Open Anterior Acromioplasty Research Articles

Open anterior acromioplasty with preservation of the coracoacromial ligament: A modified surgical technique

The importance of the preservation of the subacromial arch has been stressed recently, especially in irreparable lesions of the rotator cuff to prevent anterosuperior migration of the humeral head. The purpose of this article is to describe the surgical technique of a modified open anterior acromioplasty performed through an intra-acromial osteotomy that increases the subacromial space and preserves the insertion of the coracoacromial ligament on the undersurface of the acromion. To compare this new technique with classical acromioplasty, a prospective but nonrandomized study was performed including 20 patients undergoing open anterior acromioplasty and 22 patients undergoing a modified open anterior acromioplasty. At a mean follow-up of 18 months, no differences related to shoulder function as evaluated by the Constant score were found between these two groups. This modified acromioplasty increases the subacromial space, preserving the anatomy of the subacromial arch, and provides functional results as good as those obtained with classical open acromioplasty. (J Shoulder Elbow Surg 2003;12:9-14)

The use of a polished dessert spoon during open anterior acromioplasty

The technique of open anterior acromioplasty is well recognized for the treatment of patients with chronic impingement syndrome. We describe a modification to the technique with a polished dessert spoon.

Arthroscopically assisted mini-openrotator cuff repair

Although open anterior acromioplasty and rotator cuff repair has reliably provided satisfactory results for several decades, efforts are continually being made to improve on these results. Arthroscopically assisted mini-open rotator cuff repair provides the advantages of arthroscopic glenohumeral inspection and identification and treatment of any concomitant lesions, deltoid origin preservation (with the arthroscopic subacromial decompression), decreased surgical morbidity, and improved cosmesis. In addition, this procedure can reliably be performed as an outpatient procedure and may allow accelerated postoperative rehabilitation. This report outlines the rationale and technique for this surgical approach, which may be used for the repair of significant partial-thickness tears and small to medium-sized full-thickness tears. Also, it requires èxperience and expertise in shoulder arthroscopy and arthroscopic subacromial decompression.

Arthroscopic subacromial decompression: Two- to seven-year follow-up

Arthroscopic subacromial decompression (ASD) was performed in 88 patients (90 shoulders) with stage II or early III impingement syndrome of the shoulder unresponsive to nonoperative treatment. The purpose of this retrospective study was to evaluate the follow-up an average of 41 months (range 24 to 82 months) after surgery. We wished to compare results in (1) patients with and without rotator cuff tears, (2) in athletes and nonathletes, and (3) in throwers and nonthrowers. Patients were evaluated by (1) Neer's Criteria for Satisfactory Result, (2) the UCLA Shoulder RAting Scale, (3) the Shoulder and Elbow Surgeons Rating Scale, (4) a detailed questionnaire, and (5) patient satisfaction. In the follow-up group (n = 90), 80% met Neer's criteria for satisfactory result; 94% had satisfactory results by the UCLA Shoulder Scale; 95% had a satisfactory result by the Shoulder and Elbow Society Scale; and 93% of shoulder patients expressed satisfaction at follow-up. There were no statistically significant differences in function between the group without rotator cuff tear (n = 47) and the group with rotator cuff tear (n = 43). Satisfactory results were obtained in 68% of throwing athletes and in 90% of nonthrowing athletes ( P < .05) by the Neer Rating, whereas only 50% of competitive baseball and softball pitchers had satisfactory results. Out impression is that ASD is an acceptable alternative to open anterior acromioplasty with comparable results for the treatment of the impingement lesion. There were no differences in result in patients who had a partial rotator cuff tear and those who had no tear. Throwing athletes do not have as good a prognosis to maintain high-caliber painfree shoulder activities as do nonthrowing athletes.

Complications and failures of open and arthroscopic acromioplasties

Controversy exists over the optimal method of surgical treatment for chronic impingement refractory to conservative treatment. Success comparable with the “gold standard” open anterior acromioplasty has been reported using arthroscopic techniques, but failures and complications have been reported with both modes of operative intervention. Overall, the percentage of satisfactory results differs only slightly by approach, and the causes of failure can be divided into three categories: (1) diagnostic failures, (2) treatment failures, and (3) complications. The keys to obtaining a successful result are making the correct diagnosis and performing a technically sound procedure while avoiding complications. This issue is of importance, because operative treatment of patients with failed acromioplasties offers inferior results to primary acromioplasty.

