Coplaning of the acromioclavicular joint☆

Abstract 

Purpose: Coplaning removes inferior spurs or portions of the distal clavicle to decrease injury to the rotator cuff. This study sought to determine if the presence or degree of coplaning influenced the results and if reoperations for distal clavicle symptoms were needed. Type of Study: Nonrandomized control study. Methods: A total of 76 patients undergoing arthroscopic subacromial decompression (ASD) followed for at least 25 months were divided into 3 groups. Group 1 included 28 patients who underwent ASD with removal of only an inferior clavicular osteophyte. Group 2 included 27 patients with resection of any inferior clavicle spur, violation of the inferior joint capsule, and removal of articular cartilage to a level adjacent with the resected acromion. As much as 50% of the articular cartilage was removed in some cases. Group 3 included 21 patients who underwent a complete distal clavicle excision. Radiographs, charts, and arthroscopic videotapes were reviewed and the degree of claviculectomy exactly determined. Follow-up evaluations included the Constant-Murley, American Shoulder and Elbow Surgeons (ASES), SANE, and Rowe shoulder scores, with special attention given to acromioclavicular (AC) joint pain and additional operations. Results: The average age of the patients was 49 years (range, 19 to 81 years) and follow-up averaged 40 months (range, 25 to 68 months). Follow-up Constant, ASES, Rowe, and SANE scores for the various groups were calculated. Group 1 scores were 99.4, 98.7, 98.6, and 98.1, respectively; group 2 scores were 96.8, 98.7, 98.5, and 95.7, respectively; and group 3 scores were 98.4, 99.4, 99.3, and 98.6, respectively. No patient required any additional AC joint surgery. Conclusions: Violation of the AC joint capsule and partial distal clavicle resection to make it confluent with the resected acromion (coplaning), does not cause increased AC joint symptoms, compromise the results, or lead to additional surgery at an average 40-month follow-up.

Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 9 (November-December), 2001: pp 913–917

Keywords:  Arthroscopic subacromial decompression, Coplaning, Acromioplasty, Shoulder