Advertisement

Demographic Analysis of Open and Arthroscopic Distal Clavicle Excision in a Private Insurance Database

      Purpose

      The purpose of this study was to evaluate and quantify the demographic characteristics of patients undergoing open and arthroscopic distal clavicle excision (DCE) in the United States while also describing changes in practice patterns over time.

      Methods

      Patients who underwent DCE from 2004 to 2009 were identified by Current Procedural Terminology (CPT) codes in a national database of orthopaedic insurance records. The year of procedure, age, sex, geographic region, and concomitant rotator cuff repair or subacromial decompression (SAD) were recorded for each patient. Results were reported as the incidence of procedures identified per 10,000 patients searched in the database.

      Results

      Between 2004 and 2009, 73,231 DCEs were performed; 74% were arthroscopic and 26% were open. The incidence of arthroscopic DCE increased from 37.8 in 2004 to 58.5 in 2009 (P < .001), whereas the incidence of open DCE decreased from 21.1 in 2004 to 14.1 in 2009 (P < .001). Sixty-one percent of DCEs were performed in men (P < .001). Women were more likely to undergo an arthroscopic procedure (P < .001). Arthroscopic DCE was most common in patients aged 50 to 59 years (P < .001). Open DCE was most common in patients aged 60 to 69 years (P < .001). Open rotator cuff repair and SAD were concomitantly performed in 38% and 23% of open DCEs, respectively. Arthroscopic rotator cuff repair and SAD were concomitantly performed in 33% and 95% arthroscopic DCEs, respectively.

      Conclusions

      This analysis of DCE using a private insurance database shows that arthroscopic DCEs progressively increased, whereas open DCEs concomitantly decreased between 2004 and 2009. The majority of DCEs were performed in men between the ages of 50 and 59 years. Both arthroscopic and open DCEs are frequently performed in conjunction with rotator cuff repair or SAD.

