Distal Clavicle Resection 29824

CPT	Technique
Indications	Complications
Contraindications	Follow-up Care
Alternatives	Outomes
Pre-op Planning / Special Considerations	Review References

synonyms: DCR, Acromioclavicular Joint Resection, ACJ Resection, acromioclavicular joint (ACJ) arthroplasties

Distal Clavicle Resection CPT

Distal Clavicle Resection Indications

Distal Clavicle Resection Contraindications

Acromioclavicular instability: If there is AC instability CA ligament reconstruction +/-Distal Clavicle Resection is indicated
Active infection

Distal Clavicle Resection Alternatives

Non-operative treatment: NSAIDS, physical therapy, activity modifications, ACJ injections
Open Distal clavicle resection

Distal Clavicle Resection Pre-op Planning / Special Considerations

Ensure both 30° and 70° arthroscopes are available.
Posterior and superior acromioclavicular ligaments provide restraint to posterior translation of the acromioclavicular joint should be preserved.
Direct approach: Sharron, Schepsis 2007

Distal Clavicle Resection Technique

See Shoulder Arthroscopy
Ensure that AC joint is not unstable secondary to ACJ separation. If so concomitant coracoclavicular ligament reconstruction is indicated (Jerosch J, Unfallchirurg 1998;101:691-96)(link is external).
Ensure anterior portal is well aligned with ACJ.
Perform Subacromial Decompression and remove medial fibrofatty tissue around the distal clavicle and scapular spine.
Perform distal clavicle resection through anterior portal using a power burr while viewing from posterior portal usning a 30° scope.
Preserve superior ACJ capsule and ligaments. (Levine WN, Arthroscopy 2006;22:516).
Evaluate superior cortex posteriorly with a 70° scope, ensure resection is complete.
Perform cross-body adduction test confirming no abutment occurs.
Resect between 5 and 10mm of distal clavicle or make 5-10mm space by resection of some acromion. (Branch TP Am J Sports Med 1996;24:293-7)(link is external) (Eskola A, JBJS 1996;78A:584-7)(link is external).
Use rasp or burr of known size to quantitate ACJ space created.

Distal Clavicle Resection Complications

Instability(excessive resection)
Persistant pain / Continued symptoms (most common complication, possible from inadequate resection)
Ectopic calcification
Reactive bursitis
Clavicle/acromion fracture
Infection
Adhesive capsulitis

Distal Clavicle Resection Follow-up care

Post-op: sling as needed with pendulum ROM exercises.
See Shoulder Arthroscopy Rehab Protocol.
1 week: Start PT focused on ROM and strengthening. AAROM, PROM. AROM, free weights start at 3 weeks. Avoid cross-body adduction for 6 weeks.
6 weeks: progressive sport specific activity.
3 months: Return to sport / full activities.
In in association with SAD, or RTC repair use those rehab protocols.
Outcome measures: ASES score, pain scales.

Distal Clavicle Resection Outcomes

71% excellent, 16.5% good, 12.5% failure (Levine WN Arthroscopy 1998;14:52-6)(link is external).
100% good to excellent results for Distal Clavicle Resection with SAD at an average follow-up of 6 years. 25% asymptomatic calcific density distal to the resected clavicle. (Kay SP, Arthroscopy 2003;19:805)(link is external).

Distal Clavicle Resection Review References

Burkhart SS, A Cowboy's Guide to Advanced Shoulder Arthroscopy, 2006
Strauss EJ, Barker JU, McGill K, Verma NN. The evaluation and management of failed distal clavicle excision. Sports Med Arthrosc. 2010 Sep;18(3):213-9.
Beaver AB, Parks BG, Hinton RY. Biomechanical analysis of distal clavicle excision with acromioclavicular joint reconstruction. Am J Sports Med. 2013 Jul;41(7):1684-8.