Patients › Shoulder

Distal Clavicle Excision (Mumford Procedure)

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A Mumford procedure (distal clavicle excision) removes the small worn outer tip of the collarbone to ease shoulder pain at the AC joint. What the keyhole operation involves and what recovery looks like.

Updated May 2026

The outer end of the collarbone, at the acromioclavicular joint. Kieran Hirpara 4.0

Why this operation has been suggested

This page reflects how Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, approaches this in our clinic. You reach our clinic by GP or physiotherapist referral. A clinic assessment establishes the diagnosis. For degenerative or long-standing problems we usually try non-operative care first. We consider surgery when that has not given enough improvement.

Distal clavicle excision removes the outer end of the collarbone. This relieves pain from wear-and-tear arthritis or old injuries. We use an arthroscopic approach with two or three small incisions. A small camera guides the procedure. This method often allows a faster return to activities than open surgery. Both approaches provide significant pain reduction at 1 year. The main benefit is lasting relief from shoulder pain and improved function.

Before the operation

Please fast for six hours before your surgery. Stop any blood-thinning medicines as your surgeon advises. Arrange for someone to drive you home. Bring a list of all current medications and wear loose, comfortable clothing. You may need X-rays, an MRI, or blood tests before the procedure. These checks help us plan your care safely. We perform this operation using an arthroscopic approach. This means we use two or three small incisions and a tiny camera inside the joint. This method helps us see the area clearly while keeping the cuts small. Your surgeon will guide you through each step to ensure you are ready.

On the day

You will arrive at the hospital for admission. Our team will guide you through the pre-op checks. You will meet your anaesthetist to discuss your care plan. They will explain how we keep you comfortable and safe.

This operation is done under general anaesthetic combined with a regional nerve block. You will be fully asleep for the operation, and the block — an injection that numbs the nerves supplying the arm before you wake up — provides pain relief for the first 12 to 24 hours after surgery. The anaesthetist will meet you before the operation and talk you through both parts.

We use a keyhole technique for your procedure. This involves two or three small cuts near your shoulder. A small camera goes inside the joint to guide the surgeon. You will wake up in recovery as the anaesthetic wears off. Our nurses will monitor your comfort and stability closely.

What the operation involves

Your surgeon performs this procedure using an arthroscopic, or keyhole, approach. This means we make two or three small incisions, each about 1 cm long, over the front of your shoulder. Through these small cuts, we insert a tiny camera and specialized surgical instruments. This allows us to see inside the joint on a screen without making a large open cut.

Inside the joint, we carefully remove the outer end of your collarbone (clavicle). We typically remove about 5 mm of bone. This specific amount ensures there is no bone-to-bone rubbing when you move your arm, which helps prevent stiffness. We also ensure the incision is placed correctly to avoid injury to nearby nerves and blood vessels.

Once the bone is removed, we close the small cuts with sutures (stitches) or glue and apply a dressing. The entire operation usually takes about 30 to 60 minutes. You will be awake but comfortable throughout the process, as your surgeon manages your pain and anxiety with medication. After the procedure, you will be moved to a recovery area where our team will monitor you until you are ready to go home.

After the operation

You will wake up in the recovery ward with your arm in a sling. Most patients stay one night in hospital after this operation, though some are able to go home the same day. We provide pain relief to keep you comfortable. Keep your dressings clean and dry. Someone must stay with you for the first 24 hours. You will wear a sling for support while you rest. Do not drive for at least six weeks after any shoulder operation, regardless of which arm was operated on. You must not drive while in a sling. Once your surgeon clears you, typically at the six-week review, you may resume driving. See Driving after upper-limb surgery for full guidance.

Recovery

You will likely feel soreness and swelling in your shoulder for the first few days. This is normal as your body heals from the small keyhole incisions. We use a small camera to guide the procedure, which helps us remove the bone end precisely. Your arm will be in a sling to protect the joint while the initial healing takes place.

As the swelling settles, you will begin gentle movements. Our physiotherapist will guide you through specific exercises to restore strength and flexibility. You will do these at home, focusing on pain-free ranges of motion. Avoid heavy lifting or pushing with the operated arm until your surgeon clears you. Sleep may be uncomfortable at first; propping yourself up with pillows often helps.

Driving is not permitted while you are in a sling or if pain limits your control. Our policy requires you to wait at least six weeks after any shoulder operation before driving, regardless of which arm was treated. You can drive again once your surgeon clears you, typically at the six-week review. For more details, see our guide on Driving after upper-limb surgery.

