MODERATE RECOMMENDATION One high and seven moderate quality studies (Woodmass, 2022; MacLean, 2020; Waterman, 2021; Abrams, G. 2014; Gartsman, 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, Milano, Abrams, and Shin performed randomized prospective studies demonstrating no difference in outcomes with and without acromioplasty at the time of rotator cuff repair.
MacDonald, et al. evaluated 86 randomized patients with and without acromioplasty and also found no difference in patient reported outcomes; however, there was a higher reoperation rate in the group without acromioplasty. Four of the patients subsequently had a second surgery for acromioplasty. One had a type 2 acromion, and the others had a type 3 acromion.
The included literature comprised populations of all RC patients, and did not restrict to include only certain patients with pathology that may benefit from acromioplasty. There may be certain situations where acromioplasty is needed to optimize visualization and/or for technical optimization during a RTC repair, (i.e., suture passing and shuttling, anchor insertion, canula placement).
Risks and Harms of Implementing this Recommendation
There is no risk or harm in implementing this recommendation.
Future Research
Continued long term comparative studies between acromioplasty and surgical repair investigating larger tear sizes with pre-and postoperative advanced imaging studies should be performed Future studies should also review the potential outcomes of acromioplasty on recovery, function, and PROs.
- 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
- Gartsman, G. M., O'Connor D, P. Arthroscopic rotator cuff repair with and without arthroscopic subacromial decompression: a prospective, randomized study of one-year outcomes. Journal of Shoulder & Elbow Surgery 2004; 4: 424-6
- MacDonald, P., McRae, S., Leiter, J., Mascarenhas, R., Lapner, P.. (2011). 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, 93(21), 1953-60.
- MacLean, I. S., Gowd, A. K., Waterman, B. R., Dempsey, I. J., Bach, B. R., Cole, B. J., Romeo, A. A., Verma, N. N. The Effect of Acromioplasty on the Critical Shoulder Angle and Acromial Index. Arthroscopy, Sports Medicine, and Rehabilitation 2020; 5: e623-e628
- 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; 1: 81-8
- Shin, S. J., Oh, J. H., Chung, S. W., Song, M. H. The efficacy of acromioplasty in the arthroscopic repair of small- to medium-sized rotator cuff tears without acromial spur: prospective comparative study. Arthroscopy 2012; 5: 628-35
- Waterman, B. R., Newgren, J., Gowd, A. K., Cabarcas, B., Lansdown, D., Bach, B. R., Cole, B. J., Romeo, A. A., Verma, N. N. Randomized Trial of Arthroscopic Rotator Cuff With or Without Acromioplasty: No Difference in Patient-Reported Outcomes at Long-Term Follow-Up. Arthroscopy 2021; 10: 3072-3078
- Woodmass, J. M., Al Khatib, L., McRae, S., Lapner, P., Mascarenhas, R., Neogi, D., MacDonald, P. B. Arthroscopic Rotator Cuff Repair with and without Acromioplasty in the Treatment of Full-Thickness Rotator Cuff Tears: Long-Term Outcomes of a Multicenter, Randomized Controlled Trial. Journal of Bone & Joint Surgery - American Volume 2022; 23: 2101-2107