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Open versus arthroscopic acromioclavicular joint resection: a systematic review and meta-analysis

  • Erik HohmannEmail author
  • Kevin Tetsworth
  • Vaida Glatt
Arthroscopy and Sports Medicine
  • 12 Downloads

Abstract

Introduction

The purpose of this study was to perform a meta-analysis comparing open and arthroscopic surgical techniques for distal clavicle resection.

Methods

A systematic review of Medline, Embase, Scopus, and Google Scholar identified relevant publications in the English and German literature between 1997 and 2017. All included studies were levels I–IV, describing both treatments, with a minimum of 12 month follow-up, had at least one validated outcome score and documented patient recruitment, study design, demographic details, and surgical technique. Studies were excluded if they were only abstracts or conference proceedings, involved revision procedures, or the loss to follow-up exceeded 20%. Publication bias and risk of bias were assessed using the Cochrane Collaboration tools, and heterogeneity was assessed using the I2 statistic.

Results

Four studies (n = 319 patients) met the criteria for inclusion. The pooled estimate for clinical outcomes (Constant, ASES) demonstrated no significant differences (SMD 0.323, I2 = 0%, p = 0.065) between open and arthroscopic resection, although the analysis favored open resection. The pooled estimate for clinical outcomes (SST) also demonstrated no significant differences (SMD 0.744, I2 = 49.82%, p = 0.144) between open and arthroscopic resection, but the analysis again favored open resection. The pooled estimate for VAS assessment of pain demonstrated no differences (SMD 0.217, I2 = 58.96%; p = 0.404) between open and arthroscopic resection.

Conclusion

The results of this study suggest that similar functional and clinical outcomes can be achieved with either open or arthroscopic distal clavicle resection. The observed trend that open resection may have a more favorable outcome warrants further investigation.

Level of evidence

Level 3; systematic review and meta-analysis.

Keywords

Acromioclavicular joint Open resection Mumford procedure Arthroscopic resection Meta-analysis Systematic review Distal clavicle resection 

