature on outcomes of revision AC surgery after DCE is limited. The purpose of this study was to evaluate clinical outcomes after revision surgery for persistent pain or instability following DCE and to identify predictors associated with patient satisfaction, subjective instability, and complications.

A retrospective cohort study was performed of patients who underwent revision surgery after prior DCE between 2005 and 2024. Eligible revisions included repeat DCE or AC and/or coracoclavicular (CC) joint reconstruction. Demographic, clinical, operative, and radiographic data, including AC and CC distances and distal clavicle resection length, were collected. Patient-reported outcome measures, including American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation, visual analog scale for pain and instability, were collected preoperatively and at a minimum of 24 months postoperatively. Patient satisfaction was recorded on an ordinal 5-point Likert scale. For analysis, satisfied and very satisfied patients were grouped together, and neutral, unsatisfied, and very unsatisfied were grouped together.

Forty-six shoulders (28 males and 18 females) with a mean age of 48.3 ± 11.7 years (range: 18-78 years) were included at a follow-up of 7.6 ± 3.5 years (range: 2-17 years). Thirty-six shoulders (78%) underwent repeat DCE and 10 (22%) underwent AC/CC reconstruction. Patient-reported outcome measures improved following revision surgery, with visual analog scale pain decreasing by 4.2 ± 3.3 points, American Shoulder and Elbow Surgeons increasing by 29.8 ± 28.3 points, and Single Assessment Numeric Evaluation increasing by 31.6 ± 29.3 points. Of the 36 (78.3%) patients available for telephone follow-up, 66.6% reported being satisfied or very satisfied, while 22.2% were dissatisfied. Subjective instability remained common, reported by 30.6% of patients, and was strongly associated with dissatisfaction (58.3% vs. 16.7%, OR 7.0 [1.43-33.7], P = .02). No pre-operative radiographic or clinical variables were significantly associated with dissatisfaction. The overall complication or reoperation rate was 12.2%.

Revision surgery following failed DCE can result in meaningful improvements in pain and functional outcomes; however, over 10% of patients experience a complication and a substantial proportion of patients remain dissatisfied. Persistent subjective instability was strongly associated with dissatisfaction despite improvements in traditional outcome measures. These findings suggest that restoration of perceived AC joint stability remains a key correlate of patient satisfaction and a persistent challenge in the revision setting.