Welch Matthew, Rankin Sally, How Saw Keng Matthew, Woods David
Trauma & Orthopaedics, Great Western Hospitals NHS Foundation Trust, Swindon, UK.
Shoulder Elbow. 2024 Apr;16(2):129-144. doi: 10.1177/17585732231157090. Epub 2023 Feb 22.
This systematic review aims to comprehensively summarise and present the available evidence for the treatment of primary acromioclavicular joint (ACJ) osteoarthritis (OA).
Five databases were searched for studies investigating the management of ACJ OA. Included were studies with participants with clinical/radiological signs of primary ACJ OA, an intervention and included a functional outcome measure.
Forty-eight studies were included. Treatments consisted of physiotherapy (n = 1 study), medical only (n = 11) and operative management (n = 36). Operative studies included five comparative trials - physiotherapy versus surgery (n = 1) and open versus arthroscopic resection (n = 4). A total of 1902 shoulders were treated for ACJ OA, mean age (51 years), 58% male and mean follow-up (28.5 months). Treatment with injection showed a mean improvement of 50% in pain levels at follow-up (mean = 7.5 months). The commonest surgical procedure was arthroscopic excision of the distal clavicle and operative studies averaged 6 months of conservative management and a mean functional outcome of 87.8%.
Studies varied in indication, intervention and quality but it did not provide evidence that both non-operative and operative interventions are effective. There was no significant difference between open or arthroscopic distal clavicle excision (DCE). Participants having between 0.5 and 2 cm of clavicle excised had good outcomes and those requiring concomitant shoulder procedures had similarly good outcomes.
本系统评价旨在全面总结并呈现治疗原发性肩锁关节（ACJ）骨关节炎（OA）的现有证据。
检索了五个数据库，以查找有关ACJ OA管理的研究。纳入的研究对象为具有原发性ACJ OA临床/放射学体征的参与者，有一项干预措施且包括功能结局测量。
纳入了48项研究。治疗方法包括物理治疗（n = 1项研究）、单纯药物治疗（n = 11项）和手术治疗（n = 36项）。手术研究包括五项比较试验——物理治疗与手术对比（n = 1项）以及开放手术与关节镜下切除术对比（n = 4项）。总共1902例肩部接受了ACJ OA治疗，平均年龄（51岁），58%为男性，平均随访时间（28.5个月）。注射治疗在随访时疼痛水平平均改善了50%（平均 = 7.5个月）。最常见的手术方法是关节镜下切除锁骨远端，手术研究平均有6个月的保守治疗，平均功能结局为87.8%。
研究在适应证、干预措施和质量方面存在差异，但未提供非手术和手术干预均有效的证据。开放或关节镜下锁骨远端切除术（DCE）之间无显著差异。切除锁骨0.5至2厘米的参与者预后良好，需要同时进行肩部手术的参与者预后同样良好。