Notes

Funding

There is no funding source.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Rabalais RD, McCarty E (2007) Surgical treatment of symptomatic acriomiocavicular joint problems: a systematic review. Clin Orthop Relat Res; 455:30–37.  https://doi.org/10.1097/BLO.0b013e31802f5450 CrossRefGoogle Scholar
  2. 2.
    Duindam N, Kuiper JWP, Hoozemans MJM et al (2014) Comparison between open and arthroscopic procedures for lateral clavicle resection. Int Orthop (SICOT) 38:783–789.  https://doi.org/10.1007/s00264-013-2161-5 CrossRefGoogle Scholar
  3. 3.
    Pensak M, Grumet RC, Slabaugh MA, Bach BR (2010) Open versus arthroscopic distal clavicle resection. Arthroscopy 26(5):697–704.  https://doi.org/10.1016/j.arthro.2009.12.007 CrossRefGoogle Scholar
  4. 4.
    Robertson WJ, Griffith MH, Carroll K, O’Donnell T (2011) Arthroscopic versus open distal clavicle resection. A comparative assessment at intermediate-term follow up. Am J Sports Med 39(11):2415–2420.  https://doi.org/10.1177/0363546511419633 CrossRefGoogle Scholar
  5. 5.
    Mumford EB (1941) Acromioclavicular dislocation: a new operative treatment. J Bone Jt Surg 23(4):799–802Google Scholar
  6. 6.
    Chronopoulos E, Gill HS, Freehill MT et al (2008) Complications after open distal clavicle excisions. Clin Orthop Relat Res 466:646–651.  https://doi.org/10.1007/s11999-007-0084-4 CrossRefGoogle Scholar
  7. 7.
    Levine WN, Soong M, Ahmad CS et al (2006) Arthroscopic distal clavicle resection: a comparison of bursal and direct approaches. Arthroscopy 22(5):516–520.  https://doi.org/10.1016/j.arthro.2006.01.013 CrossRefGoogle Scholar
  8. 8.
    Elhassan B, Ozbaydar M, Diller D et al (2009) Open versus arthroscopic acromioclavicular joint resection: a retrospective comparison study. Arthroscopy 25(11):1224–1232.  https://doi.org/10.1016/j.arthro.2009.06.010 CrossRefGoogle Scholar
  9. 9.
    Freedman BA, Javernick MA et al (2007) Arthroscopic versus open distal clavicle excision: comparative results at six months and one year from a randomized, prospective clinical trial. J Shoulder Elbow Surg 16(4):413–418.  https://doi.org/10.1016/j.jse.2006.10.006 CrossRefGoogle Scholar
  10. 10.
    Docimo S Jr, Kornitsky D, Futterman B et al (2008) Surgical treatment for acriomioclavicular joint osteoarthritis: patient selection, surgical options, complications, and outcome. Curr Rev Musculoskelet Med 1:154–160.  https://doi.org/10.1007/s12178-008-9024-5 CrossRefGoogle Scholar
  11. 11.
    Higgins JPT, Green S (2011) Cochrane handbook for systematic reviews of interventions. Version 5.1.9 [updated March 2011]. The Cochrane Collaboration, LondonGoogle Scholar
  12. 12.
    Moher D, Liberati A, Tetzlaff J et al (2010) Preferred reporting items for systematic reviews and meta-analysis: the PRISMA statement. Int J Surg 8:336–334.  https://doi.org/10.1016/j.ijsu.2010.02.007 CrossRefGoogle Scholar
  13. 13.
    Guyatt GH, Oxman AD, Vist GE et al (2008) GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336(7650):924–926.  https://doi.org/10.1136/bmj.39489.470347.AD CrossRefGoogle Scholar
  14. 14.
    Higgins JPT, Thompson SG (2002) Quantifying heterogeneity in a metaanalysis. Stat Med 21:1539–1558.  https://doi.org/10.1002/sim.1186 CrossRefGoogle Scholar
  15. 15.
    Higgins JPT, Thompson SG, Deeks JJ et al (2003) Measuring inconsistency in meta-analysis. BMJ 327:557–560.  https://doi.org/10.1136/bmj.327.7414.557 CrossRefGoogle Scholar
  16. 16.
    Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13.  https://doi.org/10.1186/1471-2288-5-13 CrossRefGoogle Scholar
  17. 17.
    Gartsman GM, Khan M, Hammerman SM (1998) Arthroscopic repair of full-thickness tears of the rotator cuff. J Bone Jt Surg Am 80:832–840CrossRefGoogle Scholar
  18. 18.
    Flatow EL, Cordasco FA, Bigliani LU (1992) Arthroscopic resection of the outer end of the clavicle from a superior approach: a critical, quantitative, radiographic assessment of bone removal. Arthroscopy 81(1):55–64CrossRefGoogle Scholar
  19. 19.
    Eskola A, Santavirta S, Viljakka HT et al (1996) The results of operative resection of the lateral end of the clavicle. J Bone Jt Surg Am 78:584–587CrossRefGoogle Scholar
  20. 20.
    Sperling JW, Smith AM, Cofield RH et al (2007) Patients perceptions of open and arthroscopic shoulder surgery. Arthroscopy 23(4):361–366.  https://doi.org/10.1016/j.arthro.2006.12.006 CrossRefGoogle Scholar
  21. 21.
    Charron KM, Schepsis AA, Voloshin I (2007) Arthroscopic distal clavicle resection in athletes. A prospective comparison of the direct and indirect approach. Am J Sports Med 35(1):53–58CrossRefGoogle Scholar
  22. 22.
    Burns PB, Rohrich RJ, Chung KC (2011) The levels of evidence and their role in evidence-based medicine. Plast Reconstr Surg 128(1):305–310.  https://doi.org/10.1097/PRS.0b013e318219c171 CrossRefGoogle Scholar
  23. 23.
    Harris JD, Brand JC, Cote MP et al (2017) Research pearls: the significance of statistics and perils of pooling. Part 3: pearls and pitfalls of meta-analysis and systematic reviews. Arthroscopy 33(8):1594–1602.  https://doi.org/10.1016/j.arthro.2017.01.055 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Erik Hohmann
    • 1
    • 2
    Email author
  • Kevin Tetsworth
    • 3
    • 4
    • 5
    • 6
  • Vaida Glatt
    • 7
  1. 1.Faculty of Health SciencesUniversity of PretoriaPretoriaSouth Africa
  2. 2.Department of Orthopaedic Surgery and Sports MedicineValiant Clinic/Houston Methodist GroupDubaiUnited Arab Emirates
  3. 3.Department of Orthopaedic SurgeryRoyal Brisbane HospitalHerstonAustralia
  4. 4.Department of Surgery, School of MedicineUniversity of QueenslandSt LuciaAustralia
  5. 5.Queensland University of TechnologyBrisbaneAustralia
  6. 6.Orthopaedic Research Centre of AustraliaChatswoodAustralia
  7. 7.University of Texas Health Science CenterSan AntonioUSA

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