Return to work and sport depends on your daily tasks and how your shoulder responds. Milestones are based on events, such as when you can grip without pain or when your surgeon approves increased activity. Your timeline may differ; your surgeon and physiotherapist will guide you through each stage of your recovery.

What can go wrong

Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.

Incomplete bone removal or regrowth If too much bone is left behind, or if new bone grows back in the space, you may feel persistent pain at the top of your shoulder. This pain often feels like a deep ache or a sharp pinch when you move your arm across your body. You might notice that your symptoms do not improve as expected after surgery. If this happens, call our clinic. We may need to review your progress and discuss further treatment options.

Instability of the collarbone Removing too much of the collarbone can make it unstable. You might feel a sense of looseness or weakness in your shoulder. Simple movements could feel awkward or unsteady. If you notice significant instability, contact us for an assessment.

Fractures Rarely, the collarbone or the coracoid process (a small hook of bone below the collarbone) can fracture. This can happen during ligament repair or reconstruction. You would likely feel sudden, severe pain and significant swelling. The area may become bruised quickly. If you experience this level of pain, go to the emergency department immediately.

Infection and other reoperations Some patients, particularly older adults and women, may face a higher chance of needing another procedure. This could involve cleaning out the wound (irrigation and debridement) or revising the joint replacement. Watch for signs of infection, such as redness spreading from the incision, warmth, or fever. If you see these signs, call our clinic right away.

General surgical risks Because we use small cameras and incisions, precise placement is key to avoiding injury to nearby structures. While we take great care, any surgery carries a risk of unexpected issues. If you notice unusual symptoms that worry you, do not wait. Bring them up at your next review or contact us sooner if they are urgent.

The complications table on this page lists typical rates if you want the specifics.

When to call us

Call us if you have a fever, increasing wound redness or discharge, or sudden severe pain. Go to emergency if you notice calf swelling, shortness of breath, loss of sensation, or inability to move your limb. We want to ensure your recovery stays on track. Contact our team immediately if any of these symptoms arise so we can assess you promptly.

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Reviewed by Dr Kieran Hirpara · 10 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

Overview

• 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].
• 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].
• Simple excision of the outer end of the clavicle has yielded satisfactory results with no residual upward displacement disturbing 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 surgery [6].
• Portal placement remains paramount in facilitating surgery and avoiding injury to adjacent extra-articular structures regardless of the technique chosen for distal clavicle resection [7].
• In appropriately selected patients, open or arthroscopic distal clavicle resection is necessary to relieve symptoms [8].
• 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].
• 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].
• 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 [15].
• 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].

Anatomy & Pathophysiology

• 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 [25].
• Normative kinematic values of scapulothoracic movements in the shoulder girdle have been provided [26].
• No reconstruction strategy completely restores the shoulder girdle to its preinjured state, although each technique restores different elements of joint kinematics [27].
• The trapezoid and conoid ligaments have unique functions in normal shoulder kinematics because of their anatomic attachments [28].
• Kinematic changes could be a potential source of pain and dysfunction in the shoulder with AC joint dislocation [29].
• Scapular and clavicular kinematics were affected in AC separation models [30].
• 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 key in the development of guidelines for developing operative or non-operative treatment protocols and for establishing outcomes of the treatment protocols [31].
• 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 [32].
• Anatomically, the pectoralis minor tendon provides sufficient tissue length, excursion, and width [33].
• Biomechanically, the pectoralis minor tendon is as strong as the coracoacromial ligament [33].
• No significant biomechanical differences in displacement or stiffness were seen between the anatomical landmark technique and the coracoid-based landmarks technique for coracoclavicular stabilization [34].
• New surgical techniques continue to evolve as more biomechanical data emerge and kinematic understanding improves [35].
• Emerging concepts and strategies regarding horizontal and rotational instability and scapular biomechanics aim to lay the foundation for future studies aimed at improving treatment outcomes and patient management [36].
• Preliminary findings revealed no detectable differences between surgically reconstructed and uninjured sides in ACJ biomechanics, range of motion, and isometric strength [37].
• Nonoperatively treated shoulders showed increased internal rotation, upward rotation, and posterior tilting [37].
• Type I and II acromioclavicular joint disruptions impair long-term shoulder function in about half of patients 10 years after injury [40].
• At 150 to 200 N of loading, coracoacromial ligament excision and acromioplasty increase the rotator cuff force required to maintain normal glenohumeral biomechanics by 25% to 30% [41].
• Centre of pressure measurement detected sensorimotor functional deficits following surgical treatment of the shoulder joint in patients with confirmed successful clinical and functional outcomes [42].

