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Acromioplasty

intermediate Level

Primary Indication

Treatment of impingement syndrome; Failure of conservative treatment for 6-12 months; Recurrent symptoms; Associated with rotator cuff surgery

Danger Structures

undefined - Variable based on approach
undefined - Surrounding operative field
undefined - Bone surface
undefined - Joint surfaces if applicable

Visual Atlas

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Step-by-Step Technique

1

OPEN TECHNIQUE

Beach chair/semiupright position with head elevated 30-35 degrees, IV bag under scapula, arm draped free

2

Mobilise subcutaneous tissue

3

Identify raphe between anterior and middle deltoid, split distally (<5cm from acromion to avoid axillary nerve)

4

Detach deltoid from anterior acromion to ACJ

5

Resect CA ligament with diathermy (acromial branch of CA artery)

6

Resect SA bursa with adhesions

7

Use saw/osteotome to remove acromion anterior to anterior border of clavicle

8

Remove anteroinferior acromion to junction of anterior and middle thirds

9

Use blunt Hohmann to protect cuff during osteotomy

10

Smooth rough surfaces with rasp

11

Palpate ACJ undersurface - resect distal 1-1.5cm clavicle if degenerative

12

Inspect rotator cuff and repair/debride if necessary

13

Reattach deltoid via drill holes with non-absorbable sutures

14

Suture deltoid split side to side

15

ARTHROSCOPIC TECHNIQUE

Lateral decubitus or beach chair, 10-15 pounds traction, shoulder 30 degrees abduction and 20 degrees flexion

16

Inspect GH joint for labral, articular surface or undersurface RC pathology

17

Enter SA space with blunt trochar beneath acromion

18

Establish lateral portal with needle

19

Remove bursa with shaver - view from ACJ to RC insertion

20

Use arthroscopic diathermy to resect CA ligament

21

Remove soft tissue from undersurface of acromion to identify anterior 2cm

22

Use arthroscopic burr to remove lateral edge of acromion just medial to portal

23

Remove full thickness of anterior acromion back to clavicle

24

Taper acromioplasty anterior to posterior starting with ~5mm anteriorly

25

Can use posterior portal to complete

26

Palpate undersurface and smooth rough surfaces

27

Resect ACJ undersurface if indicated