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The Fate of Asymptomatic AC Joint Arthritis in Patients Undergoing Rotator Cuff Surgery
Prasad J. Sawardeker, MD; Katie E. Kindt, BS; Mark E. Baratz, MD; Darren Frank, MD;
Allegheny General Hospital

Introduction

When symptomatic arthritis is present at the acromioclavicular (AC) joint in patients with operative rotator cuff pathology, a distal clavicle resection is concurrently performed with rotator cuff surgery. Appropriate treatment in instances where there is asymptomatic arthritis at the AC joint remains controversial. The present study examines whether there is an evolution in symptoms from asymptomatic to symptomatic AC joint arthritis in participants who have undergone arthroscopic rotator cuff surgery without resection of the distal clavicle. Our objective is to provide insight into whether this simultaneous procedure is necessary, and identify characteristics within the population that can guide the clinician in the decision making process.

Methods

Thirty-seven shoulders in thirty-five patients (mean age = 60.26) were selected for inclusion in the present study. All 35 patients were at least 1 year following surgery for rotator cuff pathology and all had asymptomatic AC joint arthritis at pre-operative evaluation. At follow-up (mean 3.1 years) each patient was assessed for symptomatic arthritis at the AC joint. Clinical examination evaluated point tenderness at the AC joint and employed a provocative cross-body adduction test. Pain scores for clinical examinations were rated using a ten point ordinal scale where a score of zero indicated no pain. Subjective measures pertaining to patient activity and lifestyle were assessed by questionnaire.

Results

Seven out of 37 shoulders (18.9%) were noted as having a positive cross-body adduction test with an average reported pain score of 2.4. Eight of 37 shoulders (21.6%) were noted as having AC joint tenderness with an average reported pain score of 2.5. Patients were considered symptomatic for AC joint arthritis if they presented with both AC tenderness and positive cross-body adduction; four of 37 (10.8%) shoulders met symptomatic criteria. No patient was sufficiently symptomatic as to request additional treatment at final follow-up. A logistic regression was conducted in order to determine the relationship between age, gender, physical labor history, reported activity level and presentation of AC joint arthritis symptoms. All predictor variables failed to significantly predict arthritis symptom progression in the presence of other variables [age (p=.97), gender (p=.51), labor (p=.99), activity level (p=.17)].

Conclusion

The current study suggests that distal clavicle resection is not necessary in the setting of rotator cuff pathology when AC joint arthritis is asymptomatic. Age, occupation, gender, hand dominance and activity level are not prognostic variables in the evolution of symptoms in patients with asymptomatic AC joint arthritis.


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