AANA Middle East Arthroscopy Master Course (International)-Acromioplasty and distal clavicle resection

Acromioplasty and distal clavicle resection

Pdf Summary

This presentation by Dr. Pietro M Tonino discusses acromioplasty and distal clavicle resection (DCR), surgical procedures addressing shoulder issues, particularly involving the acromioclavicular (AC) joint and rotator cuff.<br /><br />Key anatomical insights note that resecting more than 1 cm of the distal clavicle risks destabilizing the AC joint by detaching part of the trapezoid ligament. Preservation of the posterosuperior capsule is critical to prevent posterior instability. Routine DCR during rotator cuff repair is questioned, as systematic review findings show no long-term (24 months) patient outcome improvements, suggesting it should not be standard unless specifically indicated.<br /><br />MRI studies reveal that asymptomatic AC joint osteoarthritis (AC-OA) often remains stable or improves over seven years, advising against simultaneous resection in patients lacking symptoms. Conditions like SLAP tears may mimic AC joint problems, and osteolysis or the presence of an os acromiale may contraindicate acromioplasty due to risk of destabilization.<br /><br />Historically, acromioplasty was introduced in the 1970s to address impingement syndrome, but studies showed limited success for overhead athletes. Surgical technique details include the importance of controlling bleeding, use of epinephrine, electrocautery, and arthroscopic pump during procedures performed in beach-chair or lateral decubitus positions. Two arthroscopic acromioplasty methods are described: cutting-block and lateral burr approaches.<br /><br />The presentation stresses clinical judgment—history and physical exam—as essential in deciding when to perform acromioplasty or DCR. Lidocaine injection in the AC joint can aid diagnosis when uncertain. Finally, the importance of understanding portals and technique nuances is emphasized for successful arthroscopic procedures.<br /><br />In summary, the talk highlights the selective use of acromioplasty and distal clavicle resection based on patient-specific pathology, avoiding routine or excessive resections that may threaten joint stability or offer no clear benefit.

Keywords

acromioplasty

distal clavicle resection

DCR

acromioclavicular joint

rotator cuff repair

trapezoid ligament

posterosuperior capsule

AC joint osteoarthritis

arthroscopic technique

shoulder surgery