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Training affects clavicle excision technique for AC joint arthritis
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Newly trained, board-eligible orthopedic surgeons were more likely to perform arthroscopic distal clavicle excision compared to open treatment for acromioclavicular joint arthritis, according to results published in Arthroscopy.
“Incidence of open distal clavicle excision has declined among newly trained, board-eligible orthopedic surgeons, possibly due to an increased complication rate with open (vs. arthroscopic) excision,” Dean Wang, MD, co-author of the study, told Healio.com/Orthopedics. “This procedure can be done effectively through [a] modern arthroscopic technique.”
Using the American Board of Orthopaedic Surgery database to find cases submitted by candidates taking part 2 of the board examination, Wang and colleagues analyzed the performance of either open (n=3,229) or arthroscopic (n=12,782) distal clavicle excision among patients with acromioclavicular joint arthritis to determine trends in annual incidence, complication rates and surgeon fellowship training.
Results showed a decrease in the overall annual incidence of open distal clavicle excision from April 2004 to September 2013. Although the annual number of arthroscopic distal clavicle excisions remained steady, researchers found an increase in the percentage of distal clavicle excisions performed arthroscopically. The open approach was more likely to be performed by surgeons without fellowship training, while the arthroscopic approach was more likely to be performed by surgeons with sports medicine training.
Compared with arthroscopic distal clavicle excision, researchers noted a higher surgical complication rate overall among patients who underwent open distal clavicle excision. Whether performing open or arthroscopic distal clavicle excision, results showed sports medicine surgeons had a lower reported surgical complication rate compared with other fellowship-trained surgeons. – by Casey Tingle
Disclosures: Wang reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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Sanjeev Bhatia, MD
The American Board of Orthopaedic Surgery database is helpful in identifying trends and practice patterns of incoming orthopedic surgeons. In this study, the authors noted that newly minted orthopedic surgeons sitting for part II of their orthopedic surgery boards chose to perform arthroscopic distal clavicle excision at a higher frequency than open distal clavicle resection as the study period progressed.
The increased preference for arthroscopic distal clavicle resection over open resection is not surprising. Over the last 10 years, the arthroscopic technique has been widely taught in sports medicine fellowships, residencies and through courses sponsored by the Arthroscopy Association of North America and American Orthopaedic Society for Sports Medicine. As such, most residents and fellows are technically proficient in the arthroscopic technique, including the pearls and common pitfalls.
We must caution that there are several limitations to this study, particularly as it pertains to interpreting the complications. In this study, open distal clavicle procedures were noted to have a slightly higher complication rate. As the authors correctly point out, the American Board of Orthopaedic Surgery (ABOS) data do not allow distinction between complications attributed to distal clavicle resection and other procedures that were concomitantly performed. Additionally, the complications reported for ABOS purposes are often nonspecific, which also limits interpretation.
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