Schneider Bryce S, Hao Kevin A, Taylor Jeremy K, Wright Jonathan O, Wright Thomas W, Pazik Marissa, Schoch Bradley S, King Joseph J
College of Medicine, University of Florida, Gainesville, FL, USA.
Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, USA.
JSES Int. 2023 Sep 22;8(1):111-118. doi: 10.1016/j.jseint.2023.08.014. eCollection 2024 Jan.
Although substantial motion at the acromioclavicular joint (ACJ) occurs during overhead shoulder motion, the influence of ACJ arthritis on postoperative outcomes of patients undergoing reverse total shoulder arthroplasty (rTSA) is unclear. We assessed the influence of ACJ arthritis, defined by degenerative radiographic changes, and its severity on clinical outcomes after primary rTSA.
We conducted a retrospective review of a prospectively collected shoulder arthroplasty database of patients that underwent primary rTSA with a minimum 2-year clinical follow-up. Imaging studies of included patients were evaluated to assess ACJ arthritis classified by radiographic degenerative changes of the ACJ; severity was based upon size and location of osteophytes. Both the Petersson classification and the King classification (a modified Petersson classification addressing superior osteophytes and size of the largest osteophyte) were used to evaluate the severity of degenerative ACJ radiographic changes. Severe ACJ arthritis was characterized by large osteophytes (≥2 mm). Active range of motion (ROM) in abduction, forward elevation, and external and internal rotation as well as clinical outcome scores (American Shoulder and Elbow Surgeons Shoulder, Constant, Shoulder Pain and Disability Index, simple shoulder test, University of California, Los Angeles scores) were assessed both preoperatively and at the latest follow-up; outcomes were compared based on severity of ACJ arthritis. Multivariable linear regression models were used to determine whether increasing severity of ACJ arthritis was associated with poorer outcomes.
A total of 341 patients were included with a mean age of 71 ± 8 years and 55% were female. The mean follow-up was 5.1 ± 2.4 years. Preoperatively, there were no differences in outcomes based on the severity of ACJ pathology. Postoperatively, there were no differences in outcomes based upon the severity of ACJ arthritis except for greater preoperative to postoperative improvement in active internal rotation in patients with normal or grade 1 ACJ arthritis vs. grade 2 and 3 (3 ± 2 vs. 1 ± 2 and 1 ± 3, = .029). Patients with ACJ arthritis and osteophytes ≥2 mm had less favorable Shoulder Pain and Disability Index scores, corresponding to greater pain (-49.3 ± 21.5 vs. -41.3 ± 26.8, = .015). On multivariable linear regression, increased severity of ACJ arthritis was not independently associated with poorer postoperative ROM or outcome scores.
Overall, our results demonstrate that greater ACJ arthritis severity score is not associated with poorer outcome scores and has minimal effect on ROM. However, patients with the largest osteophytes (≥2 mm) did have slightly worse pain postoperatively. Radiographic presence of high-stage ACJ arthritis should not alter the decision to undergo rTSA.
尽管在肩部上举运动过程中肩锁关节（ACJ）会发生显著活动，但ACJ关节炎对接受全肩关节置换术（rTSA）患者术后疗效的影响尚不清楚。我们评估了由影像学退变改变定义的ACJ关节炎及其严重程度对初次rTSA术后临床疗效的影响。
我们对前瞻性收集的接受初次rTSA且临床随访至少2年的患者肩关节置换术数据库进行了回顾性研究。对纳入患者的影像学研究进行评估，以评估根据ACJ影像学退变改变分类的ACJ关节炎；严重程度基于骨赘的大小和位置。采用彼得松分类法和金分类法（一种改良的彼得松分类法，考虑了上方骨赘和最大骨赘的大小）来评估ACJ影像学退变改变的严重程度。严重的ACJ关节炎以大骨赘（≥2 mm）为特征。评估术前及末次随访时的外展、前屈上举、外旋和内旋活动度（ROM）以及临床疗效评分（美国肩肘外科医师学会肩关节评分、Constant评分、肩痛和功能障碍指数、简易肩关节试验、加利福尼亚大学洛杉矶分校评分）；根据ACJ关节炎的严重程度比较疗效。采用多变量线性回归模型确定ACJ关节炎严重程度增加是否与较差的疗效相关。
共纳入341例患者，平均年龄71±8岁，55%为女性。平均随访时间为5.1±2.4年。术前，根据ACJ病变严重程度，疗效无差异。术后，除正常或1级ACJ关节炎患者与2级和3级患者相比，主动内旋从术前到术后的改善更大（3±2 vs. 1±2和1±3，P = 0.029）外，根据ACJ关节炎严重程度，疗效无差异。ACJ关节炎且骨赘≥2 mm的患者肩痛和功能障碍指数评分较差，对应疼痛更严重（-49.3±21.5 vs. -41.3±26.8，P = 0.015）。在多变量线性回归中，ACJ关节炎严重程度增加与术后ROM较差或疗效评分无独立相关性。
总体而言，我们的结果表明，ACJ关节炎严重程度评分越高与疗效评分越差无关，对ROM影响最小。然而，骨赘最大（≥2 mm）的患者术后疼痛确实略重。ACJ关节炎高分期的影像学表现不应改变进行rTSA的决定。
