Rossano Ayane, Manohar Nivethitha, Veenendaal Wouter J, van den Bekerom Michel P J, Ring David, Fatehi Amirreza
Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Health Discovery Building 1701 Trinity St. Austin, TX, 78712, USA.
Paul L. Foster School of Medicine, Texas Tech University Health Science Center, 5001 El Paso Dr, El Paso, TX, 79905, USA.
J Orthop. 2022 May 20;32:85-91. doi: 10.1016/j.jor.2022.05.009. eCollection 2022 Jul-Aug.
Radiographic osteoarthritis of the acromioclavicular joint (ACJ OA) is a common incidental finding and an uncommon reason for people to seek care for shoulder symptoms. We reviewed the published evidence regarding the age-specific prevalence of ACJ OA to establish the base rate of pathophysiology.
A total of 10 studies including 1831 shoulders met our criteria. A pooled analysis was done to obtain a proportion of subjects with ACJ OA across age categories.
Forty-eight percent of 953 cadaver and skeletal specimens and 70% of 210 MRI images of asymptomatic shoulders were found to have changes consistent with ACJ OA. Four studies reporting age as a continuous variable found a statistically significant association between older age and prevalence of ACJ OA.
The observation that ACJ OA is highly prevalent as humans age establishes a very high base rate of what one can infer is well-accommodated disease. Given that a high base rate of incidental disease creates a low pre-test odds that radiological findings of disease correspond with symptoms, diagnosis of symptomatic ACJ OA is subject to substantial inaccuracy and should be made sparingly, mindful of the potential harms of a diagnosis that can lead to an ablative surgery.
肩锁关节的影像学骨关节炎（ACJ OA）是一种常见的偶然发现，但却是人们因肩部症状就医的罕见原因。我们回顾了已发表的关于ACJ OA年龄特异性患病率的证据，以确定病理生理学的基础发生率。
共有10项研究（包括1831个肩部）符合我们的标准。进行了汇总分析，以获得各年龄组中患有ACJ OA的受试者比例。
在953个尸体和骨骼标本中，48%以及210个无症状肩部的MRI图像中，70%被发现有与ACJ OA一致的变化。四项将年龄作为连续变量报告的研究发现，年龄较大与ACJ OA患病率之间存在统计学上的显著关联。
随着人类年龄增长，ACJ OA高度普遍这一观察结果确定了一个非常高的基础发生率，据此可以推断这是一种适应性良好的疾病。鉴于偶然疾病的高基础发生率导致疾病的放射学发现与症状相符的预检概率较低，有症状的ACJ OA的诊断存在很大的不准确性，应谨慎做出诊断，同时要考虑到可能导致切除性手术的诊断所带来的潜在危害。
