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. 2016 Apr 13;6(2):e13. doi: 10.2106/JBJS.ST.O.00011

Arthroscopic Subacromial Decompression and Acromioplasty

Peter N Chalmers 1, Anthony A Romeo 1
PMCID: PMC6145625  PMID: 30237923

Abstract

Arthroscopic subacromial decompression with acromioplasty is among the most commonly performed arthroscopic shoulder procedures and is an important aspect of any orthopaedic surgeon’s armamentarium. This procedure is indicated for refractory subacromial bursitis and subacromial impingement. It is also a routine portion of rotator cuff repair exposure. The procedure aims to remove the subacromial bursa, which can serve as a pain generator, as well as any osteophytes on the undersurface of the acromion, which can lead to impingement and, in some circumstances, bursal-sided rotator cuff tears. Multiple randomized clinical trials have demonstrated no benefit for this procedure as an initial treatment in patients with subacromial bursitis2,7,8, and thus this procedure is indicated only for patients with refractory subacromial bursitis. The steps of this procedure include (1) placement of the arthroscope in the subacromial space and establishment of a lateral working portal, (2) performance of a thorough subacromial bursectomy, (3) achievement of hemostasis and subperiosteal exposure of the undersurface of the acromion, and (4) smoothing of the undersurface of the acromion and removal of any anterolateral osteophytes. Outcomes after this procedure have shown significant increases in UCLA (University of California at Los Angeles), Constant, visual analog pain scale, and Simple Shoulder Test scores over the preoperative status2,5,10,11. Complications, while infrequent, are mostly related to overresection or underresection of the acromion.

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Footnotes

Published outcomes of this procedure can be found at: Am J Sports Med. 2012 Feb;40(2):352-8, J Bone Joint Surg Am. 2011 Nov 2;93(21):1953-60, J Bone Joint Surg Am. 1993 Mar;75(3):409-24.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

