Evaluation of arthroscopic stabilization of acute acromioclavicular joint dislocation using the TightRope system

The purpose of this study was to evaluate the results of the arthroscopic treatment of acute acromioclavicular dislocation using the TightRope system (Arthrex, Naples, Florida). Between January 2006 and May 2007, ten shoulders in 10 patients with acute acromioclavicular joint dislocation (Rockwood types IV and V) underwent arthroscopic acromioclavicular joint stabilization using the TightRope. Average patient age was 30 years (range, 22-42 years), and mean follow-up was 24 months (range, 18-30 months). Follow-up occurred at 2 and 6 weeks, 3 months, and then every 6 months postoperatively. The shoulders were evaluated radiologically by comparing the acromioclavicular joint with the normal side and clinically by assessing the pain, function, and range of joint motion using the Constant score.Ten patients returned to work without pain 10 to 12 weeks postoperatively. Average Constant score was 96.3 (range, 94-99) at last follow-up. Because of technical error, 1 patient experienced TightRope fixation failure on the coracoid side, and the acromioclavicular joint was redislocated, which was treated by an open technique. The 10 patients were satisfied with their functional results and cosmetic appearance.The arthroscopic treatment of acute acromioclavicular dislocation using the TightRope is a minimally invasive surgical technique that has been proven effective for the treatment of these lesions. It is characterized by less morbidity, less hospitalization, excellent cosmoses, and early rehabilitation.     

Arthroscopic rotator cuff repair with and without arthroscopic subacromial decompression: a prospective, randomized study of one-year outcomes

We performed a prospective, randomized study to determine whether arthroscopic subacromial decompression changes the outcome of rotator cuff repair. We performed a power analysis to ensure statistical validity. Patients scheduled for arthroscopic rotator cuff repair were randomized to cuff repair with arthroscopic subacromial decompression (group 1) or without it (group 2). All other aspects of the surgical and postsurgical treatment were identical. We included patients with full-thickness tears limited to the supraspinatus tendon and a type 2 acromion. We excluded patients with prior surgery, those with larger tears involving two or more tendons, those with a type 1 or 3 acromion, those with workers' compensation claims, and those who had concomitant procedures (labral repair, acromioclavicular joint resection) There were 47 patients in group 1 and 46 in group 2. Minimum follow-up was 1 year (mean, 15.6 +/- 3.3 months). We recorded the American Shoulder and Elbow Surgeons (ASES) shoulder scores preoperatively and postoperatively. There was no statistical difference in postoperative ASES scores between group 1 (91.5 +/- 10.3) and group 2 (89.2 +/- 15.1) (P =.392). The change in ASES score over time did not differ between the two groups (61.1 vs 60.2, P =.363). In conclusion, within the parameters described above, arthroscopic subacromial decompression does not appear to change the functional outcome after arthroscopic repair of the rotator cuff.     

Incidence of acromioclavicular joint complications after arthroscopic subacromial decompression.

We performed a chart and radiograph review of 173 patients (183 shoulders) who underwent arthroscopic subacromial decompression between 1991 and 1994 and had preoperative and postoperative radiographs. The study focused on the presence of preoperative acromioclavicular joint pathology, intraoperative violation of the acromioclavicular joint, extent of distal clavicle excision, and subsequent development of acromioclavicular joint symptoms. The 183 surgical procedures were divided into three groups: shoulders with subacromial decompression without acromioclavicular joint violation (103 of 183; 56%; group A); shoulders with subacromial decompression with acromioclavicular joint violation and partial distal clavicle resection (36 of 183; 20%; group B); and shoulders with subacromial decompression with complete distal clavicle resection (44 of 183; 24%; group C). Groups A and C had no postoperative sequelae in reference to the acromioclavicular joint. In contrast, 14 of the 36 shoulders (39%) in group B with a documented acromioclavicular joint violation and a partial distal clavicle resection developed acromioclavicular joint symptoms at an average of 8.4 months (range, 1.8 to 19 months) after surgery. This finding was statistically significant (P=.0001). The results of this study suggest that any violation of the acromioclavicular joint in the course of an arthroscopic subacromial decompression may jeopardize the result. The degree of violation is not helpful in predicting outcome. As a result of this study, we suggest an all-or-none surgical approach to the acromioclavicular joint and distal clavicle resection.     

