Clinical Faceoff: What is the Role of Acromioplasty in the Treatment of Rotator Cuff Disease?

Rotator Cuff Repair With or Without Acromioplasty: A Systematic Review of Randomized Controlled Trials With Outcomes Based on Acromial Type

BACKGROUND

It is unclear whether the use of concomitant acromioplasty during rotator cuff repair (RCR) improves clinical outcomes and whether the outcomes are affected by acromial type.

PURPOSE

To perform a systematic review of randomized controlled trials comparing clinical outcomes of RCR with and without acromioplasty, with a subanalysis of outcomes based on acromial type.

STUDY DESIGN

Systematic review; Level of evidence, 2.

METHODS

A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching PubMed, the Cochrane Library, and Embase to identify randomized controlled trials that directly compared outcomes between RCR with versus without acromioplasty. A subanalysis was performed on the studies that provided outcomes based on acromial type. The search phrase used was rotator cuff repair (acromioplasty OR subacromial decompression) randomized. Patients were evaluated based on retear rate, reoperation rate, and patient-reported outcomes (PROs).

RESULTS

Application of inclusion criteria yielded 5 studies (2 studies were level 1, and 3 studies were level 2) including a total of 409 patients, with 211 patients undergoing RCR alone (group A) and 198 patients undergoing RCR with acromioplasty (group B). The mean patient age was 58.5 and 58.3 years in groups A and B, respectively. The mean follow-up time was 52.9 months, and the overall percentage of male patients was 54.1%. The rotator cuff tear size was 20.7 mm and 19.8 mm for groups A and B, respectively. No significant differences were found between groups for any of the PROs at final follow-up. Overall retear rates did not significantly differ between groups based on acromial type. Between 2 studies that measured reoperation rate, a significantly higher reoperation rate was found for the nonacromioplasty group (15%) versus the acromioplasty group (4.1%) (P = .031). One of these studies found that 5 of 9 patients (56%) with a type III acromion in the nonacromioplasty group underwent reoperation compared with 0 of 4 patients with a type III acromion in the acromioplasty group.

CONCLUSION

There is some evidence that acromioplasty during RCR reduces the risk for later reoperation. This may be particularly true for patients with type III acromions, although further studies with larger sample sizes are needed to corroborate these data.

Effect of arthroscopic acromioplasty on reducing critical shoulder angle: a protocol for a prospective randomized clinical trial

Background

The critical shoulder angle (CSA), which helps to predict patients who are at risk of rotator cuff tears (RCTs) with large degree and who are susceptible to osteoarthritis with low angle, has been identified as one of the most vital acromial parameters; anterolateral and lateral acromioplasties have been proven to be valid ways to reduce CSA. However, no study has compared the effect of different acromioplasties on the reduction of the large CSA (≥33°) clinically. Additionally, either anterolateral or lateral acromioplasty could not precisely correct large CSAs to a favorable range (30–33°) in each patient. Thus, we will propose a novel precise acromioplasty technique for the purpose of reducing CSA accurately and effectively, and compare the effectiveness of different acromioplasties on the reduction of the CSA.

Methods

A total of 60 RCT patients who have indications for arthroscopic rotator cuff repair and with pre-operative CSA ≥33° will be recruited in outpatient center of Sun Yat-sen Memorial Hospital. Eligible participants will be randomly allocated to Group A (anterolateral acromioplasty), Group B (lateral acromioplasty) or Group C (precise acromioplasty) via a random, computer-generated number system. Three surgical plans will be made for each participant respectively by one professional surgeon according to the results of randomization allocation. The post-operative CSA will be measured 2 days post-operation. Follow-up will be maintained at 3, 6, and 12 months after surgery including the visual analog scale score, the University of California at Los Angeles score, the Constant Shoulder Score and the American Shoulder and Elbow Surgeon Shoulder Assessment Form. Finally, all outcomes will be assessed by two researchers who are blinded to the recruitment and allocation.

Discussion

This is the first clinical trial to evaluate the impact of different acromioplasties on the reduction of the CSA. Additionally, this study will provide a new precise acromioplasty technique, which is a novel precision and individualized treatment to prevent degenerative RCTs by reducing the CSA.

Trial registration

ChiCTR2000032343. Registered on April 26th, 2020.

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

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 cm³, of which 1.6 ± 1.2 cm³ (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 cm³, of which 2.1 ± 1.6 cm³ (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.