Abstract
Introduction
Distal clavicle excision (DCE) is commonly performed with rotator cuff repair (RCR) for symptomatic acromioclavicular (AC) joint pathology. While the indications and outcomes of RCR and DCE are well established, the influence of concomitant cervical spine pathology on shoulder pain, surgical decision-making, and postoperative outcomes remains incompletely understood. This study evaluated the association between cervical spine pathology and surgery with outcomes related to AC joint pain, DCE, and RCR using the TriNetX database.
Methods
A retrospective cohort study was performed using the TriNetX database from 2015–2025. Patients older than 18 years and alive at analysis were included. The postoperative window for all outcomes was at least 1 day following surgery. To reduce confounding, propensity score matching was performed using age at index event and baseline comorbidities including diabetes mellitus, hypertension, and tobacco use, with three independent matched cohort analyses conducted.
The first analysis compared rates of DCE and postoperative AC joint pain in patients undergoing RCR with and without preexisting cervical spine pathology, identified using ICD-10 code M50 series, not requiring a clinical encounter for diagnosis. Postoperative AC joint pain was identified using ICD-10 code M25.51 series. The second analysis evaluated rates of subsequent cervical spine surgery following RCR in patients with and without concomitant DCE; cervical spine surgery included anterior cervical decompression and fusion, total disc replacement, and posterior extradural laminotomy or foraminotomy. The third analysis assessed rates of subsequent RCR and DCE following shoulder arthroscopy in patients with and without cervical spine pathology.
Results
Matched cohorts included 16,266 patients per group in the first analysis, 28,172 per group in the second, and 25,181 per group in the third. Patients with cervical spine pathology demonstrated significantly higher rates of AC joint pain following RCR (62.70% vs 56.19%; RR 1.12, 95% CI 1.10–1.14; P 0.0001). There was no difference in rates of DCE following RCR (2.89% vs 2.56%; RR 1.13, 95% CI 0.99–1.28; P = 0.0712). Patients undergoing DCE at the time of RCR had a minimally increased risk of subsequent cervical spine surgery compared with RCR alone (1.12% vs 0.88%; RR 1.26, 95% CI 1.07–1.49; P = 0.066). Patients with preexisting cervical spine pathology had increased rates of DCE (3.05% vs 2.68%; RR 1.14, 95% CI 1.03–1.26; P = 0.01) following shoulder arthroscopy. There was no difference in subsequent RCR (6.91% vs 6.62%; RR 1.04, 95% CI 0.98–1.11; P = 0.21).
Conclusion
In patients undergoing RCR, preexisting cervical spine pathology was associated with increased postoperative AC joint pain with no significant influence on rate of DCE. Patients who underwent RCR with concomitant DCE had higher rates of subsequent cervical spine surgery. Preexisting cervical spine pathology was associated with increased rates of DCE following shoulder arthroscopy, but did not influence rates of RCR. These findings suggest that underlying cervical spine pathology may be associated with persistent or overlapping shoulder symptoms in patients who undergo RCR and should be considered during patient evaluation, surgical decision-making, and preoperative counseling.