Clinical results and complications following surgical management of symptomatic os acromiale: a systematic review

Abstract

BackgroundThis review compares the outcomes and complication rates of three surgical strategies used for the management of symptomatic os acromiale. The purpose of this study was to help guide best practice recommendations.MethodsA systematic review of nine prospective studies, seven retrospective studies, and three case studies published across ten countries between 1993 and 2018 was performed. Adult patients (i.e., ≥ 18 years of age) with a symptomatic os acromiale that failed nonoperative management were included in this review. Surgical techniques utilized within the included studies include excision, acromioplasty, and open reduction and internal fixation (ORIF). The primary outcomes of interest included patient satisfaction. Range of motion and several standardized outcome measurement tools were also included in the final analysis.ResultsPatient satisfaction was highest in the excision and ORIF groups, with 92% and 82% of patients reporting good to excellent postoperative results, respectively, compared to 63% in the acromioplasty group. All three patient groups experienced improvements in postoperative outcomes (i.e., active range of motion and patient-reported outcome scores). The excision group experienced a complication rate of 1%, while the acromioplasty group experienced a complication rate of 11% and the ORIF group a rate of 67%.ConclusionThis study reports on the largest sample of patients who underwent surgical treatment for a symptomatic os acromiale. We have demonstrated that excision of the os with meticulous repair of the deltoid resulted in the best clinical outcomes with the least complications. In healthy adult patients with a large os fragment and a normal rotator cuff, surgical fixation may provide increased preservation of deltoid function while offering good to excellent patient satisfaction. However, patients must be informed that a second procedure may be required to remove symptomatic hardware.

Os acromiale: prevalence and associated patient-related factors—a population-based study of three thousand and fifty participants

“…Given that stable and asymptomatic os acromiale can become unstable and symptomatic due to trauma or surgical interventions, e.g., subacromial decompression [ 32 , 33 ], it is crucial to be aware of potential os acromiale before surgery. In addition, the os acromiale can be a cause of shoulder pain itself due to inflammation at the pseudarthrosis, dynamic subacromial impingement, or arthrosis [ 24 , 25 ]. Therefore, it is of clinical relevance to recognize os acromiale and be aware of its prevalence.…”

“…However, sometimes os acromiale is a possible cause for pain [ 23 ]. There are different theories about the pathogenesis of symptomatic os acromiale: an inflammation at the pseudarthrosis, an unstable os acromiale leading to dynamic subacromial impingement, or arthritic degeneration due to hypermobility of the unfused bone [ 24 , 25 ]. Regarding treatment of symptomatic os acromiale, there is no consensus until today.…”

Reverse shoulder arthroplasty with os acromiale

“…Os acromiale can be treated conservatively in asymptomatic cases or with surgery in cases with symptoms. Surgery is mainly comprised of excision, acromioplasty, and fixation [ 2 , 7 ]. Though no direct connection with rotator cuff tear has been demonstrated [ 1 ], some have argued that the lateral fragment of the os acromiale can be downsloped and cause impingement [ 8 ].…”

Os Acromiale-unusual Manifestation as Superior Spur and Bursitis-A Case Report

“…The observed higher patient satisfaction results in excision and ORIF group compared to acromioplasty group. Highest complication rate was noted in ORIF group with a need for second elective procedure for removal of hardware [26]. Fragment excision has been reported to have complication of deltoid weakness [27].…”