Ayane Rossano1, Nivethitha Manohar2, Wouter J Veenendaal3, Michel P J van den Bekerom3,4, David Ring1, Amirreza Fatehi1. 1. Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Health Discovery Building 1701 Trinity St. Austin, TX, 78712, USA. 2. Paul L. Foster School of Medicine, Texas Tech University Health Science Center, 5001 El Paso Dr, El Paso, TX, 79905, USA. 3. OLVG, Shoulder and Elbow Unit, Oosterpark 9, 1091, AC, Amsterdam, Netherlands. 4. Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, De Boelelaan 1105, 1081, HV, Amsterdam, Netherlands.
Abstract
Objective: Radiographic osteoarthritis of the acromioclavicular joint (ACJ OA) is a common incidental finding and an uncommon reason for people to seek care for shoulder symptoms. We reviewed the published evidence regarding the age-specific prevalence of ACJ OA to establish the base rate of pathophysiology. Methods: A total of 10 studies including 1831 shoulders met our criteria. A pooled analysis was done to obtain a proportion of subjects with ACJ OA across age categories. Results: Forty-eight percent of 953 cadaver and skeletal specimens and 70% of 210 MRI images of asymptomatic shoulders were found to have changes consistent with ACJ OA. Four studies reporting age as a continuous variable found a statistically significant association between older age and prevalence of ACJ OA. Conclusions: The observation that ACJ OA is highly prevalent as humans age establishes a very high base rate of what one can infer is well-accommodated disease. Given that a high base rate of incidental disease creates a low pre-test odds that radiological findings of disease correspond with symptoms, diagnosis of symptomatic ACJ OA is subject to substantial inaccuracy and should be made sparingly, mindful of the potential harms of a diagnosis that can lead to an ablative surgery.
Objective: Radiographic osteoarthritis of the acromioclavicular joint (ACJ OA) is a common incidental finding and an uncommon reason for people to seek care for shoulder symptoms. We reviewed the published evidence regarding the age-specific prevalence of ACJ OA to establish the base rate of pathophysiology. Methods: A total of 10 studies including 1831 shoulders met our criteria. A pooled analysis was done to obtain a proportion of subjects with ACJ OA across age categories. Results: Forty-eight percent of 953 cadaver and skeletal specimens and 70% of 210 MRI images of asymptomatic shoulders were found to have changes consistent with ACJ OA. Four studies reporting age as a continuous variable found a statistically significant association between older age and prevalence of ACJ OA. Conclusions: The observation that ACJ OA is highly prevalent as humans age establishes a very high base rate of what one can infer is well-accommodated disease. Given that a high base rate of incidental disease creates a low pre-test odds that radiological findings of disease correspond with symptoms, diagnosis of symptomatic ACJ OA is subject to substantial inaccuracy and should be made sparingly, mindful of the potential harms of a diagnosis that can lead to an ablative surgery.
Authors: Pierre Métais; David Gallinet; Ludovic Labattut; Arnaud Godenèche; Johannes Barth; Philippe Collin; Nicolas Bonnevialle; Jérôme Garret; Philippe Clavert Journal: Orthop Traumatol Surg Res Date: 2020-09-14 Impact factor: 2.256
Authors: Egbert J D Veen; Cornelia M Donders; Robin E Westerbeek; Rosalie P H Derks; Ellie B M Landman; Cornelis T Koorevaar Journal: J Shoulder Elbow Surg Date: 2018-02-28 Impact factor: 3.019
Authors: Nathan A Mall; Emily Foley; Peter N Chalmers; Brian J Cole; Anthony A Romeo; Bernard R Bach Journal: Am J Sports Med Date: 2013-05-06 Impact factor: 6.202