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Does Acromioclavicular Joint Tenderness Affect The Outcome Of Rotator Cuff Repair? A Prospective Cohort Study

Does Acromioclavicular Joint Tenderness Affect The Outcome Of Rotator Cuff Repair? A Prospective Cohort Study

Priyadarshi Amit, MS, DNB, MRCSEd, MCh, FRCS, UNITED KINGDOM Shahbaz S Malik, BSc, MB BCh, MSc (Orth Engin), LLM, FRCS (Tr&Orth), UNITED KINGDOM Samir Massoud, FRCS, UNITED KINGDOM

The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UNITED KINGDOM

2021 Congress   ePoster Presentation     Not yet rated


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Summary: Acromioclavicular joint tenderness has no effect on outcome on rotator cuff repair without distal clavicle excision in short-term follow-up.


Patients with degenerative rotator cuff tear (RCT) frequently have symptomatic acromioclavicular joint (ACJ) with tenderness irrespective of presence or absence of ACJ arthritis. The ACJ tenderness prompts the surgeon to add distal clavicle excision (DCE) during rotator cuff repair (RCR). We believe that this tenderness occurs due to long head of biceps tendon (LHBT) pathology as opposed to ACJ pathology, hence, we do not perform DCE during RCR irrespective of presence of ACJ tenderness or ACJ arthritis.


The purpose of this study was to assess the functional outcome of RCR without DCE in patients with ACJ tenderness. We also aimed to evaluate the persistence or disappearance of ACJ tenderness following the surgery.

Materials And Methods

A cohort of 70 patients undergoing arthroscopic rotator cuff repair were prospectively evaluated. None of the patients underwent DCE. Preoperative parameters as demographic details and ACJ arthritis on imaging; and intraoperative parameters including LHBT pathology were recorded. The ACJ tenderness and clinical outcome scores including Oxford shoulder score (OSS) and quick-DASH score were evaluated pre-operatively and at one year post surgery. Statistical analysis was performed using Chi-square test/Fisher Exact test and student t-test to compare the outcome between the patients with tender and non-tender ACJ. Spearman correlation test was used to evaluate the association between ACJ tenderness and LHBT tendinopathy and ACJ arthritis.


Four patients were lost to follow up. Of remaining 66 patients, ACJ tenderness was found in 50% (33 patients) of the total study population. ACJ arthritis and biceps tendinopathy were found in 36.4% and 39.4% of the study population respectively. ACJ tenderness showed significant positive correlation with biceps tendinopathy (R = 0.37, p = 0.002), whereas there was no association of ACJ tenderness with ACJ arthritis. On comparison of two groups of patients (tender and non-tender ACJ groups), there was significant improvements in clinical outcome scores following surgery, the improvement was comparable in both the groups. One patient in both groups underwent revision rotator cuff repair, however there was no revision due to ACJ pain. Among patients with tender ACJ, the tenderness was persistent in 7 patients (21.3%) who demonstrated inferior outcome scores than patients with resolved tenderness.


ACJ tenderness has no effect on outcome on rotator cuff repair without DCE in short-term follow-up and therefore routine DCE in symptomatic ACJ is not necessary. Furthermore, patients with ACJ tenderness have higher incidence of LHBT tendinopathy.

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