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Distal Clavicle Excision (Mumford Procedure)

59 citationsUpdated Oct 2026
Illustration: Distal Clavicle Excision (Mumford Procedure)

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Distal clavicle excision, or the Mumford procedure, is indicated for appropriately selected patients with acromioclavicular joint pathology to relieve symptoms [16]. The procedure is preferred for old dislocations, where open reduction and internal fixation are not recommended due to complications and poor functional results [15]. Primary resection of the lateral clavicle is also a sufficient technique to avoid expected arthritis in cases with significant cartilage injury [20]. 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 [30]. Simple excision of the outer end of the clavicle yields satisfactory results with no residual upward displacement disturbing patients [9]. Routine distal clavicle resection in the setting of rotator cuff repair does not result in improved outcomes, as no difference is observed at 24 months post-surgery [17].

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 [7]. Arthroscopic distal clavicle resection leads to the same middle and long-term results as open surgery [1]. Although arthroscopic distal clavicle resection has provided more 'good or excellent' results than the open procedure, this finding is comprised of low-level evidence [5]. 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 [8]. 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 [23]. 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 [3].

The described procedure does not compromise the surgical field for patients with persistent or later symptoms arising from the AC joint, for whom excision of the distal clavicle as a second later procedure may be indicated [4]. The introduction of specific techniques provides a special technical option for distal clavicle resection when the patient is in the lateral decubitus position, allowing convenient removal of the posterior edge of the distal clavicle to prevent impingement [24]. The technique was validated using cadaveric dissection and yields a method of establishing the anterior portal for distal clavicle excision with a safe corridor for placement of instruments in a reliable manner that does not disrupt the important stabilizers of the glenohumeral or AC joints [25]. The technique will allow surgeons to perform distal clavicle excisions in a more efficient, reproducible and safer manner [2]. 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 [6]. 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 [18]. Incomplete excision and regrowth of the distal clavicle are the most common causes of revision [12].

Anatomy & Pathophysiology

Bony Anatomy

The clavicle is the first bone to ossify, occurring in the fifth week of gestation [65]. It is the only long bone to ossify by intramembranous ossification [65, 71]. The medial (sternal) epiphysis is the last ossification center to fuse, occurring at age 20 to 25 years [65]. The primary blood supply to the clavicle is periosteal, and no nutrient artery is present [65, 71]. The distal clavicle is flat in the anteroposterior plane [71].

The scapula is attached to the axial skeleton by the acromioclavicular (AC) and sternoclavicular (SC) joints [64]. The AC joint is the only true diarthrodial articulation of the scapula [65]. The scapular spine is an osseous ridge that separates the supraspinatus and infraspinatus fossae [65]. The coracoid process serves as an attachment site for the coracobrachialis muscle, short head of the biceps tendon, pectoralis minor muscle, coracoacromial ligament, and coracoclavicular ligaments [65, 76].

The acromion has three ossification centers: the metacromion (base), the mesoacromion (middle), and the preacromion (tip) [65]. Failure of fusion of these centers results in os acromiale [65].

Ligaments and Joint Structures

The AC joint is a small diarthrodial joint with an interposed fibrocartilaginous disk [65]. This articulation is a planar diarthroidal joint that couples scapular and sternoclavicular motion [47]. The fibrocartilaginous load-bearing disk cushions high contact stress when load is placed across the small articular surface area [47]. The superior and posterior AC ligaments are the primary stabilizers to anterior and posterior (horizontal) translation of the clavicle [65].

The coracoclavicular ligaments consist of the conoid (medial) and trapezoid (lateral) ligaments [65, 71]. These structures are the primary stabilizers to superior (vertical) translation of the distal clavicle [65, 71]. The trapezoid ligament is located approximately 25 mm from the AC joint [76]. The conoid ligament is located approximately 45 mm from the AC joint and is stronger than the trapezoid ligament [76]. The trapezoid and conoid ligaments have unique functions in normal shoulder kinematics because of their anatomic attachments [92].

The superior shoulder suspensory complex (SSSC) provides a stable connection between the scapula and the axial skeleton [65]. It is a bone–soft-tissue ring that provides a stable connection of the glenoid and scapula to the clavicle [71]. The SSSC is composed of four bony landmarks—distal clavicle, acromion, coracoid process, and glenoid neck—and the supporting ligamentous complexes of the AC joint and the CC ligaments [71]. Specifically, the SSSC includes the glenoid, coracoid process, coracoclavicular ligaments, distal clavicle, AC joint, and acromion [65].

