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Distal Clavicle Excision (Mumford Procedure)

Overview

Distal clavicle excision is a necessary procedure to relieve symptoms in appropriately selected patients [8]. The technique involves simple excision of the outer end of the clavicle, which yields satisfactory results without residual upward displacement disturbing patients [4]. While excision is preferred for old dislocations, open reduction and internal fixation are not recommended due to complications and poor functional results [15]. Both open and arthroscopic approaches provide significant pain reduction at one year, with no significant difference in outcome measures between groups except for VAS pain score improvement [10].

Surgical execution dictates success, as a well-performed excision likely outperforms a poorly performed one regardless of the approach chosen [1]. Arthroscopic resection via the direct approach facilitates a faster return to activities compared with the open procedure while obtaining similar long-term outcomes [2]. Although arthroscopic resection has provided more 'good or excellent' results than the open procedure, this finding is comprised of low-level evidence [3]. Portal placement remains paramount in facilitating surgery and avoiding injury to adjacent extra-articular structures regardless of the technique chosen [7].

Resection dimensions and completeness are critical for avoiding failure. A 5 mm resection guarantees no bone-to-bone abutment, whereas 2.5 mm was successful in many specimens but less guaranteed [9]. Incomplete excision and regrowth of the distal clavicle are the most common causes of revision surgery [6]. Furthermore, patients with displacement greater than 100% of the thickness of the distal clavicle had poorer postoperative clinical outcomes [5]. Both the direct superior approach and the indirect subacromial approach to arthroscopic resection result in successful clinical outcomes with a clinically insignificant difference at final follow-up [16].

Anatomy & Pathophysiology

Kinematics and Biomechanics

A precise, low-cost, non-invasive method to analyze shoulder complex kinematics has not yet been developed [25], though normative scapulothoracic kinematic values exist [26]. In acromioclavicular (AC) joint dislocation, kinematic changes represent a potential source of pain and dysfunction [29], with scapular and clavicular kinematics demonstrably affected in AC separation models [30]. No reconstruction strategy fully restores the shoulder girdle to its preinjured state, although each technique restores distinct elements of joint kinematics [27]. Preliminary findings indicate no detectable differences between surgically reconstructed and uninjured sides regarding ACJ biomechanics, range of motion, and isometric strength [37], whereas nonoperatively treated shoulders exhibit increased internal rotation, upward rotation, and posterior tilting [37]. Sensorimotor functional deficits are detectable via centre of pressure measurement even in patients with confirmed successful clinical and functional outcomes following surgical treatment [42].

Ligamentous and Osseous Considerations

The trapezoid and conoid ligaments possess unique functions in normal shoulder kinematics due to their specific anatomic attachments [28]. Biomechanically, the pectoralis minor tendon offers sufficient tissue length, excursion, and width [33] and is as strong as the coracoacromial ligament [33]. Excision of the coracoacromial ligament and acromioplasty at 150 to 200 N of loading increases the rotator cuff force required to maintain normal glenohumeral biomechanics by 25% to 30% [41]. Regarding coracoclavicular stabilization, no significant biomechanical differences in displacement or stiffness were observed between the anatomical landmark technique and the coracoid-based landmarks technique [34].

Clinical Implications and Future Directions

Type I and II AC joint disruptions impair long-term shoulder function in approximately half of patients 10 years after injury [40]. A comprehensive clinical approach emphasizing the evaluation of anatomic injury extent and its mechanical consequences on shoulder and arm function is essential for developing operative or non-operative treatment protocols and establishing outcomes [31]. The inconsistency of AC joint testing parameters and the lack of thorough translation studies highlight a necessity for increased attention to overall shoulder stability assessment to close gaps in foundational biomechanical research [32]. New surgical techniques continue to evolve as biomechanical data emerge and kinematic understanding improves [35], with emerging concepts regarding horizontal and rotational instability and scapular biomechanics aiming to lay the foundation for future studies to improve treatment outcomes and patient management [36].

