The Efficacy of Acromioplasty in the Arthroscopic Repair of
Small- to Medium-Sized Rotator Cuff Tears Without Acromial
Spur: Prospective Comparative Study
Sang-Jin Shin, M.D., Ph.D., Joo Han Oh, M.D., Ph.D., Seok Won Chung, M.D., and
Mi Hyun Song, M.D.
Purpose: To assess the role of acromioplasty in the arthroscopic repair of small- to medium-sized
rotator cuff tears. Methods: 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. Results: 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). Conclusions: 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 of Evidence: Level II, prospective comparative study.
mioplasty, has been advocated as an integral part of
rotator cuff repair. Neer1first described acromioplasty
in 1972, and the technique and indications for com-
pletion of an acromioplasty have evolved considerably
since. The possible beneficial effects of acromioplasty
for rotator cuff treatment were based on the concept
that mechanical impingement contributes to abrasion
of the supraspinatus tendon, eventually leading to its
rupture. A cadaveric study by Bigliani et al.2showed
that 70% of specimens with a hooked-type acromion
and an anterior spur had full-thickness rotator cuff
tears; this also proved the close relation between ac-
ubacromial decompression, including bursectomy,
coracoacromial (CA) ligament release, and acro-
From the Department of Orthopaedic Surgery, Ewha Womans
University School of Medicine (S-J.S., M.H.S.), Seoul; and Seoul
National University College of Medicine, Seoul National University
Bundang Hospital (J.H.O., S.W.C.), Gyeonggi-do, South Korea.
The authors report that they have no conflicts of interest in the
authorship and publication of this article.
Received February 9, 2011; accepted October 18, 2011.
Address correspondence to Joo Han Oh, M.D., Ph.D., Department
of Orthopaedic Surgery, Seoul National University College of Medi-
cine, Seoul National University Bundang Hospital, 166 Goomi-ro,
Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, South Korea.
© 2012 by the Arthroscopy Association of North America
Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 28, No 5 (May), 2012: pp 628-635
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EFFICACY OF ACROMIOPLASTY IN ROTATOR CUFF REPAIR