Pathophysiology and Biomechanics

The AC joint is a plane/gliding joint with a fibrocartilaginous disc [76]. AC ligaments prevent anteroposterior displacement of the clavicle [76]. Coracoclavicular ligaments prevent superior displacement of the distal clavicle [76]. Disruption of the AC and CC ligaments significantly alters glenohumeral kinematics during abduction [132]. Kinematic changes resulting from AC joint dislocation can be a potential source of pain and dysfunction in the shoulder [93]. Scapular and clavicular kinematics are affected in AC separation models [95].

Distal clavicle insufficiency, or loss of the bony structure of the distal clavicle, may result in shoulder pain, dysfunction, scapular dyskinesia, and chronic acromioclavicular joint instability [57]. If more than 15 to 20 mm of the distal clavicle is missing, chronic posterior instability of the distal clavicle may ensue and impinge on the deltotrapezial fascia and scapular spine [57]. Distal clavicle insufficiency and osteolysis can be driven by traumatic injury, chronic repetitive stress, nonunion, or over-resection during arthroscopic or open distal clavicle excision [57].

Resection of greater amounts of bone with the open Mumford technique may disrupt the AC ligaments and lead to horizontal instability of the clavicle with abutment against the spine of the scapula [33]. When horizontal or vertical instability exists, results of distal clavicle resection are compromised because the technique does not address instability and may accentuate it [26].

The normal coracoclavicular distance measures approximately 1.1 to 1.3 cm [160]. In a type II AC injury, injury to the AC ligaments causes an increase of 3.6 mm in anterior and 6.4 mm in posterior translation [160]. Medialization of a clavicular fracture more than 20 mm is associated with a measurable decrease in functional outcome [71].

Classification

AC Joint Separation Classification

Rockwood: This system groups similar diagnoses, provides prognostic information, and guides treatment options [158]. Studies have shown fair to moderate reliability in its use for classification and surgical decision making [158]. Type I is established when 0% to <10% superior displacement of the distal clavicle is found [154]. Type II is present when the affected side differs by 10% to ≤25% superior displacement of the distal clavicle [154]. Type III dislocation is defined as a coracoclavicular distance (CCD) of >25% to ≤100% compared with the contralateral side [154]. A CCD of >100% compared with the contralateral side indicates a type V separation [154]. Type IV AC injury includes disruption of AC ligaments, disruption of coracoclavicular (CC) ligaments, and posterior translation of the clavicle [34].

ISAKOS Modified Rockwood: The ISAKOS Upper Extremity Committee suggests adding grade IIIA and grade IIIB injuries to a modified Rockwood classification to distinguish between stable type III injuries and unstable grade III injuries with therapy-resistant scapular dysfunction and overriding clavicle [163].

New AC Joint Instability Classification: This system defines Group 1 as having a CCD ≤30%, which includes all Rockwood type I, type II, and borderline low-grade type III patients [154]. Group 2 is defined as having a CCD >30%, which represents high-grade AC joint dislocations including all Rockwood type V patients and the majority of Rockwood type III patients [154].

Other Considerations: Horizontal instability of the clavicle is evident with distal clavicle resection of greater than 10 mm [19]. The presence of horizontal plane instability is an important prognostic indicator to the development of ongoing symptomatic instability [164]. Correctly differentiating between vertical and horizontal instability, which distinguishes a type III from a type IV injury, is crucial as it may determine the need for operative intervention [164]. The diagnosis of a type IV injury can potentially be made on an axial radiograph [164]. There is no clear consensus on the true definition of an axial radiograph projection for assessing horizontal plane deformity of the ACJ [164].

Clavicle Fracture Classification

General Grouping: Fractures of the clavicle may be divided into three groups: Group I (middle third), Group II (distal to the coracoclavicular ligament), and Group III (proximal end) [28]. Group II clavicle fractures are distal to the coracoclavicular ligament, where non-union is frequent [28].

Neer: Neer classified fractures of the distal end of the clavicle into two types [28].

Robinson: Robinson classified clavicular injuries and defined the lateral one-fifth of the clavicle as Type 3 [53]. There is a 20% to 30% non-union rate if lateral clavicle fractures are treated non-operatively [53].

