Moderate strength evidence does not support the routine use of acromioplasty as a concomitant treatment as compared to arthroscopic repair alone for patients with small to medium sized full-thickness rotator cuff tears.

Management of Rotator Cuff Injuries
Endorsed by: AANA, ASES, AOSSM, ASSET, APTA
Moderate Evidence MODERATE EVIDENCE
Rationale
Five high quality studies (Abrams, G. 2014; Garstman, G. 2004; MacDonald, P. 2011; Milano, G. 2007; Shin S. 2012) evaluated the effect of acromioplasty on rotator cuff repair of small and medium sized tears. Overall, acromioplasty did not have an effect on outcomes with the exception of one study which found a higher reoperation rate in patients without acromioplasty. Gartsman, et al. performed a randomized study on patients with supraspinatus tears and Type 2 acromions, with no difference in outcome.  Milano, et al. randomized 80 patients and similarly found no difference in outcomes after 2 years.  Abrams, et al. evaluated 52 patients, and also found no difference between groups.  Shin, et al. similarly found no differences in randomized groups with varying acromial morphology included in both groups.

MacDonald, et al. evaluated 86 randomized patients with and without acomioplasty and also found no difference in patients reported outcomes, however, there was a higher reoperation rate in the group without acromioplasty.  Four of the patients subsequently had second surgery for acromioplasty.  One had a type 2 acromion and the others had type 3 acromions.

Risks and Harms of Implementing this Recommendation
There are no harms in associated in implementing this recommendation. There were no reported statistical differences between primary or secondary repair, when physical therapy fails (p=0.23). (Moosmayer S 2014)

Future Research
Continued long term comparative studies between physical therapy and surgical repair investigating larger tear sizes with pre-and postoperative advanced imaging studies. The long-term consequences of a persistent rotator cuff tear or a re-tear is currently not known.
  1. (18) Gartsman GM, Roddey TS, Hammerman SM. Shoulder arthroplasty with or without resurfacing of the glenoid in patients who have osteoarthritis. J Bone Joint Surg Am 2000;82(1):26-34.
  2. (81) Milano G, Grasso A, Salvatore M, Zarelli D, Deriu L, Fabbriciani C. Arthroscopic rotator cuff repair with and without subacromial decompression: a prospective randomized study. Arthroscopy 2007;23(1):81-88.
  3. Abrams, G. D., Gupta, A. K., Hussey, K. E., Tetteh, E. S., Karas, V., Bach, B. R., Jr., Cole, B. J., Romeo, A. A., Verma, N. N. Arthroscopic Repair of Full-Thickness Rotator Cuff Tears With and Without Acromioplasty: Randomized Prospective Trial With 2-Year Follow-up. American Journal of Sports Medicine 2014; 6: 1296-303
  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. Journal of Bone & Joint Surgery - American Volume 2011; 21: 1953-60
  5. Moosmayer, S, Lund, G, Seljom, Us, Haldorsen, B, Svege, Ic, Hennig, T, Pripp, Ah, Smith, Hj Tendon repair compared with physiotherapy in the treatment of rotator cuff tears: a randomized controlled study in 103 cases with a five-year follow-up. The Journal of bone and joint surgery. American volume 2014; 18: 1504-14
  6. Shin, S-J, 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 - Journal of Arthroscopic and Related Surgery 2012; 5: 628-35