Long-term results of arthroscopic resection of the distal clavicle with concomitant subacromial decompression

Purpose: The goal of the study was to evaluate the long-term outcome of combined arthroscopic distal clavicle excision and subacromial decompression. Type of Study: Retrospective, long-term cohort evaluation. Methods: Twenty patients with an average follow-up of 6 years (range, 3.9 to 9 years) were reviewed. All patients had ipsilateral impingement syndrome and acromioclavicular joint disease at the time of surgery and underwent arthroscopic subacromial decompression combined with arthroscopic distal clavicle excision. All patients returned for evaluation in person, in addition to filling out a questionnaire incorporating the University of California, Los Angeles (UCLA), and Constant scoring systems. Preoperative and postoperative radiographs were available for all patients. Results: Postoperatively, all patients had pain relief and were satisfied with the result. The average postoperative UCLA Shoulder score was 29.8 ± 0.6, compared with 17.5 ± 3.0 before surgery (P = .001). The Constant Shoulder score averaged 98.5 ± 2.1 postoperatively, compared with 70.5 ± 11.2 preoperatively (P = .001). There was 100% good to excellent results using both scoring systems. Individual components of the UCLA scoring system (pain, function, and power) all showed significant postoperative improvement (P = .001). Constant categories of pain, activities of daily living, range of motion, and power also improved. Follow-up radiographs showed maintenance of the resected distal clavicle in 19 patients. Five patients (25%) had radiographic evidence of calcific density distal to the resected clavicle but were asymptomatic. Conclusions: The long-term results of arthroscopic resection of the distal clavicle with concomitant subacromial decompression are uniformly good or excellent. Impingement and acromioclavicular joint disease frequently coexist and should be identified and treated concurrently.     

Arthroscopic subacromial decompression for advanced (stage II) impingement syndrome: a study of 52 patients with five years follow-up

The authors report a prospective five-year follow-up study of 52 patients who had arthroscopic subacromial decompression for advanced (stage II: type 1 and 2) rotator cuff disease. All patients were assessed preoperatively, at six months and at five years postoperatively using the Constant-Murley score and the revised American Shoulder and Elbow Surgeons (ASES) score. From six months until five years postoperatively, 45 (out of 52) patients showed a further progressing improvement and relief of symptoms. This is established by a significant (p < 0.001) increase of the mean Constant-Murley score from 76.4 at six months postoperatively to 84.9 at five years postoperatively.     

Arthroscopic resection of the distal aspect of the clavicle with concomitant subacromial decompression

BACKGROUND: Arthroscopic subacromial decompression and arthroscopic resection of the acromioclavicular joint as separate procedures have been well documented. However, there is little information on the success rate of resection with concomitant decompression. In this study, we retrospectively evaluated the results of a consecutive group of patients who underwent arthroscopic resection of the acromioclavicular joint with concomitant subacromial decompression. METHODS: We evaluated the surgical results in thirty-one consecutive patients (thirty-two shoulders) with acromioclavicular pathology with concomitant subacromial impingement. The mean age of the patients at the time of surgery was thirty-six years (range, eighteen to sixty-seven years). Twenty-five patients, including four professional athletes, were actively involved in sports activities. The mean duration of follow-up was four years and ten months (range, three to eight years). The follow-up examination included clinical evaluation, chart review, radiographic analysis, and isokinetic testing of both upper extremities. RESULTS: Of the twenty-five patients who participated in sports, twenty-two (including the four professional athletes) returned to their previous level of sports activity. Twenty-six patients had no pain, three reported mild pain on strenuous repetitive overhead activity, two (both weight-lifters) had occasional pain in the acromioclavicular joint and the lateral aspect of the shoulder with bench-pressing, and two (both baseball players) had mild pain in the posterior aspect of the shoulder with throwing. All of the patients were satisfied with the results. In the absence of a complete rotator cuff tear, isokinetic strength-testing of both upper extremities failed to demonstrate any weakness of the involved shoulder. The mean functional score for individual activities was 2.7 points (range, 2.1 to 3.0 points) preoperatively and 3.9 points (range, 3.6 to 4.0 points) postoperatively (p = 0.0001). No patient had superior migration of the clavicle. The amount of distal clavicular resection averaged 9 mm (range, 7 to 15 mm). One patient had heterotopic ossification at the resection site, with mild pain on direct palpation of the acromioclavicular joint and on strenuous overhead activity. Five patients had calcification at the anterior deltoid insertion into the acromion that was asymptomatic, with no impingement on overhead activity and no pain on direct palpation. CONCLUSIONS: We found excellent results with arthroscopic resection of the acromioclavicular joint and concomitant subacromial decompression. When this procedure is performed on properly selected patients, the results are similar to those of an open approach.     

