2015 ISAKOS Biennial Congress ePoster #2409

Is Acromioplasty Necessary? A Systematic Review of the Literature

Filippo Familiari, MD, Catanzaro ITALY
Gazi Huri, MD, Baltimore, MD UNITED STATES
Alan Gonzalez-Zapata, MD, Lutherville, MD UNITED STATES
Bruno Iannò, MD, Catanzaro ITALY
Giorgio Gasparini, Catanzaro ITALY
Olimpio Galasso, MD, Catanzaro ITALY
Edward G. McFarland, Lutherville, MD UNITED STATES

Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA

FDA Status Not Applicable

Summary: A systematic review of the current literature does not support the routine use of partial acromioplasty or coracoacromial ligament release in the surgical treatment of rotator cuff disease .

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Abstract:

Introduction

The etiology and treatment of rotator cuff disease has been debated for over 100 years. Currently it is known that rotator cuff disease is multifactorial, and the concept of impingement has been questioned. Neer was the first to suggest that the treatment was partial acromioplasty and coracoacromial ligament reléase, but the role of these procedures for treating symptomatic rotator cuff disease has been controversial. It was the goal of this study to systematically review the current literature regarding whether partial acromioplasty and coracoacromial reléase are necessary for the successful treatment of rotator cuff disease.

MATERIALS & METHODS
A literature search of the MEDLINE database identified 96 pertinent abstracts or full-text articles on the role of acromioplasty in the treatment of rotator cuff tears (partial- and full-thickness tears) under the key-words “acromioplasty”, “arthroscopic acromioplasty”, “open acromioplasty”, and “subacromial decompression”, and “coracoacromial ligament”. Of these, 19 articles were screened after excluding 77 articles and a total of 15 met criteria for inclusion in this study (level 1 and 2 only). Descriptive statistics were used to summarize the findings of the included articles.

Results

There were 1375 patients in 15 studies. There were five level 1 and nine level 2 studies, and they were all randomized controlled trials. Acromioplasty was performed with open surgery in one study, and arthroscopically in 10 studies, and open versus arthroscopic acromioplasty was compared in four studies. None of the studies in this review found short-term statistically significant differences between patients with or without partial acromioplasty in VAS for pain or clinical outcome measures. Only two studies found any long term differences between the two treatment choices but the remainder reported no advantage of one treatment over another. Our findings are consistent with previous research reports in which there was no difference in functional and quality-of-life indices for patients who had open or arthroscopic rotator cuff repair with or without acromioplasty. The coracoacromial ligament was released in 7 of the 15 studies (605 patients), and there was no advantage to release of the CA ligament compared to leaving it intact in terms of VAS for pain and clinical outcome measures (Constant score, Simple Shoulder Test score, and UCLA shoulder score).

Conclusions

A systematic review of the current literature does not support the routine use of partial acromioplasty or coracoacromial ligament release in the surgical treatment of rotator cuff disease and we have ceased performing these procedures. Further research is needed to determine the optimum surgical techniques for the operative treatment of rotator cuff disease.