Classification

Surgical Approach: A well-performed distal clavicle excision yields superior outcomes compared to a poorly performed one, regardless of the approach chosen [1]. Patients undergoing an arthroscopic procedure via the direct approach experience a faster return to activities while achieving similar long-term outcomes to the open procedure [2]. Although arthroscopic resection has demonstrated more 'good or excellent' results than the open procedure, this finding is based on low-level evidence [3]. Both arthroscopic and open excisions provide significant pain reduction at one year with no significant difference in outcome measures, except for VAS pain score improvement [10]. In appropriately selected patients, either open or arthroscopic distal clavicle resection is necessary to relieve symptoms [8].

Resection Extent and Stability: Simple excision of the outer end of the clavicle yields satisfactory results with no residual upward displacement disturbing the patient [4]. Distal clavicle excision with 2.5 mm of bone was successful in many specimens, whereas a 5 mm resection guaranteed no bone-to-bone abutment [9]. Horizontal instability of the clavicle is evident with distal clavicle resection of greater than 10 mm [11]. Patients with displacement greater than 100% of the thickness of the distal clavicle had poorer postoperative clinical outcomes [5]. Incomplete excision and regrowth of the distal clavicle are the most common causes of revision [6].

Intraoperative Landmarks and Technique: Portal placement remains paramount in both facilitating surgery and avoiding injury to adjacent extra-articular structures regardless of the technique chosen for distal clavicle resection [7]. The cross-sectional A-frame morphology of the superior cortex of the distal clavicle provides a reproducible landmark that is eliminated approximately 1.0 cm medial to the distal, lateral end of the clavicle, which can be used intraoperatively to determine when adequate resection has been completed [24]. The new operative procedure combines resection arthroplasty with fixation of the clavicle in an anatomical position [12]. Severe chronic symptomatic AC joint separations (Rockwood types III through V) can be repaired entirely by arthroscopy safely and effectively by transferring the coracoacromial ligament with a bone block in the distal clavicle [47].

Other Considerations: Ten of 894 (1.1%) rotator cuff repairs underwent subsequent distal clavicle resection [23].

Clinical Presentation

Distal clavicle excision is indicated for appropriately selected patients with isolated acromioclavicular joint (ACJ) pathology to relieve persistent pain or posttraumatic arthritis [8], [13]. The procedure is particularly beneficial for chronic symptomatic injuries, offering negligible morbidity and a rapid return to function [19]. Operation should be considered specifically in thin patients with a prominent clavicle, those performing heavy work, or those whose occupations require frequent shoulder abduction and flexion [20]. While simple excision of the outer clavicle yields satisfactory results for complete dislocation and subluxation without residual upward displacement [4], excision is preferred for old dislocations over open reduction and internal fixation, which are associated with complications and poor functional outcomes [15].

Indications and Outcomes: Patients with displacement greater than 100% of the distal clavicle thickness experience poorer postoperative clinical outcomes [5]. In carefully selected patients, arthroscopic distal clavicle excision results in statistically and clinically significant improvements in range of motion and patient-reported outcome measures [14]. Both arthroscopic and open approaches provide significant pain reduction at one year, with no significant difference in general outcome measures except for VAS pain score improvement [10]. Arthroscopic resection may yield more 'good or excellent' results than open procedures, though this is supported by low-level evidence [3]. Patients undergoing arthroscopic procedures, specifically via the direct approach, can expect a faster return to activities while achieving similar long-term outcomes compared with open surgery [2].

Technical Considerations and Complications: A well-performed distal clavicle excision likely outperforms a poorly performed one, regardless of the open or arthroscopic approach chosen [1]. Portal placement remains paramount in facilitating surgery and avoiding injury to adjacent extra-articular structures [7]. Although a 2.5 mm resection was successful in many specimens, a 5 mm resection guarantees no bone-to-bone abutment [9]. Horizontal instability of the clavicle becomes evident with distal clavicle resection greater than 10 mm [11]. Incomplete excision and regrowth of the distal clavicle are the most common causes of revision surgery [6]. Older patients and females are more likely to experience postoperative complications requiring reoperations, including revision ACJR, distal clavicle excision, and irrigation and debridement [21].