Arthroscopic subacromial decompression. 1-3 year results]

In 148 patients with impingement lesion type I or type II, we performed an arthroscopic subacromial decompression (ASD). 122 patients ran a follow up one to three years post-operatively. All patients were pre- and postoperatively documented by a 100 point shoulder score. The mean score was 57.9 (+/- 11.5) preoperatively. Postoperatively there was a significant increase to 80.7 (+/- 17.9) (p < 0.05). 15% of the patients with a postoperative score less than 70 points were determined as failures. Patients with a preoperative pain history of more than one year had a significantly worse result (79.1 +/- 8.4) compared to those patients with a preoperative course less than one year (88.8 +/- 11.6) (p < 0.05). Other significant factors were the patient's age, and calcific tendinitis, whereas sex, preoperative range of motion, muscle atrophy, and degeneration of the acromioclavicular joint did not significantly influence the result. Our results after ASD in patients with subacromial pathology without a rupture of the rotator cuff are encouraging. Therefore, ASD seems to be a reasonable alternative to open acromioplasty.     

Effect of subacromial decompression on laxity of the acromioclavicular joint: biomechanical testing in a cadaveric model

Subacromial decompression is a well-accepted treatment for impingement syndrome when nonoperative therapies have failed. However, recent clinical data have raised concern that arthroscopic subacromial decompression may lead to laxity of the acromioclavicular joint and, potentially, predispose patients to late postoperative acromioclavicular joint pain. Our goal was to determine whether subacromial decompression with co-planing of the distal clavicle alters the laxity, or compliance, of the acromioclavicular joint in a cadaveric model. Eighteen cadaveric shoulders were dissected and tested in a specially designed rig, driven by a hydraulic materials testing machine. One hundred-Newton loads were applied to the distal clavicle in the superior, posterior, and anterior directions, while acromioclavicular joint motion was recorded with a 3-dimensional infrared optical measurement system. Acromioplasty was performed with a posterior-referenced cutting block technique and included co-planing of the distal clavicle in all specimens. Joint compliance before and after subacromial decompression was compared with the paired t test. Subacromial decompression increased anteroposterior compliance by 13%, from 8.8 +/- 2.9 mm (mean +/- SD) in the intact joint to 9.9 +/- 3.1 mm (P =.001). Subacromial decompression increased superior compliance by 32%, from 3.1 +/- 1.5 mm in the native specimen to 4.1 +/- 1.8 mm (P =.03). These observations may have implications for the technique of acromioplasty. Although the immediate result of acromioplasty with co-planing appears to be an increase in the compliance of the acromioclavicular joint, the clinical significance of these findings has yet to be determined.     

