Table 2.

A summary of studies in the literature examining different surgical treatment strategies for symptomatic os acromiale

Author	Year	Journal	Treatment	Open/arthroscopic	Study type	Study participant no. (N)	Conclusion
Neer and Marberry35	1981	JBJS	Radical acromionectomy	Open	Retrospective case series (> 80% acromion removed)	30	Poor results due to deltoid failure
Mudge et al33	1984	JBJS	Os fragment excision (+/- rotator cuff repair)	Open	Single surgeon case series	6	Excision of small os fragments alleviated symptoms in 4/6 patients
Armengol et al34	1994	JSES	Os fragment excision	Open	Single surgeon case series	40	No improvements in symptoms
Warner et al23	1998	JBJS	ORIF using 3.5 mm cannulated screws + TBW and iliac crest bone grafting	Open	Prospective single centre case series	14	In favour of ORIF with cannulated screws, TBW, and iliac crest graft
Hertel et al37	1998	JSES	Comparison of two surgical approaches. ORIF using TBW. Anterior deltoid off and transacromial	Open	Prospective single centre case series	15	Radiological union (axillary view). 3/7 deltoid off vs 7/8 transacromial. Higher constant scores when union achieved
Ryu et al38	1999	Orthopaedics	ORIF using 3.5 mm cannulated screws	Open	Single surgeon case series	4	Improvement in UCLA from 19 to 35
Satterlee42	1999	JSES	Dorsal wedge osteotomy of non-union + ORIF using 4.5 mm Herbert screws and suture TBW	Open	Single surgeon case series	6	6/6 excellent JSES PRO scores postoperatively
Wright et al46	2000	Arthroscopy	Extended arthroscopic subacromial decompression	Arthroscopic	Single surgeon case series	12	UCLA score from 17–31 at 12 months
Boehm et al48	2003	BJJ	Comparison of outcomes in open fragment excision, ORIF, and ASD	Open/ arthroscopic	Retrospective case series comparing fragment excision, ORIF, and ASD	31	No difference between different treatment
Peckett et al39	2004	JSES	ORIF using a variety of methods; k-wires, TBW, and 3.5 mm cannulated screws in patients who failed to have relief from ASD. Local bone grafting.	Open	Prospective single centre case series	26	25/26 radiological union at four months. 24/26 satisfied
Neyton et al30	2014	JSES	Acromial and deltoid reconstruction ORIF + iliac crest bone graft after failed subacromial decompression for meso-type os acromiale	Open	Single surgeon case series	2	2/2 radiographic union at 6/12. Improvement in symptoms and shoulder function
Spiegl et al40	2015	JSES	Comparison of biomechanical properties of ORIF using 3.5 mm cannulated screws alone vs 3.5 mm cannulated screws and TBW	N/A	Lab-based biomechanical prospective study in cadavers	28	Strongest fixation (higher load to failure) with 3.5 mm cannulated screws inserted in AP direction supplemented with TBW
Lebus et al41	2017	Arthrosc Tech	Description of surgical technique based on biomechanical work by Spiegl et al	Arthroscopic	Detailed description of technique with video material	1	Operative demonstration of technique from biomechanical work
Atinga et al28	2018	JSES	Comparison of different TBW techniques, and iliac crest vs local bone grafting	Open	Single surgeon case series	32	No difference between TBW techniques or bone graft harvest site. 100% union at three months postoperatively

Notes. ORIF, open reduction and internal fixation; TBW, tension band wiring; UCLA, University of California Los Angeles; JSES PRO, Journal of Shoulder & Elbow Surgery patient reported outcome; ASD, arthroscopic subacromial decompression.