Anatomic Restoration and Diagnosis: Clinical examination and surgical treatment must address the anatomic restoration of individual structures to optimize the mechanical capability of the claviscapular segment [18]. Excellent clinical results are achieved with ACJ reconstruction using coracoacromial ligament transfer via the docking technique, which decreases the risk of recurrent distal clavicle instability [46]. However, methods to diagnose both superior and posterior translation of the clavicle require further debate [17]. Late loss of reduction was common in historical contexts, yet clavicular resection reliably produced significant improvement in patients with persistent pain or posttraumatic arthritis [13].

Investigations

Plain radiography: Weighted stress radiographs significantly increase the measured elevation of the clavicle and the coracoclavicular distance compared to non-weighted views [54]. Horizontal instability of the clavicle is evident with distal clavicle resection of greater than 10 mm [11]. Incomplete excision and regrowth of the distal clavicle are the most common causes of revision after distal clavicle resection [6]. Patients with displacement greater than 100% of the thickness of the distal clavicle had poorer postoperative clinical outcomes [5]. Although radiological assessment showed a statistically significant immediate superior clavicular displacement after hardware removal following ACJ stabilization using a suspensory fixation system, this may not negatively influence the results of ACJ stabilization in a clinically relevant way [56]. Fifteen years postoperatively, anatomic reduction was overall maintained, often with asymptomatic ossification of the coracoclavicular ligaments after arthroscopically assisted 2-bundle anatomic reduction of acute acromioclavicular joint separations [57].

MRI: Methods to diagnose both superior and posterior translation of the clavicle need further debate [17].

Other Considerations: Clinical examination and surgical treatment should address anatomic restoration of individual structures to optimize the mechanical capability of the claviscapular segment [18]. In appropriately selected patients, open or arthroscopic distal clavicle resection is necessary to relieve symptoms [8]. A well-performed distal clavicle excision will likely perform better than a poorly performed one, regardless of whether an open or arthroscopic approach is chosen [1]. Among patients undergoing distal clavicle excision for acromioclavicular joint pathology, those having an arthroscopic procedure, specifically through the direct approach, can expect a faster return to activities while obtaining similar long-term outcomes compared with the open procedure [2]. Arthroscopic distal clavicle resection has provided more 'good or excellent' results than has the open procedure, but is comprised of low-level evidence [3]. Simple excision of the outer end of the clavicle has yielded satisfactory results in patients with complete dislocation and subluxation of the acromioclavicular joint, with no residual upward displacement disturbing the patients [4]. There was no significant difference between open or arthroscopic distal clavicle excision (DCE) in the treatment of primary acromioclavicular joint osteoarthritis [55]. In carefully selected patients with isolated ACJ pathology, arthroscopic distal clavicle excision results in statistically and clinically significant improvements in range of motion and patient-reported outcome measures [14]. Regardless of the technique chosen for distal clavicle resection, portal placement remains paramount in both facilitating surgery and avoiding injury to adjacent extra-articular structures [7]. Although distal clavicle excision with 2.5 mm of bone was successful in many specimens, a 5 mm resection guaranteed no bone-to-bone abutment [9]. A 5-mm distal clavicle resection guaranteed no abutment but decreased joint stiffness [22]. The cross-sectional A-frame morphology of the superior cortex of the distal clavicle provides a reproducible landmark that is eliminated approximately 1.0 cm medial to the distal, lateral end of the clavicle, which can be used intraoperatively to determine when adequate resection has been completed [24]. The new operative procedure combines resection arthroplasty with fixation of the clavicle in an anatomical position [12].

Treatment

Non-Operative

The provided evidence does not contain specific data regarding conservative management options such as physical therapy, NSAIDs, or injections. Consequently, no paragraph detailing non-operative protocols can be constructed from the available L1 evidence.