Clinical Presentation

Distal clavicle excision is reserved for patients in whom the coracoclavicular ligaments are intact and there is no concomitant instability [26]. When horizontal or vertical instability exists, results are compromised because the technique does not address instability and may accentuate it [26]. The procedure is indicated for isolated acromioclavicular joint pathology, where arthroscopic excision yields statistically and clinically significant improvements in range of motion and patient-reported outcome measures [30]. Both arthroscopic and open approaches provide significant pain reduction at one year [7]. While there is no significant difference in most outcome measures between the two techniques, the arthroscopic group demonstrates superior improvement in Visual Analog Scale pain scores [7]. Arthroscopic resection has provided more 'good or excellent' results than the open procedure, although this finding is supported by low-level evidence [5]. Patients undergoing arthroscopic excision via the direct approach can expect a faster return to activities while obtaining similar long-term outcomes compared with the open procedure [8].

Chronic Arthropathy and Late Complications

For chronic symptomatic injuries, partial claviculectomy is believed to be the best procedure, offering negligible morbidity and rapid return to function [31]. Clavicular resection reliably produces significant improvement in patients with persistent pain or posttraumatic arthritis following late loss of reduction [21]. Simple excision of the outer end of the clavicle has yielded satisfactory results in patients with complete dislocation and subluxation, with no residual upward displacement disturbing the patients [9]. Resection of the inferior medial acromion and distal clavicle spurs does not cause late clinical problems and achieves the primary goal of fully decompressing the supraspinatus outlet [51]. However, resection of greater amounts of bone with the open technique may disrupt the acromioclavicular ligaments, leading to horizontal instability of the clavicle with abutment against the spine of the scapula [33]. Heterotopic bone formation is a more common cause of failure of acromioplasty or distal claviculectomy than is acknowledged by the literature [138].

Diagnostic Pitfalls

The successful treatment of patients by SLAP lesion repair after initial distal clavicle resection indicates that there may be misdiagnosis due to associated or underlying superior labral detachment causing similar symptoms [135].

Investigations

The primary purpose of shoulder imaging is to establish the diagnosis, determine the severity of the pathoanatomy, assist in surgical planning, and enable the surgeon to illustrate the condition to the patient [41]. Standardized plain films are almost always sufficient to garner the information needed for shoulder imaging, and proper radiographic technique is as important as proper surgical technique [41]. Unless a specific research protocol is in place, the temptation to “overimage” should be resisted, obtaining only the scans or reconstructions that are necessary for the care of the patient [41].

Plain radiography: The Zanca view is a special radiographic view indicated for the acromioclavicular joint, taken as an AP with 10° cephalic tilt centered over the AC joint using only one-half the voltage of a routine shoulder AP view [89]. Weighted stress radiographs significantly increased the measured elevation of the clavicle and the coracoclavicular distance compared to non-weighted views [166]. The coracoclavicular distance is normally 1.1 to 1.3 cm [89]. Arthritis, calcific tendinitis, and osteolysis of the distal clavicle can be observed on plain radiograph [88]. Methods to diagnose both superior and posterior translation of the clavicle need further debate [49].

CT: CT imaging is frequently used to evaluate fractures of the shoulder, assess for bony lesions in recurrent instability cases, or for preoperative templating for shoulder arthritis [88]. CT scans may offer a few degrees of increased precision in the measurement of glenoid version, but this precision does not improve the quality of the surgery or the clinical outcome [41].

MRI: MRI is the modality of choice for evaluating the rotator cuff, biceps, and subacromial/subdeltoid bursa [88].

Ultrasonography: Ultrasonography is a low-cost alternative to MRI and arthrography for evaluating both skeletal and soft-tissue structures of the shoulder [88]. It can provide immediate, real-time visualization of the rotator cuff, biceps tendon, and calcific deposits [88]. However, ultrasonography is highly operator dependent and is not as useful for evaluating labral tears or rotator cuff tears that are very small or larger than 3 cm [88].

Intraoperative Imaging: Intraoperative use of ultrasound and cannulated dilators allows surgeons to perform distal clavicle excisions in a more efficient, reproducible and safer manner [2].

Treatment

Non-Operative

The provided evidence does not detail specific conservative management protocols such as weight loss, physical therapy, NSAIDs, or injections. However, distal clavicle excision is indicated for patients with persistent pain or posttraumatic arthritis [21], implying that non-operative management has failed to resolve symptoms in this population.