Arthroscopic reconstruction of the acromioclavicular joint disruption: surgical technique and preliminary results

Introduction: Numerous operative procedures have been described for the reconstruction of acromioclavicular joint separation; however, the arthroscopic reconstruction has been rarely reported. Therefore, our objective was to propose a new technique of arthroscopic acromioclavicular joint surgery and to evaluate the preliminary results. Materials and methods: Thirteen patients with a mean follow-up of 18 months underwent the arthroscopic acromioclavicular joint reconstruction using suture anchors and small titanium plate. The average age was 40.2 years (range 23–54 years). The shoulders were evaluated using Constant score and radiographs. The indications for surgery included acromioclavicular joint dislocation Rockwood type IV–V. Results: Twelve patients returned to their work without pain within 3 months after operation. The average Constant score at last follow-up was 95. Postoperative radiographs confirmed anatomic reduction in ten patients, residual subluxation in two patients and redislocation of the joint in one patient. One patient had radiographic evidence of coracoclavicular ossification. All patients but one were satisfied with results and cosmetic appearance. Conclusion: Considering its less morbidity, excellent cosmesis, no need of hardware removal, and minimal complications from breakage or migration of metal implants, this new technique offers an attractive alternative in acromioclavicular joint stabilization.     

Functional and radiological outcome after arthroscopic and open acromioclavicular stabilization using a double-button fixation system

The aim of this study was to determine the functional outcome and radiological results after open and arthroscopic stabilization of the acromioclavicular joint using a double-button fixation system. We reviewed 16 patients that were surgically treated for acromioclavicular dislocation using a double-button fixation system. An arthroscopic technique was used in 9 patients for acute injuries and an open technique in 7 patients for subacute or chronic lesions. Mean follow-up was 17 months (range : 6-26 months). The mean DASH score post-operatively was 2.29 (range : 0-5.83), VAS score was 0.82 (range : 0-2) and SSV averaged 90.5 % (range: 80-95%). Radiologically the reduction of the acromioclavicular joint was complete in 10 patients. A clinically stable residual subluxation was present in 5 patients. Only one patient experienced a redislocation after new trauma and needed revision surgery. Operative treatment of grade 3 and 4 acromioclavicular dislocations, using a double button coracoclavicular fixation system, yielded good functional results with full return to work and recreational activities. Arthroscopic coracoclavicular fixation without CA ligament transfer should be reserved for acute injuries within 2 weeks after the trauma.     

High patient satisfaction after arthroscopic subacromial decompression for shoulder impingement: a prospective study of 50 patients

BACKGROUND: Arthroscopic subacromial decompression (ASD) for shoulder impingement has gained popularity. We evaluated the result of this common procedure prospectively, from a patient perspective. METHOD: We used the Disability of the Arm, Shoulder and Hand questionnaire (DASH) and the Visual Analogue Scale (VAS) to evaluate 50 patients with a mean age of 49 (27-72) years. All patients had undergone 6 months of failed nonoperative treatment prior to surgery. Exclusion criteria were total rotator cuff rupture, shoulder instability, clinically verified acromioclavicular joint osteoarthritis, calcifying tendonitis or neurological symptoms. All the decompressions were done by experienced shoulder arthroscopists. RESULTS: A significant improvement in both the median DASH score and the VAS had occurred 6 months after surgery. INTERPRETATION: ASD for impingement in properly selected patients performed by experienced surgeons gives a high degree of patient satisfaction 6 months after surgery.     

术前肩关节功能训练对合并冻结肩的肩袖损伤患者手术效果的影响

背景:目前对合并冻结肩的肩袖损伤患者的手术时机有一定争议,部分研究认为应先通过肩关节功能训练在一定程度上缓解冻结肩后再手术,也有研究认为推迟修复肩袖的手术可能会导致肩袖损伤进一步扩大,影响修复效果.目的:探讨合并冻结肩的肩袖损伤患者术前肩关节功能训练后行关节镜下肩袖修复关节松解术与入院后一期行关节镜手术的临床疗效差别....     