Open anterior acromioplasty

Anterior acromioplasty is known to be an effective surgical treatment for subacromial impingement syndrome in those patients who do not respond to nonoperative treatment. The operative procedure, consisting of enlarging the supraspinatus “outlet” through which the musculotendinous cuff must pass, has a proven track record and has a high degree of success in relieving pain, improving function, and restoring the patient to preoperative level of activity.In those patients undergoing open anterior acromioplasty, the goals of surgery continue to be preservation of deltoid origin, adequate exposure so that satisfactory decompression can be performed, and adequate access to the rotator cuff so that associated pathology can be identified and corrected.

Arthroscopic subacromial decompression: Results in advanced impingement syndrome

A study group composed of 25 shoulders in 24 patients underwent arthroscopic subacromial decompression for advanced impingement syndrome. There were no full thickness rotator cuff tears, biceps tendon ruptures, significant acromioclavicular arthrosis, or evidence of glenohumeral instability. Twenty men and four women ranging in age from 18 to 63 years (mean age 37) with dominant arm involvement in 17/24 were evaluated for an average follow-up of 20.3 months (range 14–32) postoperatively. Operative results were based on the UCLA shoulder rating scale. Eighty-eight percent of the cases (22/25) had good or excellent results. Twelve percent had fair results (3/25). There were no poor results. The average UCLA pain score improved from 2.6 preoperative (constant pain) to 7.8 postoperative (occasional pain). Ninety-two percent of the patients were satisfied, said they were better, and that they would have the surgery again. Arthroscopic subacromial decompression is recommended as an alternative to open anterior acromioplasty in advanced impingement syndrome.

Shoulder arthroscopy: current indications and techniques.

The role of arthroscopy in the diagnosis and treatment of shoulder disorders is evolving. Arthroscopic subacromial decompression is an alternative to open anterior acromioplasty in the treatment of chronic stage II impingement syndromes prior to the development of full thickness rotator cuff tear. Patients with massive and otherwise unrepairable cuff tears have achieved significant pain relief from arthroscopic decompression and debridement of the floppy and irregular cuff margins. Routine repairable full thickness cuff tears are best treated by open reconstruction. The arthroscope is an adjunct in confirming the diagnosis and direction of shoulder instability. Arthroscopic stabilization is most feasible when the anterior glenohumeral ligament/labral complex is detached. The introduction of a metal staple is controversial, however, reported complications are diminishing with experience. Alternate methods of stabilization are being investigated. Effective arthroscopic techniques have been established for the removal of loose bodies, the treatment of calcific tendinitis, septic arthritis, and other disorders. Shoulder arthroscopy will undoubtedly achieve an appropriate place in the armamentarium of the orthopedic surgeon.

Arthroscopic subacromial decompression: Analysis of one- to three-year results

Arthroscopic subacromial decompression (ASD) is a method of performing anterior acromioplasty utilizing basic arthroscopic techniques. The procedure is indicated in cases of chronic impingement syndrome that have failed to respond to prolonged conservative management. The purpose of this study is to present an analysis of the 1- to 3-year follow-up results of the initial 50 consecutive cases of ASD that I have performed. Forty (80%) of the cases had advanced stage II impingement without rotator cuff tear. Ten (20%) had full-thickness tears of the rotator cuff. Patients were evaluated pre and postoperatively on the UCLA Shoulder Rating Scale, which includes an assessment of pain, function, range of motion (ROM), strength, and patient satisfaction. Eighty-eight percent of the cases were rated "satisfactory" (excellent or good), and 12% were rated "unsatisfactory" (fair or poor). The procedure is technically demanding, and to achieve a satisfactory result the criteria of open anterior acromioplasty must be met. Arthroscopic subacromial decompression is presented as an alternative to open anterior acromioplasty in advanced stage II and selected cases of stage III impingement syndrome.