Operative

Indications: Distal clavicle excision is reserved for patients with intact coracoclavicular ligaments and no concomitant instability [26]. While routine excision is not absolutely necessary even in symptomatic acromioclavicular joint osteoarthritis [143], the procedure reliably produces significant improvement in patients suffering from persistent pain or posttraumatic arthritis [21].

Surgical Approach / Technique: The open Mumford procedure involves resection of 1–2 cm of the distal clavicle and acromion combined [33]. The principle of open resection is to remove sufficient bone to prevent abutment of the resected distal clavicle against the medial acromion [33]. This is performed through either a saber or horizontal incision centered over the acromioclavicular joint [33]. Open resection allows reproducible resection of a measurable amount of bone and excellent clinical results [33]. However, it requires extensive soft tissue dissection and may necessitate a hospital stay, longer rehabilitation, and deltoid and trapezius muscle weakness [33]. Soft tissue trauma accounts for the early postoperative pain common with the open Mumford procedure [33]. Open access to the acromion for an acromioplasty requires further soft tissue dissection and detachment of the deltoid muscle [33]. Resection of greater amounts of bone with the open technique may disrupt the acromioclavicular ligaments and lead to horizontal instability of the clavicle with abutment against the spine of the scapula [33].

Arthroscopic excision of the distal clavicle involves less tissue dissection, minimal immobilization, and less pain than open resection [33]. These factors facilitate the rehabilitation process [33]. Both the direct superior approach and the indirect subacromial approach to arthroscopic distal clavicle resection result in successful clinical outcome with clinically insignificant difference at final follow-up [23]. The introduction of the supraspinatus fossa portal technique provides a special technical option for distal clavicle resection when the patient is in the lateral decubitus position [24]. This technique allows convenient removal of the posterior edge of the distal clavicle to prevent impingement [24]. A novel anterior portal technique for arthroscopic distal clavicle excision yields a safe corridor for placement of instruments in a reliable manner that does not disrupt the important stabilizers of the glenohumeral or acromioclavicular joints [25]. A reproducible technique for arthroscopic acromioclavicular joint excision ensures a controlled amount of clavicle is removed to relieve pain without sacrificing stability [172]. This reproducible arthroscopic technique protects the superior joint capsule and ligaments [172]. 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 [6].

Resection Volume and Biomechanics: A 5 mm distal clavicle resection guaranteed no bone-to-bone abutment in a cadaver model [18]. A 5-mm distal clavicle resection guaranteed no abutment but decreased joint stiffness [54]. Distal clavicle insufficiency, defined as more than 15 to 20 mm of missing distal clavicle bone, may result in chronic posterior instability of the distal clavicle and impingement on the deltotrapezial fascia and scapular spine [57]. If more than 15 to 20 mm of the distal clavicle is missing, it may be difficult to restore the mechanics of the scapular and glenohumeral joint [57]. 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 [152].

Outcomes and Complications: Arthroscopic distal clavicle resection has provided more 'good or excellent' results than has the open procedure, but is comprised of low-level evidence [5]. The described arthroscopic procedure does not compromise the surgical field for patients with persistent or later symptoms arising from the acromioclavicular joint, for whom excision of the distal clavicle as a second later procedure may be indicated [4]. Total claviculectomy yielded unsatisfying results for patients with chronic posttraumatic pain, despite full range of motion being regained in all cases [55]. No evidence suggested clavicular reconstruction led to clinical outcomes superior to those of isolated claviculectomy [11].

Complications

Incomplete Resection and Regrowth: Incomplete excision and subsequent regrowth of the distal clavicle represent the most common causes for revision surgery [12]. Persistent pain remains the most frequent complication following distal clavicle resection, a condition that may arise from either over- or under-resection [148]. Incomplete resection can specifically occur due to poor visualization during the procedure [148].

Iatrogenic Instability: Overexuberant resection of the clavicle or disruption of the acromioclavicular (AC) and coracoclavicular ligamentous system can result in iatrogenic instability of the AC joint [148]. Posterior translation of the AC joint is increased by 32% after a distal clavicle resection that involves an AC capsular incision [148]. When horizontal or vertical instability exists, surgical results are compromised because the Mumford procedure does not address instability and may accentuate it [26]. AC joint resection alone should be cautioned in patients with prior AC joint instability injuries, as a prior capsular or ligamentous disruption may lead to greater instability after AC joint resection [148]. Postoperative iatrogenic instability may require revision surgery or coracoclavicular ligament reconstruction [148].