All-arthroscopic versus mini-open rotator cuff repair: A long-term retrospective outcome comparison

Purpose: The goal of the study was to compare the results of all-arthroscopic rotator cuff repair with those of our mini-open rotator cuff repair. Type of Study: Retrospective outcome study. Methods: Sixty-four shoulders (58 patients) were identified; 35 in the all-arthroscopic group and 29 in the mini-open group. Average follow-up for all patients was 44.6 months, with a minimum of 24 months. The all-arthroscopic group included 3 small tears (< 1 cm), 24 medium-size tears (1 to 3 cm), and 9 large tears (3 to 5 cm). The mini-open group included 2 small tears, 9 medium tears, and 18 large tears. All patients in both groups underwent arthroscopic assessment with arthroscopic subacromial decompression. None underwent formal acromioclavicular joint resection. Four of the all-arthroscopic and 11 of the mini-open patients underwent coplaning of the acromioclavicular joint. Anchors were the primary method of arthroscopic fixation, with an average of 1.5 anchors per case. Results: The average final follow-up UCLA score for the arthroscopic group was 32.6 and for the mini-open group was 31.4, and the average final follow-up ASES score for the arthroscopic group was 91.7 and for the mini-open group was 90.0. No patients in the arthroscopic group developed fibrous ankylosis, whereas 4 patients in the mini-open group developed the condition (14%). No anchor-related complications were noted. Shoulders in the all-arthroscopic group showed greater motion at 6 and 12 weeks postoperatively and slightly better motion at final review. However, final motion difference was not statistically significant. Overall, 4 patients (6.3%) demonstrated some tenderness in the acromioclavicular joint on palpation, but none had clinical symptoms requiring treatment. Conclusions: All-arthroscopic cuff repair provides comparable outcomes and complication rates to arthroscopic decompression with mini-open repair. The lower incidence of fibrous ankylosis favors the all-arthroscopic technique. A trend for better early motion was also noted in the all-arthroscopic group. Analysis of variance shows no measurable outcome difference between tear sizes.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 19, No 3 (March), 2003: pp 234–238     

镜下钮扣钢板锚钉与开放钩钢板治疗肩锁关节脱位

[目的]比较肩关节镜下钮扣钢板(Endobutton)结合锚钉与钩钢板治疗急性肩锁关节脱位的临床疗效。[方法]回顾性分析2014年08月~2018年06月本院收治的63例急性不稳定肩锁关节脱位的患者,按手术方式不同分组,其中34例采用肩关节镜下改良钮扣钢板结合锚钉内固定(关节镜组),29例采用钩钢板内固定(钩钢板组)。[结果]两组患者手术均顺利完成,无血管、神经损伤。关节镜组与钩钢板组在手术时间、术中出血量的差异无统计学意义(P>0.05)。63例随访12~24个月,平均(15.39±3.26)个月。关节镜组未发生晚期并发症,而钩钢板组术后出现肩峰下溶解6例、肩峰下撞击3例、钩钢板取出后再脱位1例,两组间并发症发生率的差异有统计学意义(P<0.05)。随术后时间推移,两组患者Constant评分均显著增加(P<0.05),术后1、3、6、12个月,关节镜组的Constant评分明显优于钩钢板组(P<0.05)。影像方面,两组术后喙锁间距、肩锁间距均较术前显著减少(P<0.05);相同时间点两组间喙锁间距和肩锁间距的差异均无统计学意义(P>0.05)。[结论]关节镜下改良钮扣钢板结合锚钉内固定治疗肩锁关节脱位的临床效果优于钩钢板固定。     

Return to work after arthroscopic subacromial decompression

The incidence of arthroscopic subacromial decompression has been increasing over the last few years. Little is known about the duration of sick leave after such a procedure. The aim of this study was to determine the time till return to full duty and to explore the various influencing factors. We retrospectively evaluated a group of 166 patients who consecutively underwent arthroscopic subacromial decompression for subacromial impingement syndrome. One hundred patients were professionally active at the time of surgery; the mean duration till return to full duty was 11.1 weeks. Self-employed workers had the shortest sick leave period (median time of 1 week). No statistically significant difference was seen between the group with a financial compensation from the national health insurance system (median time of 12 weeks) and the group with income replacement by a private insurance company (median time of 8 weeks). Patients performing manual labour typically had a longer period of sick leave than other employees (12 versus 8 weeks). A longer absence from work was also observed in individuals who underwent a concomitant arthroscopic AC resection and patients with a higher BMI.     