Classification

• 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 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 this finding is comprised of low-level evidence [3].
• 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].
• 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].
• In appropriately selected patients, open or arthroscopic distal clavicle resection is necessary to relieve symptoms [8].
• 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].
• 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].
• Horizontal instability of the clavicle is evident with distal clavicle resection of greater than 10 mm [11].
• The new operative procedure combines resection arthroplasty with fixation of the clavicle in an anatomical position [12].
• A records review found that 10 of 894 (1.1%) rotator cuff repairs underwent subsequent distal clavicle resection [23].
• 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].
• 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].

Clinical Presentation

• 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 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].
• 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].
• 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].
• In appropriately selected patients, open or arthroscopic distal clavicle resection is necessary to relieve symptoms [8].
• 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].
• 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].
• Horizontal instability of the clavicle is evident with distal clavicle resection of greater than 10 mm [11].
• Late loss of reduction was common, and clavicular resection reliably produced significant improvement in patients with persistent pain or posttraumatic arthritis [13].
• 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].
• 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 [15].
• Methods to diagnose both superior and posterior translation of the clavicle need further debate [17].
• Clinical examination and surgical treatment should address anatomic restoration of individual structures to optimize the mechanical capability of the claviscapular segment [18].
• For chronic symptomatic injuries, partial claviculectomy is believed to be the best procedure, offering negligible morbidity and rapid return to function [19].
• 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].
• Older patients and females were more likely to experience postoperative complications requiring reoperations, including revision ACJR, distal clavicle excision, and irrigation and debridement [21].
• Excellent clinical results were achieved with acromioclavicular joint reconstruction with coracoacromial ligament transfer using the docking technique, decreasing the risk of recurrent distal clavicle instability [46].

Investigations

• 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 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 this group of patients, 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].
• 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].
• In appropriately selected patients, open or arthroscopic distal clavicle resection is necessary to relieve symptoms [8].
• 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].
• Horizontal instability of the clavicle is evident with distal clavicle resection of greater than 10 mm [11].
• The new operative procedure combines resection arthroplasty with fixation of the clavicle in an anatomical position [12].
• 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].
• Methods to diagnose both superior and posterior translation of the clavicle need further debate [17].
• Clinical examination and surgical treatment should address anatomic restoration of individual structures to optimize the mechanical capability of the claviscapular segment [18].
• 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].
• Weighted stress radiographs significantly increased the measured elevation of the clavicle and the coracoclavicular distance compared to non-weighted views [54].
• There was no significant difference between open or arthroscopic distal clavicle excision (DCE) [55].
• Although radiological assessment showed a statistically significant immediate superior clavicular displacement after hardware removal following ACJ stabilization, 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 [56].
• Fifteen years postoperatively, good clinical results persisted and anatomic reduction was overall maintained, often with asymptomatic ossification of the coracoclavicular ligaments [57].

Treatment

• 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 via the direct approach can expect a faster return to activities compared with the open procedure while obtaining similar long-term outcomes [2].
• Arthroscopic distal clavicle resection has provided more 'good or excellent' results than the open procedure, though this is based on low-level evidence [3].
• Simple excision of the outer end of the clavicle has yielded satisfactory results with no residual upward displacement disturbing 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 surgery [6].
• Portal placement remains paramount in facilitating surgery and avoiding injury to adjacent extra-articular structures regardless of the technique chosen for distal clavicle resection [7].
• In appropriately selected patients, open or arthroscopic distal clavicle resection is necessary to relieve symptoms [8].
• 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].
• 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].
• Horizontal instability of the clavicle is evident with distal clavicle resection of greater than 10 mm [11].
• Late loss of reduction was common, and clavicular resection reliably produced significant improvement in patients with persistent pain or posttraumatic arthritis [13].
• 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 [15].
• Both the direct superior approach and the indirect subacromial approach to arthroscopic distal clavicle resection result in successful clinical outcomes with clinically insignificant difference at final follow-up [16].
• A 5-mm distal clavicle resection guaranteed no abutment but decreased joint stiffness [22].
• 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