References

  • 1.Abrams GD, Gupta AK, Hussey KE, Tetteh ES, Karas V, Bach BR, Jr, Cole BJ, Romeo AA, Verma NN. Arthroscopic repair of full-thickness rotator cuff tears with and without acromioplasty: randomized prospective trial with 2-year follow-up. Am J Sports Med. 2014. June;42(6):1296-303. Epub 2014 Apr 14. [DOI] [PubMed] [Google Scholar]
  • 2.Henkus HE, de Witte PB, Nelissen RG, Brand R, van Arkel ER. Bursectomy compared with acromioplasty in the management of subacromial impingement syndrome: a prospective randomised study. J Bone Joint Surg Br. 2009. April;91(4):504-10. [DOI] [PubMed] [Google Scholar]
  • 3.Koh KH, Laddha MS, Lim TK, Lee JH, Yoo JC. A magnetic resonance imaging study of 100 cases of arthroscopic acromioplasty. Am J Sports Med. 2012. February;40(2):352-8. Epub 2011 Nov 17. [DOI] [PubMed] [Google Scholar]
  • 4.MacDonald P, McRae S, Leiter J, Mascarenhas R, Lapner P. Arthroscopic rotator cuff repair with and without acromioplasty in the treatment of full-thickness rotator cuff tears: a multicenter, randomized controlled trial. J Bone Joint Surg Am. 2011. November 2;93(21):1953-60. [DOI] [PubMed] [Google Scholar]
  • 5.Odenbring S, Wagner P, Atroshi I. Long-term outcomes of arthroscopic acromioplasty for chronic shoulder impingement syndrome: a prospective cohort study with a minimum of 12 years’ follow-up. Arthroscopy. 2008. October;24(10):1092-8. Epub 2008 Jun 16. [DOI] [PubMed] [Google Scholar]
  • 6.Rockwood CA, Lyons FR. Shoulder impingement syndrome: diagnosis, radiographic evaluation, and treatment with a modified Neer acromioplasty. J Bone Joint Surg Am. 1993. March:75(3):409-24. [PubMed] [Google Scholar]
  • 7.Dorrestijn O, Stevens M, Winters JC, van der Meer K, Diercks RL. Conservative or surgical treatment for subacromial impingement syndrome? A systematic review. J Shoulder Elbow Surg. 2009. Jul-Aug;18(4):652-60. [DOI] [PubMed] [Google Scholar]
  • 8.Rhon DI, Boyle RB, Cleland JA, Rhon DI, Boyles RB, Cleland JA. One-year outcome of subacromial corticosteroid injection compared with manual physical therapy for the management of the unilateral shoulder impingement syndrome: a pragmatic randomized trial. Ann Intern Med. 2014. August 5;161(3):161-9. [DOI] [PubMed] [Google Scholar]
  • 9.Vitale MA, Arons RR, Hurwitz S, Ahmad CS, Levine WN. The rising incidence of acromioplasty. J Bone Joint Surg Am. 2010. August 4; 92(9):1842-50. [DOI] [PubMed] [Google Scholar]
  • 10.Farfaras S, Sernert N, Hallström E, Kartus J. Comparison of open acromioplasty, arthroscopic acromioplasty and physiotherapy in patients with subacromial impingement syndrome: a prospective randomised study. Knee Surg Sports Traumatol Arthrosc. 2014. November 11 [Epub ahead of print]. [DOI] [PubMed] [Google Scholar]
  • 11.Ketola S, Lehtinen J, Arnala I, Nissinen M, Westenius H, Sintonen H, Aronen P, Konttinen YT, Malmivaara A, Rousi T. Does arthroscopic acromioplasty provide any additional value in the treatment of shoulder impingement syndrome?: a two-year randomised controlled trial. J Bone Joint Surg Br. 2009. October;91(10):1326-34. [DOI] [PubMed] [Google Scholar]
  • 12.Bigliani LU, Levine WN. Subacromial impingement syndrome. J Bone Joint Surg Am. 1997. December;79(12):1854-68. [PubMed] [Google Scholar]
  • 13.Chahal J, Mall N, MacDonald PB, Van Thiel G, Cole BJ, Romeo AA, Verma NN. The role of subacromial decompression in patients undergoing arthroscopic repair of full-thickness tears of the rotator cuff: a systematic review and meta-analysis. Arthroscopy. 2012. May;28(5):720-7. [DOI] [PubMed] [Google Scholar]
  • 14.Davis AD, Kakar S, Moros C, Kaye EK, Schepsis AA, Voloshin I. Arthroscopic versus open acromioplasty: a meta-analysis. Am J Sports Med. 2010. March;38(3):613-8. [DOI] [PubMed] [Google Scholar]
  • 15.Frank JM, Chahal J, Frank RM, Cole BJ, Verma NN, Romeo AA. The role of acromioplasty for rotator cuff problems. Orthop Clin North Am. 2014. April;45(2):219-24. [DOI] [PubMed] [Google Scholar]
  • 16.Gartsman GM, Blair ME, Jr, Noble PC, Bennett JB, Tullos HS. Arthroscopic subacromial decompression. An anatomical study. Am J Sports Med. 1988. Jan-Feb;16(1):48-50. [DOI] [PubMed] [Google Scholar]
  • 17.Neer CS., 2nd Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am. 1972. January;54(1):41-50. [PubMed] [Google Scholar]
  • 18.Randelli P, Margheritini F, Cabitza P, Dogliotti G, Corsi MM. Release of growth factors after arthroscopic acromioplasty. Knee Surg Sports Traumatol Arthrosc. 2009. January;17(1):98-101. [DOI] [PubMed] [Google Scholar]
  • 19.Shin SJ, Oh JH, Chung SW, Song MH. The efficacy of acromioplasty in the arthroscopic repair of small- to medium-sized rotator cuff tears without acromial spur: prospective comparative study. Arthroscopy. 2012. May;28(5):628-35. [DOI] [PubMed] [Google Scholar]

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