Operative

Indications: Surgical intervention is necessary to relieve symptoms in appropriately selected patients [8]. Excision of the outer end of the clavicle is specifically preferred for old dislocations, whereas open reduction and internal fixation is not recommended due to complications and poor functional results [15]. Late loss of reduction was common, yet clavicular resection reliably produced significant improvement in patients with persistent pain or posttraumatic arthritis [13].

Surgical Approach / Technique: A well-performed distal clavicle excision will likely perform better than a poorly performed one, regardless of whether an open or arthroscopic approach is chosen [1]. Patients undergoing arthroscopic distal clavicle excision through the direct approach can expect a faster return to activities compared with the open procedure while obtaining similar long-term outcomes [2]. Both the direct superior approach and the indirect subacromial approach to the arthroscopic distal clavicle resection result in successful clinical outcome with clinically insignificant difference at final follow-up [16]. Portal placement remains paramount in both facilitating surgery and avoiding injury to adjacent extra-articular structures regardless of the technique chosen for distal clavicle resection [7]. Simple excision of the outer end of the clavicle has yielded satisfactory results with no residual upward displacement disturbing the patients [4].

Implant Selection: The provided evidence does not contain data regarding implant selection, prosthesis design, or fixation devices for distal clavicle excision.

Alignment / Balancing Strategy: Distal clavicle excision with 2.5 mm of bone was successful in many specimens, but a 5 mm resection guaranteed no bone-to-bone abutment [9]. A 5-mm distal clavicle resection guaranteed no abutment but decreased joint stiffness [22]. Horizontal instability of the clavicle is evident with distal clavicle resection of greater than 10 mm [11]. Patients with displacement greater than 100% of the thickness of the distal clavicle had poorer postoperative clinical outcomes [5]. Incomplete excision and regrowth of the distal clavicle are the most common causes of revision surgery [6].

Pain Management: Arthroscopic and open distal clavicle excisions both provide significant pain reduction at 1 year with no significant difference in outcome measures between groups, except for VAS pain score improvement [10]. Arthroscopic distal clavicle resection has provided more 'good or excellent' results than has the open procedure, though this finding is comprised of low-level evidence [3].

Adjuncts: The provided evidence does not contain data regarding the use of tourniquets, tranexamic acid, drains, navigation, or robotics.

Setting of Care: The provided evidence does not contain data regarding outpatient versus inpatient settings for this procedure.

Revision: Incomplete excision and regrowth of the distal clavicle are the most common causes of revision surgery [6].

Other Considerations: Surgical treatment may offer early benefits in pain relief and coracoclavicular distance improvement but does not enhance long-term functional outcomes and is associated with higher specific complication rates [49]. The slight increase in the in situ graft force only in the posterosuperior and posterior direction after distal clavicle excision suggests only a marginal protective role of the acromioclavicular articulation [50]. A bone anchor system for distal fixation in the base of the coracoid process and a medialized hole in the clavicle restored anatomy best [52].

Complications

Technical Execution: A well-performed distal clavicle excision will likely perform better than a poorly performed one, regardless of whether an open or arthroscopic approach is chosen [1]. Portal placement remains paramount in both facilitating surgery and avoiding injury to adjacent extra-articular structures [7]. Incomplete excision and regrowth of the distal clavicle are the most common causes of revision [6]. While distal clavicle excision with 2.5 mm of bone was successful in many specimens, a 5 mm resection guaranteed no bone-to-bone abutment [9]. Horizontal instability of the clavicle is evident with distal clavicle resection of greater than 10 mm [11].

Patient-Specific Risk: Older patients and females were more likely to experience postoperative complications requiring reoperations, including revision ACJR, distal clavicle excision, and irrigation and debridement [21].

Other Considerations: The incidence of complications in operative acromioclavicular joint separations in an active population was 1.35 per 100 person-years [59]. Clavicle and coracoid fractures occurred in 1.9 out of 100 cases of operative acromioclavicular joint separations [59]. Fracture of the distal clavicle or coracoid process after CC ligament repair or reconstruction is a rare but serious complication that can occur independent of bone tunnels created during the index procedure [62]. Coracoclavicular ligament reconstruction is an effective surgical approach for decreasing the incidence of subacromial osteolysis [60]. Additionally, 1.1% of rotator cuff repairs underwent subsequent distal clavicle resection [23].

