Acromioclavicular joint reoperation after arthroscopic subacromial decompression with and without concomitant acromioclavicular surgery

Abstract

Purpose: The purpose of this study was to examine the reoperation rate on the acromioclavicular (AC) joint after arthroscopic subacromial decompression (ASAD) with and without concomitant AC joint surgery and to identify factors related to continued AC joint symptoms.

Methods: We conducted a retrospective review of 1,482 cases without concomitant shoulder pathology that were followed up by physical examination, phone interview, questionnaire, or chart review. Group A, patients who underwent ASAD alone, consisted of 1,091 cases. Group B, patients who underwent ASAD with concomitant AC joint surgery consisting of either co-planing or arthroscopic distal clavicle resection (ADCR), consisted of 391 cases.

Results: A total of 22 patients underwent reoperation on the AC joint. The overall reoperation rate was 1.5%, or 22 of 1,482 patients. The index procedure failed in 16 patients from the ASAD group (group A), yielding a reoperation rate of 1.5%. The index procedure failed in 6 patients from the group undergoing ASAD with concomitant AC joint surgery (group B), for a reoperation rate of 1.5%. Reoperation occurred at a mean of 22 months and 8 months for group A and group B, respectively. Overall, 17 of 22 patients (77%) who required AC joint reoperation were either Workers' Compensation (WC) or litigation cases. The reoperation rate was 2.4% for WC patients and 0.8% for non-WC patients. WC status was found to be a statistically significant factor in the rate of reoperation for AC joint symptoms (P < .05). Of the 22 patients, 10 continued to have pain at a mean of 25.9 months (range, 9 to 53 months) after reoperation. Given the similar rates of reoperation, routine AC joint violation by co-planing or ADCR is not recommended during ASAD. Reoperation for continued AC joint symptoms was associated with a nearly 50% rate of continued symptoms.

Conclusions: The results of the study show that the incidence of reoperation on the AC joint after ASAD with or without concomitant AC joint surgery is small for both groups with a 1.5% rate of reoperation for each group. The incidence of reoperation is lower, at 0.8%, for non-WC cases. In addition, there was a high rate of continued symptoms, with 45% of patients having continued pain after reoperation. Violation of the AC joint during the initial surgery by co-planing or ADCR did not alter the reoperation rate for AC joint symptoms.

Level of evidence: Level IV, therapeutic case series.