      Level of Evidence

      Level IV, cross-sectional study.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Mumford E.
        Acromioclavicular dislocations. A new operative treatment.
        J Bone Joint Surg. 1941; 23: 799-802
        • Gurd F.
        The treatment of complete dislocation of the outer end of the clavicle: A hitherto undescribed operation.
        Ann Surg. 1941; 216: 80-88
        • Alford W.
        • Bach B.
        Open distal clavicle resection.
        Oper Tech Sports Med. 2004; 12: 9-17
        • Ellman H.
        • Kay S.
        Arthroscopic subacromial decompression for chronic impingement. Two to five-year results.
        J Bone Joint Surg Br. 1991; 73: 395-398
        • Buttaci C.
        • Stitik T.
        • Yonclas P.
        • Foye P.
        Osteoarthritis of the acromioclavicular joint: A review of anatomy, biomechanics, diagnosis, and treatment.
        Am J Phys Med Rehabil. 2004; 83: 791-797
        • Freedman B.
        • Javernick M.
        • O'Brien F.
        • Ross A.
        • Doukas W.
        Arthroscopic versus open distal clavicle excision: Comparative results at six months and one year from a randomized, prospective clinical trial.
        J Shoulder Elbow Surg. 2007; 16: 413-418
        • Chronopoulos E.
        • Gill H.
        • Freehill M.
        • Petersen S.
        • McFarland E.
        Complications after open distal clavicle excision.
        Clin Orthop Relat Res. 2008; 466: 646-651
        • Klimkiewicz J.
        • Williams G.
        • Sher J.
        • Karduna A.
        • Des Jardins J.
        • Iannotti J.
        The acromioclavicular capsule as a restraint to posterior translation of the clavicle: A biomechanical analysis.
        J Shoulder Elbow Surg. 1999; 8: 119-124
        • Renfree K.
        • Riley M.
        • Wheeler D.
        • Hentz J.
        • Wright T.
        Ligamentous anatomy of the distal clavicle.
        J Shoulder Elbow Surg. 2003; 12: 355-359
        • Bigliani L.
        • Nicholson G.
        • Flatow E.
        Arthroscopic resection of the distal clavicle.
        Orthop Clin North Am. 1993; 24: 133-141
        • Strauss E.
        • Barker J.
        • McGill K.
        • Verma N.
        The Evaluation and management of failed distal clavicle excision.
        Sports Med Arthrosc. 2010; 18: 213-219
        • Matthews L.
        • Parks B.
        • Pavlovich L.
        • Giudice M.
        Arthroscopic versus open distal clavicle resection: A biomechanical analysis on a cadaveric model.
        Arthroscopy. 1999; 15: 237-240
        • Elhassan B.
        • Ozbaydar M.
        • Diller D.
        • Massimini D.
        • Higgins L.
        • Warner J.
        Open versus arthroscopic acromioclavicular joint resection: A retrospective comparison study.
        Arthroscopy. 2009; 25: 1224-1232
        • Auge W.
        • Fischer R.
        Arthroscopic distal clavicle resection for isolated atraumatic osteolysis in weight lifters.
        Am J Sports Med. 1998; 26: 189-192
        • Cook F.
        • Tibone J.
        The Mumford procedure in athletes. An objective analysis of function.
        Am J Sports Med. 1988; 16: 97-100
        • Eskola A.
        • Santavirta S.
        • Viljakka H.
        • Wirta J.
        • Partio T.
        • Hoikka V.
        The results of operative resection of the lateral end of the clavicle.
        J Bone Joint Surg Am. 1996; 78: 584-587
        • Kay S.
        • Ellman H.
        • Harris E.
        Arthroscopic distal clavicle excision. Technique and early results.
        Clin Orthop Relat Res. 1994; 301: 181-184
        • Novak P.
        • Bach B.
        • Romeo A.
        • Hager C.
        Surgical resection of the distal clavicle.
        J Shoulder Elbow Surg. 1995; 4: 35-40
        • Zawadsky M.
        • Marra G.
        • Wiater J.
        • et al.
        Osteolysis of the distal clavicle: Long-term results of arthroscopic resection.
        Arthroscopy. 2000; 16: 600-605
        • Daffner S.
        • Beimesch C.
        • Wang J.
        Geographic and demographic variability of cost and surgical treatment of idiopathic scoliosis.
        Spine. 2010; 35: 1165-1169
        • Rabalais R.
        • McCarty E.
        Surgical treatment of symptomatic acromioclavicular joint problems.
        Clin Orthop Relat Res. 2006; 455: 30-37
        • Horvath F.
        • Kery L.
        Degenerative deformations of the acromioclavicular joint in the elderly.
        Arch Gerontol Geriatr. 1984; 3: 259-265
        • Stein B.
        • Wiater J.
        • Pfaff H.
        • Biglani L.
        • Levine W.
        Detection of acromioclavicular joint pathology in asymptomatic shoulders with magnetic resonance imaging.
        J Shoulder Elbow Surg. 2001; 10: 204-208
        • Stenlund B.
        • Goldie I.
        • Hagberg M.
        • Hogstedt C.
        • Marions O.
        Radiographic osteoarthrosis in the acromioclavicular joint resulting from manual work or exposure to vibration.
        Br J Ind Med. 1992; 49: 588-593
        • Pensak M.
        • Grumet R.
        • Slabaugh M.
        • Bach B.
        Open versus arthroscopic distal clavicle resection.
        Arthroscopy. 2010; 26: 697-704
        • Gartsman G.
        Arthroscopic resection of the acromioclavicular joint.
        Am J Sports Med. 1993; 21: 71-77
        • Basmania C.
        • Wirth M.
        • Rockwood C.
        • Moya D.
        Failed distal clavicle resection.
        Orthop Trans. 1995; 19: 355
        • Blazar P.
        • Iannotti J.
        • Williams G.
        Anteroposterior instability of the distal clavicle after distal clavicle resection.
        Clin Orthop Relat Res. 1998; 348: 114-120
        • Sachs R.
        • Stone M.
        • Devine S.
        Open vs. arthroscopic acromioplasty: A prospective, randomized study.
        Arthroscopy. 1994; 10: 248-254
        • Needell S.
        • Zlatkin M.
        • Sher J.
        • Murphy B.
        • Uribe J.
        MR imaging of the rotator cuff: Peritendinous and bone abnormalities in an asymptomatic population.
        AJR Am J Roentgenol. 1996; 166: 863-867
        • Zhang A.
        • Montgomery S.
        • Ngo S.
        • Hame S.
        • Wang J.
        • Gamradt S.
        Analysis of rotator cuff repair trends in a large private insurance population.
        Arthroscopy. 2013; 29: 623-629