Acromioplasty during repair of rotator cuff tears removes only half of the impinging acromial bone

Abstract

Background To date, there is no consensus on when and how to perform acromioplasty during rotator cuff repair (RCR). We aimed to determine the volume of impinging bone removed during acromioplasty and whether it influences postoperative range of motion (ROM) and clinical scores after RCR. Methods Preoperative and postoperative computed tomography scans of 57 shoulders that underwent RCR were used to reconstruct scapula models to simulate volumes of impinging acromial bone preoperatively and then compare them to the volumes of bone resected postoperatively to calculate the proportions of desired (ideal) vs. unnecessary (excess) resections. All patients were evaluated preoperatively and at 6 months to assess ROM and functional scores. Results The volume of impinging bone identified was 3.5 ± 2.3 cm 3 , of which 1.6 ± 1.2 cm 3 (50% ± 27%) was removed during acromioplasty. The volume of impinging bone identified was not correlated with preoperative critical shoulder angle ( r = 0.025, P = .853), nor with glenoid inclination ( r = −0.024, P = .857). The volume of bone removed was 3.7 ± 2.2 cm 3 , of which 2.1 ± 1.6 cm 3 (53% ± 24%) were unnecessary resections. Multivariable analyses revealed that more extensive removal of impinging bone significantly improved internal rotation with the arm at 90° of abduction (beta, 27.5, P = .048) but did not affect other shoulder movements or clinical scores. Conclusions Acromioplasty removed only 50% of the estimated volume of impinging acromial bone. More extensive removal of impinging bone significantly improved internal rotation with the arm at 90° of abduction.

Aquatic therapy following arthroscopic rotator cuff repair enables faster improvement of Constant score than land‐based therapy or self‐rehabilitation therapy

“…The arthroscopic procedure was performed using suture anchors (Mitek Healix 4.5 mm mounted with two Orthocord sutures), as well as knotless anchors for double-row fixation (Mitek Healix 5.5 mm knotless). A systematic partial bursectomy was carried out, as well as acromioplasty in cases with impingement or an offending spur [ 15 , 16 ] but was limited to smoothing the bone spurs. A footprint was created and was limited to the repair size by performing gentle and superficial burring using a 5 mm Arthrex Bone Cutter.…”

Proper Indications for Shoulder Subacromial Decompression Result in Excellent Outcomes

“…However, the role of acromioplasty in 2021 is still not clearly defined. [8][9][10] Some have argued that gliding of the rotator cuff under the acromiohumeral arch is probably part of human evolution, since we stand erect to compensate the deficiency of the superior rotator cuff. 11,12 Similarly to Ulysses, 150 years after the initial description of Duplay and a tumultuous journey, subacromial impingement has in some respects returned to its starting position (Fig 1).…”

Traumatic and Atraumatic Rotator Cuff Tears Have the Same Rates of Healing

“… 31 Tenodesis or tenotomy of the long head of the biceps was systematically performed. Adjuvant acromioplasty was performed in patients who had radiographic signs of dynamic impingement or to improve visualization, 32 , 33 , 34 and resection of the distal section of the clavicle was performed when pain was elicited by palpation of the acromioclavicular joint. At the end of the intervention, all RCRs were complete and “watertight,” with adequate restoration of the tendons to their footprints.…”