Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug 1;13(8):1221.
doi: 10.3390/jpm13081221.

Bony Regrowth and New Spur Formation as Possible Causes of Failed Distal Clavicle Excision-Mid-Term Outcomes after Revision Surgery in a Matched-Pair Analysis

Roman C Ostermann  1   2   3 , Martin Eigenschink  3   4 , Philipp R Heuberer  1   3 , Paul Siegert  5 , Willi Muellbacher  2 , Lisa Anderl  6 , Beate Schrott  7 , Brenda Laky  3   7 , Leo Pauzenberger  2   3 , Werner Anderl  1   3
Affiliations

Bony Regrowth and New Spur Formation as Possible Causes of Failed Distal Clavicle Excision-Mid-Term Outcomes after Revision Surgery in a Matched-Pair Analysis

Roman C Ostermann et al. J Pers Med. .

Abstract

Background: Despite high rates of successful outcomes after open and arthroscopic distal clavicle excision (DCE) for symptomatic acromioclavicular joint (ACJ) degeneration, some patients present with persistent symptoms and disabilities after surgical intervention. This study aims to compare radiological, functional, and subjective outcomes of open revision surgery after failed arthroscopic DCE to primary successful arthroscopic DCE.

Methods: In this retrospective case-control study, 10 patients who underwent open DCE revision were age- and gender-matched with 10 patients who did not require revision surgery after DCE. Radiographic evaluation included presence of acromioclavicular spurs and acromioclavicular joint distance. Functional and subjective outcomes were assessed using the CS, SSV, SST, VAS for pain, patient's satisfaction, ASES and quick DASH score.

Results: At the latest postoperative follow-up (case: 57.3 ± 19.2 months; control: 63.5 ± 16.3 months), spur formation was detected in twice as many cases in the revision group, while acromioclavicular distance showed no significant difference. However, a significant bony regrowth was noticed in the revision group between revision surgery and latest follow-up, with a decrease of the acromioclavicular distance from 9.2 ± 1.6 mm to 5.9 ± 4.6 mm (p = 0.026) and a development of new spur formations in 30% of cases. There were no significant differences in overall CS between the revision and control group (p = 0.174) at final follow-up, but the control group scored significantly higher in the CS subgroups pain (p = 0.012) and internal rotation (p = 0.016). Mean SSV was significantly lower in the revision (65.5 ± 22.3%) compared to the control group (85.9 ± 16.4%; p = 0.031).

Conclusions: Bony regrowth at the distal clavicle presenting as postoperative AC-distance narrowing and new spur formation was observed more distinctly in the revision group. Despite a slight increase in postoperative outcomes after revision surgery, subjective satisfaction and recalcitrant pain remain a concern.

Level of evidence: Therapeutic Level III, retrospective case-control study.

Keywords: AC-joint; acromio-clavicular; arthroscopy; revision.

PubMed Disclaimer

Conflict of interest statement

W.A., R.C.O. and P.R.H. receive personal fees from Arthrex, Inc. The company had no influence on the study design, data collection, interpretation of the results, or the final manuscript. The remaining authors (M.E., P.S., W.M., L.A., B.S., B.L. and L.P.) declare that they do not have any conflict of interest pertinent to this study.

Figures

Figure 1
Figure 1
Zanca view radiograph of a right shoulder. The black arrow shows an inferior bony spur of the distal clavicle, the white arrow shows a small inferior bony spur of the medial acromion.
Figure 2
Figure 2
Detection of acromioclavicular spurs in absolute numbers (n) upon radiographic imaging. Group A (10 patients) was evaluated preoperatively, immediately after index surgery, at latest follow-up before revision surgery, immediately after revision surgery, and at latest follow-up, while group B (10 patients) was evaluated preoperatively, immediately after index surgery, and at latest follow-up.
Figure 3
Figure 3
Acromioclavicular distance (ACD) in millimeters in both groups. Group A (10 patients) was evaluated preoperatively, immediately after index surgery, at latest follow-up before revision surgery, immediately after revision surgery, and at latest follow-up, while group B (10 patients) was evaluated preoperatively, immediately after index surgery, and at latest follow-up. Significant p-values are indicated with *.
See this image and copyright information in PMC

References

    1. Rabalais R.D., McCarty E. Surgical treatment of symptomatic acromioclavicular joint problems: A systematic review. Clin. Orthop. Relat. Res. 2007;455:30–37. doi: 10.1097/BLO.0b013e31802f5450. - DOI - PubMed
    1. Robertson W.J., Griffith M.H., Carroll K., O’Donnell T., Gill T.J. Arthroscopic versus open distal clavicle excision: A comparative assessment at intermediate-term follow-up. Am. J. Sports Med. 2011;39:2415–2420. doi: 10.1177/0363546511419633. - DOI - PubMed
    1. Mall N.A., Foley E., Chalmers P.N., Cole B.J., Romeo A.A., Bach B.R., Jr. Degenerative joint disease of the acromioclavicular joint: A review. Am. J. Sports Med. 2013;41:2684–2692. doi: 10.1177/0363546513485359. - DOI - PubMed
    1. Chronopoulos E., Gill H.S., Freehill M.T., Petersen S.A., McFarland E.G. Complications after open distal clavicle excision. Clin. Orthop. Relat. Res. 2008;466:646–651. doi: 10.1007/s11999-007-0084-4. - DOI - PMC - PubMed
    1. Freedman B.A., Javernick M.A., O’Brien F.P., Ross A.E., Doukas W.C. Arthroscopic versus open distal clavicle excision: Comparative results at six months and one year from a randomized, prospective clinical trial. J. Shoulder Elb. Surg. 2007;16:413–418. doi: 10.1016/j.jse.2006.10.006. - DOI - PubMed