Arthroscopic Acromioclavicular Joint Resection
Osteoarthritic findings of the acromioclavicular joint are commonly observed in adult population, especially with increased age. For symptomatic patients who resulted in failed conservative treatment, surgical treatment is needed. In addition to the class
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Taku Hatta and Eiji Itoi
12.1 Introduction The acromioclavicular (AC) joint connects the scapula and the clavicle, supporting the upper limb girdle on the thorax. Osteoarthritis of the AC joint frequently occurs in the adult population, especially in the fourth decade. For patients of AC joint osteoarthritis resistant to conservative treatment, AC joint resection has been considered the gold standard. In addition to conventional open procedure, arthroscopic procedure has gained popularity due to potential advantages of quick return to activities and lower rate of complications.
12.2 Epidemiology of Acromioclavicular Joint Osteoarthritis DePalma [1] described that the degenerative features of the AC joint could be a natural consequence of aging, beginning in the second decade. Needell et al. [2] investigated magnetic resonance (MR) images of the AC joint in 100 asymptomatic volunteers ranging from 19 to 88 years of age and found osteoarthritic changes with the prevalence of 39% in those younger than 40 years, T. Hatta · E. Itoi (*) Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan e-mail: [email protected]
89% in those aged 40–60 years, and 90% in those aged 60 years or over. Edelson [3] investigated the pattern of degenerative changes of AC joints in 280 dry bone skeletons. They revealed consistent patterns of degeneration in the joint: an anteroposterior elongation of the joint on the acromial side, broadening and rounding of the distal clavicle in the anteroposterior direction, and inferior projecting osteophytes during the progression of osteoarthritis of the AC joint. Hatta et al. [4] investigated the histological features of 38 cadaveric AC joints aged between 69 and 91 years, to evaluate the localization of arthritic changes in the joints. They found the consistent findings that the lower half of the AC joint is more subject to advanced degeneration of the articular cartilage and the intra-articular disk than the upper half.
12.3 Symptoms The most common symptom in patients with AC joint osteoarthritis is pain on the AC joint. Especially, the pain can be induced or enhanced with the arm in forward flexion, cross-body adduction, and/or internal rotation in abduction. It is known that these positions provide the narrowing of the AC joint which results in increased pressure in the joint, whereas, arthroscopic observation reveals various narrowing patterns among these positions. Anterior joint space often
© ISAKOS 2019 A. B. Imhoff, F. H. Savoie III (eds.), Rotator Cuff Across the Life Span, https://doi.org/10.1007/978-3-662-58729-4_12
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becomes narrow with arm in cross-body adduction; in contrast, posterior joint space becomes narrow with forward flexion and internal rotation in abduction. Accordingly, it is notable that painful position may change according to the location of osteoarthritic changes in the AC joint.
12.4 Diagnosis In addition to characteristic arm positions which induce the pain as described above, the
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