Recovery

Light activity (weeks): Patients undergoing arthroscopic distal clavicle excision can expect a faster return to activities compared with open procedures [2]. More than 90% of patients manage to return to driving within 4 weeks and to work within 6 weeks following arthroscopic subacromial decompression and acromio-clavicular joint excision [38].

Full activity (months): For chronic symptomatic injuries, partial claviculectomy offers a rapid return to function [19]. The arthroscopic partial distal clavicle beveling procedure for nonincarcerated type IV AC separations resulted in an early return to sport [58]. In contrast, late reconstruction of the ligaments in young patients with complete acromioclavicular separations can yield better results than excision of the lateral clavicle, allowing patients to return to strenuous sports or heavy labor [43].

Complete recovery / outcome plateau (months): Arthroscopic and open distal clavicle excisions both provide significant pain reduction at 1 year with no significant difference in outcome measures between groups, except for VAS pain score improvement [10]. Clavicular resection reliably produced significant improvement in patients with persistent pain or posttraumatic arthritis, although late loss of reduction was common [13]. Arthroscopic distal clavicle resection has provided more 'good or excellent' results than has the open procedure, though this finding is comprised of low-level evidence [3].

Rehabilitation protocol: The anatomic reconstruction complex could withstand early rehabilitation, but the decrease in the structural properties and stiffness of the clavicle should be considered in optimizing the anatomic reconstruction technique [45]. Satisfactory outcome depends upon restoring the stability of the clavicle as well as the acromioclavicular joint [53].

Functional milestones: A well-performed distal clavicle excision will likely perform better than a poorly performed one, regardless of whether an open or arthroscopic approach is chosen [1]. Simple excision of the outer end of the clavicle has yielded satisfactory results with no residual upward displacement disturbing the patients [4]. Patients with displacement greater than 100% of the thickness of the distal clavicle had poorer postoperative clinical outcomes [5]. Incomplete excision and regrowth of the distal clavicle are the most common causes of revision [6].

Other Considerations: Operation should be considered only in thin patients with a prominent clavicle, those doing heavy work, or those whose work requires frequent shoulder abduction and flexion [20]. The described single-tunnel technique for coracoclavicular and acromioclavicular ligament reconstruction results in satisfactory objective and patient-reported outcomes and return to sports while avoiding coracoid and clavicle fractures [44].

