ARTHROSCOPIC DISTAL CLAVICLE RESECTION FROM A BURSAL APPROACH

We retrospectively reviewed 117 consecutive patients who underwent art hroscopic acromioclavicular joint (ACI) arthroplasties. Only patients who underwent ACJ arthroplasties from a bursal approach in conjunction with subacromial decompression were included. Patients with isolated ACJ arthrosis treated with resection of the distal clavicle from a sup erior approach, isolated impingement with only undersurface distal cla vicle debridement, prior surgery, or other shoulder pathology were exc luded. Twenty-four patients met these rigid criteria for inclusion in the study. After an arthroscopic subacromial decompression, the distal clavicle was visualized and resected through a standard bursal approa ch. In addition, an anterosuperior portal was used in 50% of the patie nts to confirm adequate clavicle resection. Postoperative follow-up av eraged 32.5 months (range, 24 to 70 months). Preoperative and postoper ative pain were rated subjectively on a 5-point scale (1, incapacitati ng pain; 5, no pain). Operative reports and postoperative radiographs were reviewed to determine technical factors that may have influenced outcome. Seventeen patients had excellent results (71%), 4 good (16.5% ), and there were 3 failures (12.5%). Average preoperative pain rating was 1.8 and was improved to 4.3 postoperatively. The average amount o f clavicle resection was only 5.4 mm. Given smooth, even, and complete bone removal, the amount of bone resected did not correlate with outc ome. Arthroscopic distal clavicle resection performed in conjunction w ith subacromial decompression gave excellent results, comparable to is olated ACJ procedures. In this series, additional use of an anterosupe rior portal for more direct shaver placement and complete ACJ viewing allowed consistent bone resection; and excellent results in a high per centage of patients.