PDF(Pubmed)
Abstract：
UNASSIGNED: Although substantial motion at the acromioclavicular joint (ACJ) occurs during overhead shoulder motion, the influence of ACJ arthritis on postoperative outcomes of patients undergoing reverse total shoulder arthroplasty (rTSA) is unclear. We assessed the influence of ACJ arthritis, defined by degenerative radiographic changes, and its severity on clinical outcomes after primary rTSA.
UNASSIGNED: We conducted a retrospective review of a prospectively collected shoulder arthroplasty database of patients that underwent primary rTSA with a minimum 2-year clinical follow-up. Imaging studies of included patients were evaluated to assess ACJ arthritis classified by radiographic degenerative changes of the ACJ; severity was based upon size and location of osteophytes. Both the Petersson classification and the King classification (a modified Petersson classification addressing superior osteophytes and size of the largest osteophyte) were used to evaluate the severity of degenerative ACJ radiographic changes. Severe ACJ arthritis was characterized by large osteophytes (≥2 mm). Active range of motion (ROM) in abduction, forward elevation, and external and internal rotation as well as clinical outcome scores (American Shoulder and Elbow Surgeons Shoulder, Constant, Shoulder Pain and Disability Index, simple shoulder test, University of California, Los Angeles scores) were assessed both preoperatively and at the latest follow-up; outcomes were compared based on severity of ACJ arthritis. Multivariable linear regression models were used to determine whether increasing severity of ACJ arthritis was associated with poorer outcomes.
UNASSIGNED: A total of 341 patients were included with a mean age of 71 ± 8 years and 55% were female. The mean follow-up was 5.1 ± 2.4 years. Preoperatively, there were no differences in outcomes based on the severity of ACJ pathology. Postoperatively, there were no differences in outcomes based upon the severity of ACJ arthritis except for greater preoperative to postoperative improvement in active internal rotation in patients with normal or grade 1 ACJ arthritis vs. grade 2 and 3 (3 ± 2 vs. 1 ± 2 and 1 ± 3, P = .029). Patients with ACJ arthritis and osteophytes ≥2 mm had less favorable Shoulder Pain and Disability Index scores, corresponding to greater pain (-49.3 ± 21.5 vs. -41.3 ± 26.8, P = .015). On multivariable linear regression, increased severity of ACJ arthritis was not independently associated with poorer postoperative ROM or outcome scores.
UNASSIGNED: Overall, our results demonstrate that greater ACJ arthritis severity score is not associated with poorer outcome scores and has minimal effect on ROM. However, patients with the largest osteophytes (≥2 mm) did have slightly worse pain postoperatively. Radiographic presence of high-stage ACJ arthritis should not alter the decision to undergo rTSA.
UNASSIGNED: We conducted a retrospective review of a prospectively collected shoulder arthroplasty database of patients that underwent primary rTSA with a minimum 2-year clinical follow-up. Imaging studies of included patients were evaluated to assess ACJ arthritis classified by radiographic degenerative changes of the ACJ; severity was based upon size and location of osteophytes. Both the Petersson classification and the King classification (a modified Petersson classification addressing superior osteophytes and size of the largest osteophyte) were used to evaluate the severity of degenerative ACJ radiographic changes. Severe ACJ arthritis was characterized by large osteophytes (≥2 mm). Active range of motion (ROM) in abduction, forward elevation, and external and internal rotation as well as clinical outcome scores (American Shoulder and Elbow Surgeons Shoulder, Constant, Shoulder Pain and Disability Index, simple shoulder test, University of California, Los Angeles scores) were assessed both preoperatively and at the latest follow-up; outcomes were compared based on severity of ACJ arthritis. Multivariable linear regression models were used to determine whether increasing severity of ACJ arthritis was associated with poorer outcomes.
UNASSIGNED: A total of 341 patients were included with a mean age of 71 ± 8 years and 55% were female. The mean follow-up was 5.1 ± 2.4 years. Preoperatively, there were no differences in outcomes based on the severity of ACJ pathology. Postoperatively, there were no differences in outcomes based upon the severity of ACJ arthritis except for greater preoperative to postoperative improvement in active internal rotation in patients with normal or grade 1 ACJ arthritis vs. grade 2 and 3 (3 ± 2 vs. 1 ± 2 and 1 ± 3, P = .029). Patients with ACJ arthritis and osteophytes ≥2 mm had less favorable Shoulder Pain and Disability Index scores, corresponding to greater pain (-49.3 ± 21.5 vs. -41.3 ± 26.8, P = .015). On multivariable linear regression, increased severity of ACJ arthritis was not independently associated with poorer postoperative ROM or outcome scores.