Key Evidence

  • [L5] A well-performed distal clavicle excision will likely perform better than a poorly performed one, regardless of whether an open or arthroscopic approach is chosen. (10.1016/j.arthro.2018.03.004)
  • [L3] Among patients undergoing distal clavicle excision for acromioclavicular joint pathology, those having an arthroscopic procedure, specifically through the direct approach, can expect a faster return to activities while obtaining similar long-term outcomes compared with the open procedure. (10.1016/j.arthro.2009.12.007)
  • [L3] Arthroscopic distal clavicle resection has provided more 'good or excellent' results than has the open procedure, but is comprised of low-level evidence. (10.1097/blo.0b013e31802f5450)
  • [L3] Patients with displacement greater than 100% of the thickness of the distal clavicle had poorer postoperative clinical outcomes. (10.1186/s12891-025-09190-x)
  • [L4] Incomplete excision and regrowth of the distal clavicle are the most common causes of revision. (10.1016/j.arthro.2009.06.010)
  • [Case_report] Regardless of the technique chosen for distal clavicle resection, portal placement remains paramount in both facilitating surgery and avoiding injury to adjacent extra-articular structures. (10.1016/j.jse.2010.08.032)
  • [L5] In appropriately selected patients, open or arthroscopic distal clavicle resection is necessary to relieve symptoms. (10.5435/00124635-199905000-00004)
  • [Abstract] Although distal clavicle excision with 2.5 mm of bone was successful in many specimens, a 5 mm resection guaranteed no bone-to-bone abutment. (10.1016/j.jse.2007.02.105)
  • [L1] Arthroscopic and open distal clavicle excisions both provide significant pain reduction at 1 year with no significant difference in outcome measures between groups, except for VAS pain score improvement. (10.1016/j.jse.2006.10.006)
  • [L4] Horizontal instability of the clavicle is evident with distal clavicle resection of greater than 10 mm. (10.1016/j.xrrt.2021.05.003)
  • [L4] The new operative procedure combines resection arthroplasty with fixation of the clavicle in an anatomical position. (10.2106/00004623-197254060-00005)
  • [L3] Late loss of reduction was common, and clavicular resection reliably produced significant improvement in patients with persistent pain or posttraumatic arthritis. (10.2106/00004623-198769070-00013)
  • [L4] In carefully selected patients with isolated ACJ pathology, arthroscopic distal clavicle excision results in statistically and clinically significant improvements in range of motion and patient-reported outcome measures. (10.1016/j.jseint.2023.07.014)
  • [L4] Excision of the outer end of the clavicle is preferred for old dislocations, while open reduction and internal fixation are not recommended due to complications and poor functional results. (10.2106/00004623-196345080-00024)
  • [L2] Both the direct superior approach and the indirect subacromial approach to the arthroscopic distal clavicle resection result in successful clinical outcome with clinically insignificant difference at final follow-up. (10.1177/0363546506294855)
  • [L4] Methods to diagnose both superior and posterior translation of the clavicle need further debate. (10.1016/j.jseint.2019.11.006)
  • [L5] Clinical examination and surgical treatment should address anatomic restoration of individual structures to optimize the mechanical capability of the claviscapular segment. (10.5435/jaaos-d-24-00360)
  • [L1] Operation should be considered only in thin patients with a prominent clavicle, those doing heavy work, or those whose work requires frequent shoulder abduction and flexion. (10.2106/00004623-198668040-00011)
  • [L4] Older patients and females were more likely to experience postoperative complications requiring reoperations, including revision ACJR, distal clavicle excision, and irrigation and debridement. (10.1007/s00167-016-4206-y)
  • [L5] A 5-mm distal clavicle resection guaranteed no abutment but decreased joint stiffness. (10.1016/j.arthro.2007.07.004)
  • [L3] This records review found that 10 of 894 (1.1%) rotator cuff repairs underwent subsequent distal clavicle resection. (10.1177/2325967119844295)
  • [L5] The cross-sectional A-frame morphology of the superior cortex of the distal clavicle provides a reproducible landmark that is eliminated approximately 1.0 cm medial to the distal, lateral end of the clavicle, which can be used intraoperatively to determine when adequate resection has been completed. (10.1016/j.jse.2021.10.013)
  • [L5] Despite technology innovations, a precise, easy to use and low-cost non-invasive method able to draw and analyze the kinematics of the shoulder complex has not been developed yet. (10.1177/17585732221090226)
  • [L5] This study provided normative kinematic values of scapulothoracic movements in the shoulder girdle. (10.1016/j.jseint.2022.09.014)
  • [L5] Although each technique was able to restore different elements of the joint kinematics, none of the strategies completely restored the shoulder girdle to its preinjured state. (10.1177/03635465221095231)
  • [L5] The trapezoid and conoid ligaments have unique functions in normal shoulder kinematics because of their anatomic attachments. (10.1016/j.arthro.2009.12.031)
  • [L5] The kinematic changes could be a potential source of pain and dysfunction in the shoulder with AC joint dislocation. (10.1177/0363546512458571)
  • [L5] Scapular and clavicular kinematics were affected in AC separation models. (10.1016/j.jse.2013.01.004)
  • [L5] A comprehensive clinical approach emphasizing the evaluation of the extent of the anatomic injury and understanding its mechanical consequences regarding shoulder and arm function is a key in the development of guidelines for developing operative or non-operative treatment protocols and for establishing outcomes of the treatment protocols. (10.1177/17585732221122335)
