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Acromioclavicular Joint Resection
Arthroscopic Two Portal Technique (Direct Approach)
Acromioclavicular (AC) joint pain is a common shoulder problem and joint resection relieves the pain effectively. Because AC pathology is less commonly seen as an isolated condition, AC joint resection is often performed either open or arthroscopically with other shoulder procedures. In cases of isolated AC pathology, open or arthroscopic techniques are available after nonsurgical management has failed. Quantitative comparisons have shown that an adequate amount of bone can be resected arthroscopically compared to open. The direct superior and bursal approaches are options for arthroscopic approaches to AC joint resection.
The direct superior arthroscopic approach, described by Johnson, can be advantageous for numerous reasons in the correct clinical setting. First, the AC pathology is directly addressed without violating the bursa or resecting the AC ligament and capsule, avoiding unnecessary swelling and bleeding. Second, the variable angle of inclination in the coronal plane can cause the clavicle to override the acromion, inhibiting adequate resection through a bursal approach unless an acromioplasty is performed first (unnecessary with isolated AC pathology). Third, when performed arthroscopically, the surgery can be done as an outpatient and allows patients to start active rehabilitation immediately. Patients have been shown to return to full activity 3.4 months earlier than in open procedures. Fourth, open approach can result in deltoid weakness during maximal effort.
Indications
1. Osteolysis of the distal clavicle
2. Primary or posttraumatic osteoarthritis of the AC joint
Contraindications
1. Bursal or rotator cuff pathology
2. AC instability
Physical Examination
1. AC joint tenderness and swelling
2. Pain with forced horizontal adduction and internal rotation
3. O’Brien’s test causing pain in the AC joint area
Diagnostic Tests
1. Radiographic shoulder series including an anteroposterior in the scapular plane in both internal and external rotation, an outlet view, and an axillary view.
2. An anteroposterior radiograph with a 10 to 15 degree cephalic tilt using reduced voltage. The view can reveal subtle changes in the distal clavicle and the true inclination of the joint can be determined.
3. Magnetic resonance imaging can be done to evaluate cuff pathology, encroaching osteophytes on the bursa or cuff, and AC synovitis.
4. A local lidocaine injection of the AC joint can aid in diagnosis and can help predict the effectiveness of a future surgical resection.
Special Instruments
1. 2.7-mm arthroscope
2. 2.0-mm synovial resector
3. 2- or 3.5-mm burr
4. 8-mm rasp
Anesthetic Options
1. Regional interscalene anesthesia
2. General anesthesia
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