Predictive role of chronic pain and injection response profile in postoperative dissatisfaction following arthroscopic distal clavicle resection

Arthroscopic distal clavicle resection (ADCR) is the standard surgical treatment for symptomatic acromioclavicular (AC) joint osteoarthritis unresponsive to conservative therapy. However, a proportion of patients remain dissatisfied despite objectively favorable outcomes. We aimed to evaluate whether chronic symptom duration and the brevity of pain relief following diagnostic corticosteroid injection could serve as preoperative predictors of postoperative dissatisfaction. This retrospective monocentric study included 35 consecutive patients who underwent ADCR between 2017 and 2022. The primary endpoint was functional satisfaction at 6 months, defined by a QuickDASH improvement of ≥20 points combined with a visual analog scale (VAS) score ≤3. Two preoperative variables—symptom duration >12 months and post-injection pain relief <15 days—were assessed via univariate analysis and then entered into a bivariate logistic regression model. Model performance was evaluated using the area under the ROC curve (AUC) and the Hosmer–Lemeshow goodness-of-fit test. The mean age was 55.4 ± 10.0 years. At 6 months, 28 patients (80 %) were classified as satisfied, and 7 (20 %) as dissatisfied. Symptom chronicity and brief post-injection relief were associated with higher odds of dissatisfaction (OR = 1.45 and 1.72, respectively), although neither reached statistical significance. The regression model showed modest discrimination (AUC = 0.59) and adequate calibration, but with limited statistical power (<80 %). All functional scores (QuickDASH, VAS, and Constant score) improved significantly postoperatively (p < 0.001). Chronic symptom duration and short-lived corticosteroid injection response may represent simple clinical markers associated with postoperative dissatisfaction following ADCR. While their predictive strength remains inconclusive, incorporating these factors into the preoperative assessment could contribute to more tailored surgical decision-making. IV (Retrospective Case Series).