The Efficacy of Acromioplasty in the Arthroscopic Repair of Small- to Medium-Sized Rotator Cuff Tears Without Acromial Spur: Prospective Comparative Study

Department of Orthopaedic Surgery, Ewha Womans University School of Medicine, Seoul, South Korea.
Arthroscopy The Journal of Arthroscopic and Related Surgery (Impact Factor: 3.21). 01/2012; 28(5):628-35. DOI: 10.1016/j.arthro.2011.10.016
Source: PubMed

ABSTRACT To assess the role of acromioplasty in the arthroscopic repair of small- to medium-sized rotator cuff tears.
A prospective randomized trial of 120 patients who had small- to medium-sized rotator cuff tears and various types of acromions without spurs were included. Sixty patients received arthroscopic rotator cuff repair with acromioplasty (group I), and another sixty received the same procedure without acromioplasty (group II). The mean age at surgery was 57.8 ± 9.3 years in group I and 55.8 ± 8.0 years in group II. The shape of the acromion was flat in 18 patients, curved in 32, and hooked in 10 in group I, and it was flat in 15 patients, curved in 36, and hooked in 9 in group II. The mean tear size was similar in the two groups (14.6 ± 5.2 mm in group I and 15.3 ± 7.0 mm in group II). Pain and satisfaction were estimated and range of motion was measured at a mean of 35 months after surgery. Functional outcomes were assessed with American Shoulder and Elbow Surgeons: Constant; and University of California, Los Angeles scores. Tendon healing was evaluated by magnetic resonance imaging postoperatively.
Clinical outcome was significantly improved in both groups after arthroscopic rotator cuff repair (P < .05). There were no significant differences with respect to pain and range of motion between the groups at the final follow-up (1.1 ± 0.9 v 1.3 ± 1.4 on visual analog scale). Functional outcomes also showed no significant differences between the 2 groups (American Shoulder and Elbow Surgeons score, 90.7 ± 13.1 v 87.5 ± 12.0; Constant score, 85.0 ± 11.3 v 83.3 ± 13.0; and University of California, Los Angeles score, 33.4 ± 3.3 v 32.3 ± 3.5). Postoperative imaging showed that the retear rate was 17% in group I and 20% in group II (P = .475).
Arthroscopic repair of small- to medium-sized rotator cuff tears provided pain relief and improved functional outcome with or without acromioplasty. Clinical outcomes were not significantly different, and acromioplasty may not be necessary in the operative treatment of patients with small- to medium-sized rotator cuff tears in the absence of acromial spurs.
Level II, prospective comparative study.

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    • "They all had similar randomization design with one group having arthroscopic rotator cuff repair with subacromial bursectomy and acromioplasty (ARCR-A) and another group having arthroscopic rotator cuff repair with bursectomy alone (ARCR). Shin et al. focused on small (<1 cm) and medium-sized (1–3 cm) full-thickness rotator cuff tears [27]. Accounting for a follow-up rate of 80%, the authors enrolled 60 patients in each arm of the study and followed them for 35 months postoperatively. "
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    ABSTRACT: The incidence of acromioplasty has increased dramatically in recent decades, but its role in rotator cuff surgery has been debated. Neer popularized the extrinsic theory of rotator cuff pathology, where mechanical compression of the coracoacromial arch leads to tearing of the rotator cuff. Under this theory, acromioplasty is advocated to modify acromial morphology as an essential part of rotator cuff surgery. Proponents of the intrinsic theory suggest rotator cuff tendons undergo degeneration through aging and overuse, and that bursectomy alone without acromioplasty is sufficient. There exist cadaveric studies, expert opinions, and numerous case series espousing both sides of the argument. Recently, however, numerous high-quality prospective randomized controlled trials have been published examining the role of acromioplasty. They have similar study design and randomization protocols, including groups of arthroscopic rotator cuff repair with bursectomy and acromioplasty versus isolated bursectomy. The results have been consistent across all studies, with no difference in the outcomes of the acromioplasty and isolated bursectomy groups. Current evidence does not support the routine use of acromioplasty in the treatment of rotator cuff disease.
    12/2012; 2012(1):467571. DOI:10.1155/2012/467571
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