Letter to the Editor: Acquired Acromion Compromise, Including Thinning and Fragmentation, Is Not Associated With Poor Outcomes After Reverse Shoulder Arthroplasty

To the Editor,

I read with interest the recent article, “Acquired Acromion Compromise, Including Thinning and Fragmentation, Is Not Associated With Poor Outcomes After Reverse Shoulder Arthroplasty,” by Kim et al. [3]. This study provides valuable insights into the implications of acromial compromise on reverse shoulder arthroplasty (RSA) outcomes. With respect, I would like to offer a few suggestions that could further enhance the study’s value for readers.

First, while the authors [3] report that acromial compromise does not impact outcomes after RSA, it would be beneficial to dive deeper into the characteristics of acromial compromise, such as the location and degree of thinning. Specific acromial conditions, like focal fragmentation, can lead to acromial insufficiency fractures and impact postoperative function, especially in patients with prior rotator cuff repair [6]. Including these distinctions may clarify whether certain types of acromial compromise are more closely associated with postoperative challenges than others.

Second, this study [3] notes an elevated risk of infection among patients with acromial compromise. Given that patients with prior rotator cuff repairs often have altered joint anatomy and tissue integrity, it may be valuable to explore whether the increased risk of infection observed in this study correlates with this element of surgical history, as suggested by previous work [2]. Understanding this potential association could help surgeons anticipate and manage infection risk in this patient population.

Another area for further exploration is the use of lateralized glenoid prostheses. While this study [3] reported no impact on outcomes based on whether the device was lateralized or not, another study [1] found that lateralized prostheses may increase stress on the acromion, potentially exacerbating acromial thinning. Providing more context on the prosthesis types used in this study would help readers assess the degree to which the findings are generalizable to other RSA implant designs.

Additionally, while range of motion and strength are important outcome metrics, assessing patient-reported outcome measures (PROMs) would offer a more comprehensive understanding of how acromial compromise influences functional recovery and quality of life [4]. Including or recommending PROMs could enrich this study’s [3] insights into patient satisfaction and perceived functionality post-RSA.

Finally, although the study’s 2-year follow-up is informative, previous research [5] suggests that acromial compromise and related complications may evolve over longer periods of time. Extending the follow-up period in future studies would be valuable in identifying late-onset issues that may not be evident within 2 years, providing a clearer picture of the long-term durability and functionality of RSA in patients with compromised acromions.

I thank the authors for their thought-provoking article.