  • [L4] The inconsistency of AC joint testing parameters and the lack of thorough translation studies indicate a necessity for increased attention in the overall assessment of shoulder stability to close the gap in the foundational biomechanical research. (10.1016/j.xrrt.2024.06.009)
  • [L5] Anatomically, it provides sufficient tissue length, excursion, and width, and biomechanically, it is as strong as the coracoacromial ligament. (10.1016/j.jse.2006.09.007)
  • [L5] No significant biomechanical differences in displacement or stiffness were seen between the anatomical landmark technique and the coracoid-based landmarks technique. (10.1177/23259671221132541)
  • [L5] New surgical techniques continue to evolve as more biomechanical data emerge and kinematic understanding improves. (10.5435/jaaos-d-16-00776)
  • [L5] By exploring emerging concepts and strategies regarding horizontal and rotational instability and scapular biomechanics, the article aims to lay the foundation for future studies aimed at improving treatment outcomes and patient management. (10.1016/j.jseint.2023.11.018)
  • [L4] Preliminary findings revealed no detectable differences between surgically reconstructed and uninjured sides in ACJ biomechanics, range of motion, and isometric strength, while nonoperatively treated shoulders showed increased internal rotation, upward rotation, and posterior tilting. (10.1177/23259671241274707)
  • [L3] The results obtained in the present study suggest that more than 90% of the patients manage to return to driving within 4 weeks and to work within 6 weeks following arthroscopic subacromial decompression and acromio-clavicular joint excision. (10.1111/j.1758-5740.2010.00048.x)
  • [L4] Type I and II acromioclavicular joint disruptions impair long-term shoulder function in about half of patients 10 years after injury. (10.1177/0363546508319047)
  • [L5] At 150 to 200 N of loading, CAL excision and acromioplasty increase the rotator cuff force required to maintain normal glenohumeral biomechanics by 25% to 30%. (10.1016/j.jse.2015.10.022)
  • [L3] Centre of pressure measurement detected sensorimotor functional deficits following surgical treatment of the shoulder joint in patients with confirmed successful clinical and functional outcomes. (10.1007/s00167-021-06751-0)
  • [L4] Late reconstruction of the ligaments in young patients with complete acromioclavicular separations can yield better results than excision of the lateral clavicle, allowing patients to return to strenuous sports or heavy labor. (10.2106/00004623-197658060-00008)
  • [L4] The described technique results in satisfactory objective and patient-reported outcomes and return to sports while avoiding coracoid and clavicle fractures. (10.1016/j.jse.2017.11.032)
  • [L5] The low level of permanent elongation after cyclic loading suggests that the anatomic reconstruction complex could withstand early rehabilitation; however, the decrease in the structural properties and stiffness of the clavicle should be considered in optimizing the anatomic reconstruction technique. (10.1177/0363546504264637)
  • [L4] Excellent clinical results were achieved, decreasing the risk of recurrent distal clavicle instability. (10.1186/1471-2474-10-6)
  • [L4] Severe chronic symptomatic AC joint separations (Rockwood types III through V) can be repaired entirely by arthroscopy safely and effectively by transferring the coracoacromial ligament with a bone block in the distal clavicle. (10.1016/j.arthro.2009.08.008)
  • [L1] Surgical treatment may offer early benefits in pain relief and coracoclavicular distance improvement but does not enhance long-term functional outcomes and is associated with higher specific complication rates. (10.1186/s12891-024-08100-x)
  • [L5] The slight increase in the in situ graft force only in the posterosuperior and posterior direction after distal clavicle excision suggests only a marginal protective role of the acromioclavicular articulation. (10.1177/0363546510374447)
  • [L5] A bone anchor system for distal fixation in the base of the coracoid process and a medialized hole in the clavicle restored anatomy best. (10.1007/s001670050182)
  • [L4] Satisfactory outcome depends upon restoring the stability of the clavicle as well as the acromioclavicular joint. (10.1111/j.1758-5740.2010.00102.x)
  • [L4] Weighted stress radiographs significantly increased the measured elevation of the clavicle and the coracoclavicular distance compared to non-weighted views. (10.1016/j.jseint.2023.06.011)
  • [L4] There was no significant difference between open or arthroscopic distal clavicle excision (DCE). (10.1177/17585732231157090)
  • [L4] Although radiological assessment showed a statistically significant immediate superior clavicular displacement after this rarely required procedure, with an increased incidence in the first year following stabilization, this may not negatively influence the results of ACJ stabilization in a clinically relevant way. (10.1007/s00167-022-06978-5)
  • [L3] Fifteen years postoperatively, good clinical results persisted and anatomic reduction was overall maintained, often with asymptomatic ossification of the coracoclavicular ligaments. (10.1177/03635465251355958)
  • [L4] The arthroscopic partial distal clavicle beveling procedure for nonincarcerated type IV AC separations resulted in a significant reduction in pain, improved daily function, and early return to sport. (10.1016/j.arthro.2016.06.013)
  • [L3] This review demonstrated an incidence of 1.35 complications per 100 person-years, with clavicle and coracoid fractures occurring in 1.9 out of 100 cases. (10.1177/2325967121s00330)
  • [L1] The current analysis suggests coracoclavicular ligament reconstruction as an effective surgical approach for decreasing the incidence of subacromial osteolysis. (10.1016/j.jse.2024.03.018)
  • [L4] Fracture of the distal clavicle or coracoid process after CC ligament repair or reconstruction is a rare but serious complication that can occur independent of bone tunnels created during the index procedure. (10.1177/03635465211036713)

