ACROMIOCLAVICULAR JOINT RESECTION: AN OPEN APPROACH

Acromioclavicular Joint Resection

An Open Approach

James E. Tibone

Arthritis of the acromioclavicular (AC) joint is a common entity. This is a natural aging phenomenon, with most cases of arthritis seen on X-ray being asymptomatic. Arthritis of this joint can be seen in a younger population after injury or vigorous weight lifting. Injuries to the AC and coracoclavicular ligaments are classified according to Rockwood. They can lead to late degenerative changes in a small group of individuals, approximately 10%. Weight lifting puts significant forces on the AC joint, especially the bench press, which can cause osteolysis of the distal clavicle and subsequent degenerative changes.

Indications

1. A painful AC joint that is relatively stable (Rockwood types I or II)

2. X-ray confirmation of degenerative arthritis or osteolysis

Contraindications

A grossly unstable AC joint (types III, IV, V, VI)

Mechanism of Injury

Arthritis of the AC joint is caused by aging and accelerated by injury and weight lifting.

Physical Examination

1. Tenderness and swelling over the AC joint

2. Pain with cross-chest adduction

3. Pain with full internal rotation

Diagnostic Tests

1. Standard shoulder radiographs may show the lesion.

2. An anteroposterior view of the shoulder with a 10 to 15 degree cephalic tilt and approximately 50% reduction of the normal X-ray penetration can better demonstrate the AC joint (Zanca view).

3. An axillary lateral view to demonstrate the position of the clavicle in an anterior-posterior direction.

Special Considerations

1. The distal clavicle can be resected either arthroscopically or open, based on the judgment and experience of the surgeon.

2. The size of the distal clavicle and the other surgeries that are being performed concurrently may influence the decision.

Preoperative Planning and Timing of Surgery

Clinically, determine the stability of the distal clavicle; the timing of the surgery is based on the patient’s symptoms and is not a consideration.

Special Instruments

1. Small oscillating saw

2. Chandler retractors

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