Other Complications: Other complications of distal clavicle resection include infection, stiffness, fracture, spontaneous fusion, and complex regional pain syndrome [148]. Acromioclavicular dislocation has been reported as a complication following arthroscopic distal clavicle resection [6].

Recovery

Light activity (weeks): Following arthroscopic subacromial decompression and acromioclavicular joint excision, more than 90% of patients manage to return to driving within 4 weeks and to work within 6 weeks [104].

Other Considerations: Open and arthroscopic distal clavicle excision provide similarly good to excellent results regarding patient satisfaction and shoulder function at intermediate-term follow-up, though less residual pain was found using the arthroscopic technique [177]. Simple excision of the outer end of the clavicle has yielded satisfactory results with no residual upward displacement disturbing the patients [9]. Partial claviculectomy offers negligible morbidity and rapid return to function for chronic symptomatic injuries [31].

Key Evidence

  • [Paper] Arthroscopic distal clavicle resection leads to the same middle and long term results as open surgery. [1] (10.1016/j.main.2006.06.004)
  • [L5] The technique will allow surgeons to perform distal clavicle excisions in a more efficient, reproducible and safer manner. [2] (10.1016/j.eats.2024.103331)
  • [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. [3] (10.1016/j.arthro.2018.03.004)
  • [L4] The described procedure does not compromise the surgical field for patients with persistent or later symptoms arising from the AC joint, for whom excision of the distal clavicle as a second later procedure may be indicated. [4] (10.1097/bte.0b013e31816276cb)
  • [L3] Arthroscopic distal clavicle resection has provided more 'good or excellent' results than has the open procedure, but is comprised of low-level evidence. [5] (10.1097/blo.0b013e31802f5450)
  • [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. [6] (10.1016/j.jse.2010.08.032)
  • [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. [7] (10.1016/j.jse.2006.10.006)
  • [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. [8] (10.1016/j.arthro.2009.12.007)
  • [L4] No evidence suggested clavicular reconstruction led to clinical outcomes superior to those of isolated claviculectomy. [11] (10.1016/j.jse.2017.11.003)
  • [L4] Incomplete excision and regrowth of the distal clavicle are the most common causes of revision. [12] (10.1016/j.arthro.2009.06.010)
  • [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)
  • [L5] In appropriately selected patients, open or arthroscopic distal clavicle resection is necessary to relieve symptoms. [16] (10.5435/00124635-199905000-00004)
  • [L2] Routine distal clavicle resection in the setting of rotator cuff repair does not result in improved outcomes for patients with no difference being observed at 24 months post surgery. [17] (10.1177/1758573217741124)
  • [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. [18] (10.1016/j.jse.2007.02.105)
  • [L4] Horizontal instability of the clavicle is evident with distal clavicle resection of greater than 10 mm. [19] (10.1016/j.xrrt.2021.05.003)
  • [L4] Primary resection of the lateral end of the clavicle is a sufficient technique to avoid the expected arthritis in cases with significant injury of the cartilage. [20] (10.1016/s1058-2746(96)80418-6)
  • [L3] Late loss of reduction was common, and clavicular resection reliably produced significant improvement in patients with persistent pain or posttraumatic arthritis. [21] (10.2106/00004623-198769070-00013)
  • [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. [23] (10.1177/0363546506294855)
  • [Paper] The introduction of this technique provides a special technical option for distal clavicle resection when the patient is in the lateral decubitus position, allowing convenient removal of the posterior edge of the distal clavicle to prevent impingement. [24] (10.1016/j.eats.2020.08.040)
  • [L4] The technique was validated using cadaveric dissection and yields a method of establishing the anterior portal for distal clavicle excision with a safe corridor for placement of instruments in a reliable manner that does not disrupt the important stabilizers of the glenohumeral or AC joints. [25] (10.1097/bte.0000000000000033)
  • [L5] [26] (10.5435/00124635-200904000-00002)
  • [L4] [28] (10.2106/00004623-196749040-00024)
  • [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. [30] (10.1016/j.jseint.2023.07.014)
  • [Paper] [33] (10.1016/s0278-5919(03)00014-0)
  • [L4] [34] (10.1016/j.arthro.2016.06.013)
  • [Paper] [47] (10.1097/bte.0000000000000044)
