Trends in the Surgical Management of Acromioclavicular Joint Arthritis Among Board-Eligible US Orthopaedic Surgeons.

Autor:	Amirtharaj MJ; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A., Wang D; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A.. Electronic address: deanwangmd@gmail.com., McGraw MH; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A., Camp CL; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A., Degen RA; Fowler Kennedy Sports Medicine Clinic, Western University, London, Ontario, Canada., Dines DM; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A., Dines JS; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A.
Jazyk:	angličtina
Zdroj:	Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association [Arthroscopy] 2018 Jun; Vol. 34 (6), pp. 1799-1805. Date of Electronic Publication: 2018 Feb 21.
DOI:	10.1016/j.arthro.2018.01.024
Abstrakt:	Purpose: (1) Define the epidemiologic trend of distal clavicle excision (DCE) for acromioclavicular (AC) joint arthritis among board-eligible orthopaedic surgeons in the United States, (2) describe the rates and types of reported complications of open and arthroscopic DCE, and (3) evaluate the effect of fellowship training on preferred technique and reported complication rates. Methods: The American Board of Orthopaedic Surgery (ABOS) database was used to identify DCE cases submitted by ABOS Part II Board Certification examination candidates. Inclusion criteria were predetermined using a combination of ICD-9 and CPT codes. Cases were dichotomized into 2 groups: open or arthroscopic DCE. The 2 groups were then analyzed to determine trends in annual incidence, complication rates, and surgeon fellowship training. Results: From April 2004 to September 2013, there were 3,229 open and 12,782 arthroscopic DCE procedures performed and submitted by ABOS Part II Board Eligible candidates. Overall, the annual incidence of open DCE decreased (78-37 cases per 10,000 submitted cases, P = .023). Although the annual number of arthroscopic DCE remained steady (1160-1125, P = .622), the percentage of DCE cases performed arthroscopically increased (65%-79%, P = .033). Surgeons without fellowship training were most likely to perform a DCE via an open approach (31%) whereas surgeons with sports medicine training were more likely to perform DCE arthroscopically compared with other fellowship groups (88%, P < .001). Open DCE was associated with a higher surgical complication rate overall when compared with arthroscopic DCE (9.4% vs 7.6%, respectively; P < .001). When compared with other fellowship-trained surgeons, sports medicine surgeons maintained a lower reported surgical complication rate whether performing open or arthroscopic DCE (5.5%, P = .027). Conclusions: In recent years, open management of AC joint arthritis has declined among newly trained, board-eligible orthopaedic surgeons, possibly because of an increased complication rate associated with open treatment. Fellowship training was significantly associated with the type of treatment (open vs arthroscopic) rendered and complication rates. Level of Evidence: Level IV, case series. (Copyright © 2018 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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