关节镜下非打结型缝合锚钉修补Bankart损伤治疗复发陛肩关节前脱位

目的 探讨关节镜下非打结型缝合锚钉修补Bankan损伤治疗复发性肩关节前脱位的疗效.方法 复发性肩关节前脱位患者14例,均为男性;年龄18～34岁,平均25.2岁;左侧4例,右侧10例,涉及主力侧12例;均为单向不稳.术前脱位次数为3～36次,平均13.5次.关节镜下采用可吸收非打结型缝合锚钉治疗Bankart损伤.术前及术后随访采用ASES评分及Constant-Murley功能评估.结果 所有患者均获得随访,随访时间11～22个月,平均17个月.术中发现9例合并Hill-Sachs损伤,3例合并骨性Bankart损伤,2例合并后下盂唇损伤,2例合并SLAPⅡ型损伤,1例合并关节内游离体.14例患者术前及末次随访时肩关节平均前屈上举为163.4°±8.6°和169.7°±4.2°;外展90°时,平均外旋角度分别为58.5°+13.6°和90.3 °±5.5.;术后外展90°时,患侧外旋角度较健侧受限8.4°±6.2°术前及末次随访时ASES评分为(77.4±3.7)分和(94.3±2.6)分,两者比较差异有统计学意义(P＜0.05);其中VAS不稳定评分平均为(7.2±1.4)分和(1.2 ±0.6)分(P＜0.01);Constant-Mudey评分平均为(78.1±4.6)分和(93.9±3.7)分.术后无一例患者发生再脱位,且均重返伤前工作岗位.结论 肩关节镜下Bankart 重建手术是治疗复发性肩关节脱位的有效方法 .非打结型缝合锚钉简化了手术操作步骤,减少手术时间和创伤.     

关节镜下双后入路结合前方入路盂肱关节囊松解治疗重度原发性冻结肩

目的研究肩关节镜双后入路结合前方入路盂肱关节囊松解治疗重度原发性冻结肩的临床效果。 方法2013年1月至2016年12月南京中医药大学附属医院对16例重度原发性冻结肩患者行关节镜下双后入路结合前方入路盂肱关节囊松解术,男2例、女14例,平均年龄46.6岁,左肩4例、右肩12例。所有患者术前均拍摄肩关节正位片、冈上肌出口位X线片和肩关节MRI检查,全部患者均行双后入路关节镜下盂肱关节囊松解术,所有病例均同时行肩峰下滑囊清理术,分别在术前和末次随访时采用视觉模拟评分（visual analogue scale,VAS）、Constant-Murley评分和美国加利福尼亚大学（University of California, Los Angeles,UCLA）肩关节评分标准进行评价。 结果随访时间10~37个月,平均26个月。术前、术后即刻和末次随访平均UCLA评分分别为（10.3±3.2）分、（28.2±3.3）分和（31.2±5.3）分,差异有统计学意义（P<0.01）;平均Constant-Murley评分为（38.3±4.2）分、（89.2±4.5）分和（95.2±3.3）分;VAS评分平均为（6.3±1.9）分、（1.3±0.3）分和（1.0±0.2）分（P<0.01）。所有患者均对手术效果表示满意。 结论关节镜下双后入路结合前方入路盂肱关节囊松解治疗重度原发性冻结肩,便于术中操作,可以显著地缓解疼痛、恢复肩关节功能。关节镜下双后入路结合前方入路盂肱关节囊松解为治疗重度原发性冻结肩提供有效方法。     