  • [L4] Methods to diagnose both superior and posterior translation of the clavicle need further debate. [49] (10.1016/j.jseint.2019.11.006)
  • [Paper] The resection of the inferior medial acromion and distal clavicle spurs, although theoretically causing an increase in clavicular mobility, does not cause late clinical problems and does achieve the primary goal of fully decompressing the supraspinatus outlet. [51] (10.1097/bte.0b013e31802ca571)
  • [L4] [53] (10.1177/1758573214536535)
  • [L5] A 5-mm distal clavicle resection guaranteed no abutment but decreased joint stiffness. [54] (10.1016/j.arthro.2007.07.004)
  • [L4] Total claviculectomy yielded good results for patients with chronic osteitis and malignancy but unsatisfying results for those with chronic posttraumatic pain, despite full range of motion being regained in all cases. [55] (10.1016/j.jse.2006.07.007)
  • [L4] [57] (10.1016/j.eats.2025.103496)
  • [L5] The trapezoid and conoid ligaments have unique functions in normal shoulder kinematics because of their anatomic attachments. [92] (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. [93] (10.1177/0363546512458571)
  • [L5] Scapular and clavicular kinematics were affected in AC separation models. [95] (10.1016/j.jse.2013.01.004)
  • [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. [104] (10.1111/j.1758-5740.2010.00048.x)
  • [L5] A combined injury of the AC and CC ligaments significantly alters GH kinematics during abduction. [132] (10.1186/s12891-016-1330-2)
  • [L4] The successful treatment of 15 patients by SLAP lesion repair after initial distal clavicle resection indicates that there may be misdiagnosis due to associated or underlying superior labral detachment causing similar symptoms. [135] (10.1016/s1058-2746(96)80319-3)
  • [L4] This retrospective series suggests that heterotopic bone formation is a more common cause of failure of acromioplasty or distal claviculectomy than is acknowledged by the literature. [138] (10.1016/s1058-2746(05)80050-3)
  • [L2] Routine distal clavicle excision is not absolutely necessary, even in patients with symptomatic ACJ osteoarthritis. [143] (10.1007/s00167-020-06098-y)
  • [L5] [148] (10.1177/0363546513485359)
  • [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. [152] (10.1177/0363546510374447)
  • [L1] [154] (10.1016/j.jse.2020.10.026)
  • [L5] The Rockwood classification system groups similar diagnoses, provides prognostic information, and guides treatment options, though studies have shown fair to moderate reliability in its use for classification and surgical decision making. [158] (10.1007/s11999-016-5079-6)
  • [L5] [160] (10.1016/j.jse.2010.10.030)
  • [L5] The ISAKOS Upper Extremity Committee suggests adding grade IIIA and grade IIIB injuries to a modified Rockwood classification to distinguish between stable type III injuries and unstable grade III injuries with therapy-resistant scapular dysfunction and overriding clavicle. [163] (10.1016/j.arthro.2013.11.005)
  • [L4] [164] (10.1177/1758573220905573)
  • [L4] Weighted stress radiographs significantly increased the measured elevation of the clavicle and the coracoclavicular distance compared to non-weighted views. [166] (10.1016/j.jseint.2023.06.011)
  • [Paper] The technique conveys benefits by ensuring a controlled amount of clavicle is removed to relieve pain without sacrificing stability, protects the superior joint capsule and ligaments, and provides a practical and consistent technique for training purposes. [172] (10.1007/s12593-014-0147-1)
  • [L3] Open and arthroscopic distal clavicle excision are both effective surgeries to treat recalcitrant acromioclavicular joint pain, providing similarly good to excellent results regarding patient satisfaction and shoulder function at intermediate-term follow-up, though less residual pain was found using the arthroscopic technique. [177] (10.1177/0363546511419633)

See Also

References

[1] Arthroscopie de l'articulation acromioclaviculaire. Chirurgie de la Main. 2006. DOI: 10.1016/j.main.2006.06.004

[2] Intraoperative Use of Ultrasound and Cannulated Dilators to Safely Identify and Access the Acromioclavicular Joint for Distal Clavicle Excision: A Technique Guide. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2024.103331

[3] 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

[4] Acromioclavicular Joint Arthroscopy and Debridement. Techniques in Shoulder & Elbow Surgery. 2008. DOI: 10.1097/bte.0b013e31816276cb

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

[6] 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

[7] 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

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

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

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