• A well-performed distal clavicle excision performs better than a poorly performed one, regardless of whether an open or arthroscopic approach is chosen [1].
• Incomplete excision and regrowth of the distal clavicle are the most common causes of revision surgery [6].
• Portal placement is paramount in facilitating surgery and avoiding injury to adjacent extra-articular structures [7].
• 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].
• 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].
• Older patients and females were more likely to experience postoperative complications requiring reoperations, including revision ACJR, distal clavicle excision, and irrigation and debridement [21].
• 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].
• Excellent results can be obtained with coracoacromial ligament transfer using the docking technique, decreasing the risk of recurrent distal clavicle instability [61].

Recovery

• 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 an arthroscopic procedure, specifically through the direct approach, can expect a faster return to activities compared with the open procedure while obtaining similar long-term outcomes [2].
• Arthroscopic distal clavicle resection has provided more 'good or excellent' results than has the open procedure, though this is comprised of low-level evidence [3].
• 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].
• 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].
• For chronic symptomatic injuries, partial claviculectomy is believed to be the best procedure, offering negligible morbidity and rapid return to function [19].
• 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].
• 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].
• 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].
• 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].
• 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].
• 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 [58].

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. [1] (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. [2] (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. [3] (10.1097/blo.0b013e31802f5450)
• [L3] Patients with displacement greater than 100% of the thickness of the distal clavicle had poorer postoperative clinical outcomes. [5] (10.1186/s12891-025-09190-x)
• [L4] Incomplete excision and regrowth of the distal clavicle are the most common causes of revision. [6] (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. [7] (10.1016/j.jse.2010.08.032)
• [L5] In appropriately selected patients, open or arthroscopic distal clavicle resection is necessary to relieve symptoms. [8] (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. [9] (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] (10.1016/j.jse.2006.10.006)
• [L4] Horizontal instability of the clavicle is evident with distal clavicle resection of greater than 10 mm. [11] (10.1016/j.xrrt.2021.05.003)
• [L4] The new operative procedure combines resection arthroplasty with fixation of the clavicle in an anatomical position. [12] (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. [13] (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. [14] (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. [15] (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. [16] (10.1177/0363546506294855)
• [L4] Methods to diagnose both superior and posterior translation of the clavicle need further debate. [17] (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. [18] (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. [20] (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. [21] (10.1007/s00167-016-4206-y)
• [L5] A 5-mm distal clavicle resection guaranteed no abutment but decreased joint stiffness. [22] (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. [23] (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. [24] (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. [25] (10.1177/17585732221090226)
• [L5] This study provided normative kinematic values of scapulothoracic movements in the shoulder girdle. [26] (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. [27] (10.1177/03635465221095231)
• [L5] The trapezoid and conoid ligaments have unique functions in normal shoulder kinematics because of their anatomic attachments. [28] (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. [29] (10.1177/0363546512458571)
• [L5] Scapular and clavicular kinematics were affected in AC separation models. [30] (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. [31] (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. [32] (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. [33] (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. [34] (10.1177/23259671221132541)
• [L5] New surgical techniques continue to evolve as more biomechanical data emerge and kinematic understanding improves. [35] (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. [36] (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. [37] (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. [38] (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. [40] (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%. [41] (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. [42] (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. [43] (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. [44] (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. [45] (10.1177/0363546504264637)
• [L4] Excellent clinical results were achieved, decreasing the risk of recurrent distal clavicle instability. [46] (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. [47] (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. [49] (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. [50] (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. [52] (10.1007/s001670050182)
• [L4] Satisfactory outcome depends upon restoring the stability of the clavicle as well as the acromioclavicular joint. [53] (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. [54] (10.1016/j.jseint.2023.06.011)
• [L4] There was no significant difference between open or arthroscopic distal clavicle excision (DCE). [55] (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. [56] (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. [57] (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. [58] (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. [59] (10.1177/2325967121s00330)
• [L1] The current analysis suggests coracoclavicular ligament reconstruction as an effective surgical approach for decreasing the incidence of subacromial osteolysis. [60] (10.1016/j.jse.2024.03.018)
• [Abstract] Excellent results can be obtained with this technique, decreasing the risk of recurrent distal clavicle instability. [61] (10.1016/j.jse.2007.02.104)
• [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. [62] (10.1177/03635465211036713)

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