Arthroscopic management of the acromioclavicular joint disorder. A review

Acromioclavicular joint symptoms may originate from either osteolysis or osteoarthritis. Initial treatment consists of 6 to 12 months of physical therapy, nonsteroidal antiinflammatory drugs, avoidance of exacerbating activities, and other conservative modalities. The majority of patients respond well, but a few remain unable to return to their previous or desired activity levels. Previously this group of patients underwent open resection of the distal clavicle. [The approach violates the deltotrapezial fascia, weakening the surgically treated extremity, which has caused controversy in the literature.] Even without complications, the recovery and time away from work is prolonged. With advances in arthroscopic techniques, resection of the distal clavicle and medial aspect of the acromion has become possible with minimal invasiveness. The arthroscopic technique offers the advantages of rapid rehabilitation with excellent functional results. Several different modifications of 2 basic approaches, the bursal and direct superior, have been described by various authors. The authors sought to examine critically and review the data supporting the choice of arthroscopic surgery rather than an open technique, as well as the advantages of 1 arthroscopic approach over the other.