Editorial Commentary: Lateral Acromioplasty Is Clinically Safe and Has the Potential to Reduce the Risk for Rotator Cuff Re-tears

Abstract

The critical shoulder angle and lateral acromioplasty are areas of controversy that are being studied in association with rotator cuff tears both as potential pathogenic variables and as surgically modifiable variables that could improve clinical outcomes. Current clinical evidence regarding the effectiveness and potential benefit of lateral acromioplasty support the hypothesis that modification of the bony anatomy may influence the integrity of the rotator cuff.

Influence of Radiographic Parameters on Reduction of the Critical Shoulder Angle With Arthroscopic Lateral Acromioplasty—A Mathematical Model

“… 13 , 14 Thus, reduction of a large CSA to a “favorable” range of 30° to 34° may potentially prevent progression of rotator cuff tears or protect rotator cuff repair from re-tear. 15 Furthermore, subacromial spurs and sclerosis of the greater tuberosity are commonly encountered in shoulders with rotator cuff tears. 16 , 17 , 18 A subacromial osteophyte may enlarge the CSA and should therefore be included in measurement and therapy.…”

No Indications for Subacromial Decompression in Rotator Cuff Tendinopathy: A Level I Evidence Clinical Guideline

“…3 Although the first results of changing the CSA have been published, we still do not know if changing the CSA is really beneficial in treating rotator cuff pain in the long term. 4,5 From recent placebo-controlled randomized trials and the BMJ Guideline, we can conclude that even sham surgery in patients with rotator cuff pain will lead to improvement in shoulder function. 6 Jones et al 7 recently concluded that high-quality randomized trials are needed before widespread adoption of promising operative procedures so as to avoid overtreatment and wasted resources.…”

“…1 In their letter to the editor, van den Bekerom and Poolman 2 argue strongly against SAD and referenced several published trials in support. [3][4][5][6] We agree that there is no current and strong evidence to either support SAD or nonoperative treatment. In the introduction, we have clearly stated that credible, reliable, reproducible, and valid evidence is required.…”

“…Therefore, surgeons have to rely on clinical judgment and careful patient selection. van den Bekerom and Poolman 2 have based their opinion on a recently published metaanalysis 4 and a randomized trial investigating failures in both surgical and nonoperative treatment. 6 The meta-analysis of Karjalainen et al 4 included 8 studies and concluded that SAD does not provide clinically important benefits over placebo; however, due to the imprecision of results, the certainty of evidence was downgraded to moderate.…”

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

“… 27 , 50 Some authors suggested removing 5 or 10 mm of the lateral aspect of the acromion, solely in patients at high risk of retear (severe tendinopathy, thickness tear >50%) or those with large critical shoulder angles (ie, CSAs >35°). 28 , 35 Recent studies 20 , 33 criticized the use of such thresholds, arguing that small variations in patient position could significantly change the CSA on anteroposterior radiographs, and that in some cases acromioplasty may not decrease the CSA at all.…”