UNASSIGNED: Overall, our results demonstrate that greater ACJ arthritis severity score is not associated with poorer outcome scores and has minimal effect on ROM. However, patients with the largest osteophytes (≥2 mm) did have slightly worse pain postoperatively. Radiographic presence of high-stage ACJ arthritis should not alter the decision to undergo rTSA.
摘要：
■尽管肩锁关节（ACJ）在头顶肩运动期间发生了大量运动，ACJ关节炎对反向全肩关节置换术(rTSA)患者术后结局的影响尚不清楚.我们评估了ACJ关节炎的影响，由退化的射线照相变化定义，及其严重程度对原发性rTSA后临床结局的影响。
■我们对前瞻性收集的肩关节置换术数据库进行了回顾性分析，该数据库的患者接受了至少2年的临床随访。对纳入患者的影像学研究进行了评估，以评估ACJ关节炎，根据ACJ的影像学退行性变化进行分类；严重程度取决于骨赘的大小和位置。Petersson分类和King分类（针对上骨赘和最大骨赘大小的改良Petersson分类）均用于评估退行性ACJ影像学变化的严重程度。严重的ACJ关节炎以巨大的骨赘（≥2mm）为特征。绑架活动范围(ROM)，向前高程,以及外部和内部旋转以及临床结果评分(美国肩肘外科医生肩关节，常数,肩痛和残疾指数，简单的肩膀测试，加州大学,洛杉矶评分）在术前和最新随访中进行评估；根据ACJ关节炎的严重程度比较结果。使用多变量线性回归模型来确定ACJ关节炎严重程度的增加是否与较差的预后相关。
■共纳入341例患者，平均年龄71±8岁，55%为女性。平均随访时间为5.1±2.4年。术前,根据ACJ病理的严重程度,结局无差异.术后,根据ACJ关节炎的严重程度，结果没有差异，除了正常或1级ACJ关节炎患者的积极内旋与术前术后改善更大。2级和3级(3±2vs.1±2和1±3，P=.029）。ACJ关节炎和骨赘≥2mm的患者肩痛和残疾指数评分较差，对应于更大的疼痛(-49.3±21.5vs.-41.3±26.8，P=.015）。关于多元线性回归，ACJ关节炎严重程度的增加与术后ROM或结局评分较差无关.
■总的来说，我们的结果表明,ACJ关节炎严重程度评分越高,结局评分越低,对ROM的影响越小.然而,骨赘最大(≥2mm)的患者术后疼痛轻微加重.放射学上高阶段ACJ关节炎的存在不应改变接受rTSA的决定。
■我们对前瞻性收集的肩关节置换术数据库进行了回顾性分析，该数据库的患者接受了至少2年的临床随访。对纳入患者的影像学研究进行了评估，以评估ACJ关节炎，根据ACJ的影像学退行性变化进行分类；严重程度取决于骨赘的大小和位置。Petersson分类和King分类（针对上骨赘和最大骨赘大小的改良Petersson分类）均用于评估退行性ACJ影像学变化的严重程度。严重的ACJ关节炎以巨大的骨赘（≥2mm）为特征。绑架活动范围(ROM)，向前高程,以及外部和内部旋转以及临床结果评分(美国肩肘外科医生肩关节，常数,肩痛和残疾指数，简单的肩膀测试，加州大学,洛杉矶评分）在术前和最新随访中进行评估；根据ACJ关节炎的严重程度比较结果。使用多变量线性回归模型来确定ACJ关节炎严重程度的增加是否与较差的预后相关。
■共纳入341例患者，平均年龄71±8岁，55%为女性。平均随访时间为5.1±2.4年。术前,根据ACJ病理的严重程度,结局无差异.术后,根据ACJ关节炎的严重程度，结果没有差异，除了正常或1级ACJ关节炎患者的积极内旋与术前术后改善更大。2级和3级(3±2vs.1±2和1±3，P=.029）。ACJ关节炎和骨赘≥2mm的患者肩痛和残疾指数评分较差，对应于更大的疼痛(-49.3±21.5vs.-41.3±26.8，P=.015）。关于多元线性回归，ACJ关节炎严重程度的增加与术后ROM或结局评分较差无关.
■总的来说，我们的结果表明,ACJ关节炎严重程度评分越高,结局评分越低,对ROM的影响越小.然而,骨赘最大(≥2mm)的患者术后疼痛轻微加重.放射学上高阶段ACJ关节炎的存在不应改变接受rTSA的决定。
