Introduction
Arthroscopy of the shoulder is not routinely preformed during reconstruction of the acromioclavicular joint (ACJ). During an open ACJ reconstructive procedure, failure to recognize and address glenohumeral joint (GHJ) pathology can adversely affect outcomes. There is no consensus in the literature regarding the need for concomitant GHJ arthroscopy during the time of ACJ reconstruction. The objective is to determine the need for routine GHJ arthroscopy with open ACJ reconstruction pro-cedures by retrospectively identifying the incidence and type of GHJ pathology in patients undergoing ACJ reconstruction and to determine if pre-operative MRI's are sufficient to preclude routine GHJ arthroscopy during these procedures.
Methods
61 consecutive patients had arthroscopic evaluation of the GHJ concomitant with ACJ reconstruction surgery. ACJ injuries were graded using Rockwood's classification. Preoperative MRI's were reviewed when available. Diagnostic arthroscopy of the GHJ was performed in the beach chair position prior to open surgical treatment. If additional pathology was found, it was addressed surgically at that time.
Results
Of the 61 patients, there were 37 type III injuries, 16 type IV injuries and 7 type V injuries. There was also one type II with an associated distal clavicle fracture, and three isolated distal clavicle fractures. There were 55 males and 6 females. Average age at the time of surgery was 37.7 years. Time to surgery from date of injury was 8 days to 51 months (average 9.9 months). 17 patients had early surgery (within 6 weeks) and 44 were delayed (after 6 weeks). 11 of the patients had pre-operative MRI scans. 46% (28 patients) had GHJ pathology. There were 22 labral tears (36%) and eight rotator cuff tears (13%). There were 11 SLAP I lesions, 7 SLAP II lesions and 4 other labral tears. Two patients (3%) had instability requiring capsulolabral repair. 46% of patients with Type III ACJ injuries, 31% with Type IV lesions, and 86% of Type V injuries had associated GHJ pathology. 100% of the rotator cuff tears and 43% of the labral tears with pre-operative MRI's were detected.
Conclusion
In patients requiring ACJ reconstruction surgery for traumatic ACJ separations, diagnostic arthroscopy of the GHJ may be warranted due to the high incidence of associated pathology. Pre-operative MRI's do not preclude concomitant GHJ arthroscopy.
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Copyright
© 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
