American Shoulder and Elbow Surgeons
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Your partner performs distal clavicle excisions through an open approach while you prefer to use an arthroscopic approach. He notes that the literature shows both techniques have similar results with the exception of which of the following benefits of an arthroscopic approach?
Ability to evaluate the glenohumeral joint
Preservation of the coracoclavicular ligaments
Preservation of the inferior acromioclavicular ligaments
Lower complication rate
Decreased surgical time
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The arthroscopic approach with an initial diagnostic arthroscopy of the glenohumeral space prior to subacromial space is felt to be helpful in confirming the diagnosis and identifying other pathology.
Berg et al. reviewed failures of open distal clavicle excision and found that 15 patients had a missed SLAP lesion. Fewer complications, lower infection rate, and decreased surgical time have not been documented in the literature.
Lemos & Tolo reviewed complications resulting from treatment of AC joint pathology. The open technique can often miss other underlying pathology, such as rotator cuff and labral pathology, that may be associated with degenerative changes of the acromioclavicular joint. Therefore, they recommend that even if an open distal clavicle excision is the treatment of choice, an arthroscopic evaluation of the glenohumeral joint be performed at the same time.
Berg EE, Ciullo JV.
Arthroscopy. 1997 Feb;13(1):85-9. PMID: 9043609 (Link to Abstract)
Berg, ASCOPY 1997
Lemos MJ, Tolo ET.
Clin Sports Med. 2003 Apr;22(2):371-85. PMID: 12825537 (Link to Abstract)
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