Open versus arthroscopic distal clavicle resection

PURPOSE: The purpose of this systematic review was to critically evaluate the available literature in an attempt to compare the outcome of open versus arthroscopic distal clavicle resection in the treatment of acromioclavicular joint pathology.

METHODS: From January 1966 to December 2008, Medline was searched for the following key words: "acromioclavicular joint arthritis," "acromioclavicular osteolysis," "distal clavicle excision," "acromioclavicular joint excision," "Mumford," and "clavicle." Inclusion criteria included studies that compared the outcome of open versus arthroscopic distal clavicle resection. Studies that could not be translated into the English language or were not published in a peer-reviewed journal were excluded. Data were abstracted from the studies, including patient demographics, surgical procedure, rehabilitation, strength, range of motion, and clinical scoring system.

RESULTS: Seventeen studies met the inclusion criteria, including 2 Level II studies, 1 Level III and 14 Level IV studies. Arthroscopic distal clavicle excision results in more "good" or "excellent" outcomes compared with the open procedure. Both arthroscopic techniques result in success rates in excess of 90%, with the direct procedure permitting a quicker return to athletic activities. Performing distal clavicle excision in conjunction with either subacromial decompression or rotator cuff repair also has a high degree of success. A trend toward more "poor" results is seen when distal clavicle excision is performed in patients with post-traumatic acromioclavicular instability or in Workers' Compensation patients.

CONCLUSIONS: Our analysis suggests that among patients undergoing distal clavicle excision for acromioclavicular joint pathology, those having an arthroscopic procedure, specifically through the direct approach, can expect a faster return to activities while obtaining similar long-term outcomes compared with the open procedure.

LEVEL OF EVIDENCE: Level III, systematic review.