关节镜下Twin Tail TightRope带袢钛板Y型固定治疗急性RockwoodⅢb型以上肩锁关节脱位的早期疗效

目的评价Twin Tail TightRope带袢钛板Y型固定术治疗急性肩锁关节脱位的早期临床疗效。 方法回顾性分析2015年6月至2017年6月昆明市第一人民医院采用Twin Tail TightRope带袢钛板内固定系统在关节镜下行Y型固定治疗急性肩锁关节脱位患者共16例。采用视觉模拟评分法（visual analogue scale，VAS）及Constant-Murley评分评估手术效果。 结果所有患者获得随访，随访时间3~12个月，平均（6.48±1.51）个月。术后无血管、神经损伤及切口感染，末次随访时均未发生复位丢失、锁骨应力性骨折、喙突切割等并发症。末次随访时VAS评分（0.36±0.04）分较术前（7.46±1.24）分降低，Constant-Murley评分（90.07±3.13）分较术前（46.13±3.25）分提高。 结论采用Twin Tail TightRope带袢钛板Y型固定术治疗急性肩锁关节脱位可有效解决术后水平、前后方向不稳定问题，此技术具有较低的锁骨、喙突骨折发生率，关节镜下操作可以减少手术损伤、提高精准度。     

Arthroscopic versus open distal clavicle excision: comparative results at six months and one year from a randomized, prospective clinical trial

The purpose of this report is to compare outcomes after arthroscopic versus open distal clavicle excision in the treatment of refractory acromioclavicular joint pain. A randomized, prospective clinical trial comparing the 6-month and 1-year outcomes of patients undergoing open distal clavicle excision (group 1) with those undergoing arthroscopic distal clavicle excision (group 2) was carried out. The Modified American Shoulder and Elbow Surgeons form, visual analog scale pain score, Short Form 36, and satisfaction questions were assessed preoperatively and at 6 months and 1 year postoperatively. Seventeen patients were enrolled. There was a trend across all measures for earlier or better outcomes (or both) after arthroscopic over open treatment. The improvement in visual analog scale pain score from preoperatively to 1 year postoperatively was significant for group 2 but not group 1 (P = .006 vs P = .13). Occult intra-articular pathology was detected and treated in 50% of group 2 patients. Arthroscopic and open distal clavicle excisions both provide significant pain reduction at 1 year. Both are effective surgeries for the treatment of refractory acromioclavicular joint pain. The ability to diagnosis and treat subtle concomitant shoulder pathology is a unique advantage of the arthroscopic approach.     

Post-cholecystectomy symptoms after laparoscopic cholecystectomy.

Abdominal symptoms persist in up to 40% of patients after laparotomy cholecystectomy and biliary lithotripsy. Laparoscopic cholecystectomy is now the treatment of choice for symptomatic gallstone disease. However, no data exist as to the influence of laparoscopic cholecystectomy on symptoms. We analysed 100 patients who had undergone laparoscopic cholecystectomy at a median of 12 months (range 10-19 months) previously. Pre- and postoperative symptoms were compared and patient satisfaction was graded from 1 (best) to 5 (worst). Time to resumption of full activity (mean +/- SD) was recorded. All patients had more than two symptoms preoperatively. Postoperatively, 61 patients had complete absence of symptoms, 14 patients complained of only one symptom during the postoperative period and 25 patients continued to have at least two symptoms. The mean time taken to return to full activity was 2.4 +/- 1.7 weeks. In patients without any symptoms postoperatively, time taken to return to full activity was 2.3 +/- 1.5 weeks, 2.7 +/- 1.4 weeks for patients with one symptom postoperatively, while patients with two or more symptoms returned to full activity in 2.3 +/- 1.3 weeks and 2.6 +/- 1.7 weeks, respectively. Notwithstanding that 25% of patients reported two or more symptoms postoperatively, most patients (n = 84) considered the procedure to be a complete success. A further 10 patients had significant improvement after laparoscopic cholecystectomy. Five patients considered themselves only slightly improved, while a single patient was no better off postoperatively. These data indicate that after laparoscopic cholecystectomy most patients return to full activity within 3 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)