Park Yong Bok, Koh Kyoung Hwan, Shon Min Soo, Park Young Eun, Yoo Jae Chul
Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University, Goyang, Korea.
Am J Sports Med. 2015 Apr;43(4):985-90. doi: 10.1177/0363546514563911. Epub 2015 Jan 12.
The treatment of symptomatic acromioclavicular joint (ACJ) injury in the rotator cuff (RC) tear has not been well clarified.
To compare the clinical results between patients who had distal clavicle resection (DCR) and those who did not during RC repair.
Randomized controlled trial; Level of evidence, 1.
From August 2008 to December 2009, a total of 56 consecutive patients (58 shoulders) were included. All patients had either a full-thickness or high-grade (>50%) RC tear, ACJ tenderness, arthritic change visible on plain radiographs, and a positive ACJ lidocaine injection test the day before surgery. Patients were randomized into 2 groups: DCR and RC repair (DCR+RCR group) and RC repair only (isolated RCR). Evaluation was performed preoperatively, at 6 months postoperatively, and at a final follow-up a minimum of 24 months postoperatively using the American Shoulder and Elbow Surgeons (ASES) score, the Constant shoulder score, range of motion examination, and pain visual analog scale (VAS).
After simple randomization, 26 shoulders were allocated in the DCR+RCR group, and 32 were placed in the isolated RCR group. Five shoulders in the DCR+RCR group and 6 in the isolated RCR group were excluded from analysis due to loss of follow-up. Therefore, the evaluation was performed for 21 shoulders in the DCR+RCR group and 26 shoulders in the isolated RCR group. The mean follow-up period was 44.2 months in the DCR+RCR group and 44.0 months in the isolated RCR group. There were no differences in age, sex, symptom duration, RC tear size, or preoperative ASES, Constant, and VAS scores between the 2 groups (P > .05). At final follow-up, the ASES, Constant, and VAS scores were significantly improved in both groups (P < .001). There were no differences in ASES, Constant, and VAS scores between the 2 groups at final follow-up (P > .05), and there was no difference in residual ACJ tenderness (7 in the DCR+RCR group and 5 in the isolated RCR group) between the 2 groups (P = .270).
There was no difference in the clinical evaluations between the combined arthroscopic DCR and RCR group and the isolated RCR group at a minimum 24-month follow-up. Arthroscopic DCR should be carefully considered in patients who have symptomatic ACJ arthritis with RC tears.
肩袖（RC）撕裂合并有症状的肩锁关节（ACJ）损伤的治疗方法尚未完全明确。
比较在肩袖修复术中进行锁骨远端切除术（DCR）的患者与未进行该手术的患者的临床结果。
随机对照试验；证据等级为1级。
2008年8月至2009年12月，共纳入56例连续患者（58个肩部）。所有患者均为全层或高度（>50%）肩袖撕裂、ACJ压痛、X线平片可见关节炎改变，且术前一天ACJ利多卡因注射试验呈阳性。患者被随机分为两组：DCR联合肩袖修复组（DCR+RCR组）和单纯肩袖修复组（单纯RCR组）。术前、术后6个月以及术后至少24个月的最终随访时，使用美国肩肘外科医师（ASES）评分、Constant肩部评分、活动范围检查以及疼痛视觉模拟量表（VAS）进行评估。
简单随机分组后，DCR+RCR组分配到26个肩部，单纯RCR组分配到32个肩部。由于失访，DCR+RCR组有5个肩部和单纯RCR组有6个肩部被排除在分析之外。因此，对DCR+RCR组的21个肩部和单纯RCR组的26个肩部进行了评估。DCR+RCR组的平均随访期为44.2个月，单纯RCR组为44.0个月。两组在年龄、性别、症状持续时间、肩袖撕裂大小或术前ASES、Constant和VAS评分方面均无差异（P>.05）。在最终随访时，两组的ASES、Constant和VAS评分均显著改善（P<.001）。最终随访时两组的ASES、Constant和VAS评分无差异（P>.05），两组之间残留ACJ压痛情况也无差异（DCR+RCR组7例，单纯RCR组5例）（P=.270）。
在至少24个月的随访中，关节镜下DCR联合RCR组与单纯RCR组的临床评估无差异。对于有症状的ACJ关节炎合并肩袖撕裂的患者，应谨慎考虑关节镜下DCR。