See Also

References

[1] Editorial Commentary: The “Mumford” & Sons: For Distal Clavicle Excisions, What Are Our Young Surgeons Doing, and How Well Are They Doing It?. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2018.03.004

[2] Open Versus Arthroscopic Distal Clavicle Resection. Arthroscopy. 2010. DOI: 10.1016/j.arthro.2009.12.007

[3] Surgical Treatment of Symptomatic Acromioclavicular Joint Problems. Clinical Orthopaedics and Related Research. 2007. DOI: 10.1097/blo.0b013e31802f5450

[4] Complete Dislocation and Subluxation of the Acromioclavicular Joint: End Result in Seventy-three Cases.. The Journal of Bone and Joint Surgery. American Volume. 1961.

[5] Predicting reduction loss risk after acromioclavicular joint dislocation treated with the endobutton device. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09190-x

[6] Open Versus Arthroscopic Acromioclavicular Joint Resection: A Retrospective Comparison Study. Arthroscopy. 2009. DOI: 10.1016/j.arthro.2009.06.010

[7] Acromioclavicular dislocation after arthroscopic distal clavicle resection: a case report. Journal of Shoulder and Elbow Surgery. 2011. DOI: 10.1016/j.jse.2010.08.032

[8] Painful Conditions of the Acromioclavicular Joint. Journal of the American Academy of Orthopaedic Surgeons. 1999. DOI: 10.5435/00124635-199905000-00004

[9] Arthroscopic Distal Clavicle Resection: A Biomechanical Analysis In A Cadaver Model. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2007.02.105

[10] Arthroscopic versus open distal clavicle excision: Comparative results at six months and one year from a randomized, prospective clinical trial. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.10.006

[11] The reverse coracoacromial ligament transfer for “horizontal” acromioclavicular joint instability. JSES Reviews, Reports, and Techniques. 2021. DOI: 10.1016/j.xrrt.2021.05.003

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[23] Preoperative Factors Associated With Subsequent Distal Clavicle Resection After Rotator Cuff Repair. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119844295

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[25] Evaluation of the range of motion of scapulothoracic, acromioclavicular and sternoclavicular joints: State of the art. Shoulder & Elbow. 2022. DOI: 10.1177/17585732221090226

[26] Kinematic analysis of scapulothoracic movements in the shoulder girdle: a whole cadaver study. JSES International. 2023. DOI: 10.1016/j.jseint.2022.09.014

[27] Differences between Coracoclavicular, Acromioclavicular, or Combined Reconstruction Techniques on the Kinematics of the Shoulder Girdle. The American Journal of Sports Medicine. 2022. DOI: 10.1177/03635465221095231

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