Building upon previous work by Codman and Akerson, researchers have implicated the anterior acromion in the pathogenesis of what Neer initially described as chronic impingement syndrome. It was hypothesized that excrescences on the acromion caused mechanical impingement on the rotator cuff, resulting in rotator cuff injury and attrition. Neer discussed the role of performing acromioplasty, with and without rotator cuff repair, to smooth the area of contact over the supraspinatus tendon and decrease mechanical wear.

Arthroscopic Acromioplasty

Open acromioplasty developed into a viable treatment option for impingement syndrome as a primary treatment or as an adjunct to subacromial decompression. As modern arthroscopic techniques evolved, Ellman developed a technique for an arthroscopic anterior acromioplasty. Advantages of the arthroscopic approach are that it allows a more thorough evaluation of the glenohumeral joint, treatment of intra-articular injuries, improved cosmesis, preservation of the deltoid origin, and quicker postoperative rehabilitation. Because of these factors, arthroscopic acromioplasty is being performed with increasing frequency. A recent randomized controlled trial, however, suggested that arthroscopic acromioplasty showed no significant benefit compared with a supervised and structured exercise program for the treatment of subacromial impingement.

Arthroscopic Rotator Cuff Repair With and Without Acromioplasty

Acromioplasty is commonly performed concomitantly with rotator cuff repair if the acromion is believed to be a source of mechanical wear on the rotator cuff. There have been no high-level investigations, however, that demonstrate an improved clinical outcome with acromioplasty at the time of rotator cuff repair. Despite this, the incidence of acromioplasty at the time of rotator cuff repair has significantly increased recently. The purpose of this study was to evaluate short-term functional outcomes of patients undergoing arthroscopic rotator cuff repair with and without acromioplasty. The null hypothesis was that no difference in clinical outcomes would be found after arthroscopic repair of full-thickness rotator cuff tears in patients with or without concomitant acromioplasty.

Full Article: Arthroscopic Repair of Full-Thickness Rotator Cuff Tears With and Without Acromioplasty