Moderate strength evidence supports the use of distal clavicle resection as a concomitant treatment to arthroscopic repair for patients with full-thickness rotator cuff tears and symptomatic acromioclavicular joints.

Management of Rotator Cuff Injuries
Endorsed by: AANA, ASES, AOSSM, ASSET, APTA
Moderate Evidence MODERATE EVIDENCE
Rationale
Two studies (Oh, J. 2014 and Park, Y. 2015) showed no difference in patients with and without distal clavicle resection. One study (Oh) included patients with symptomatic AC joint arthrosis, and while the outcomes were the same, a distal clavicle resection resulted in symptomatic instability in a small number.

Another study (Kim, J. 2011) studied the use of DCR in asymptomatic AC joint arthrosis however, this study may not be generalizable to most patients as this included patients with asymptomatic AC joints with inferior spurs.

Risks and Harms of Implementing this Recommendation
There is no known harm to patients by implementing this recommendation, but there could potentially be a slightly higher reoperation rate on patients who did not undergo the concomitant procedures.

Future Research
Future research could be performed to elucidate risk factors for reoperation rates in certain groups who did not undergo concomitant procedures.
  1. Kim, J., Chung, J., Ok, H. Asymptomatic acromioclavicular joint arthritis in arthroscopic rotator cuff tendon repair: a prospective randomized comparison study. Archives of Orthopaedic & Trauma Surgery 2011; 3: 363-9
  2. Oh, J. H., Kim, J. Y., Choi, J. H., Park, S. M. Is arthroscopic distal clavicle resection necessary for patients with radiological acromioclavicular joint arthritis and rotator cuff tears? A prospective randomized comparative study. American Journal of Sports Medicine 2014; 11: 2567-73
  3. Park, J. S., Park, H. J., Kim, S. H., Oh, J. H. Prognostic Factors Affecting Rotator Cuff Healing After Arthroscopic Repair in Small to Medium-sized Tears. American Journal of Sports Medicine 2015; 10: 2386-92