Acromioplasty: Easy To Do But Is It Necessary?One of the most common orthopedic procedures performed in the United States is an acromioplasty. In fact, according to this report, in the last 10 years, the number of acromioplasties done in the U.S. has increased by more than 250 per cent. The study was done in New York where there were 5,571 acromioplasties done in 1996 and 19,743 in 2006.
What's an acromioplasty? It's the removal of a small piece of bone called the acromion. The acromion comes from the scapula (shoulder blade at the back of the shoulder) across the top of the shoulder to connect with the clavicle collar bone in the front of the shoulder.
Why is it removed? Generally, removal of the acromion is done to take pressure off the rotator cuff tendons as they pass under the acromion to attach to the upper arm. Until recently, it was believed that the reason these tendons got frayed or damaged was from rubbing against the bottom of the acromion. Shaving the underside of the acromion or removing the end of the bone altogether is one way to deal with the problem.
Rotator cuff degeneration seems to be common in midlife, often occurring between the ages 30 to 40 years old. Mechanical impingement (pinching) from the acromion was considered the major cause of this problem. So it seemed logical that to remove the acromion would solve the problem.
As a result, the acromioplasty procedure, first used in the early 1970s has gained in popularity since then. But better technology with the use of magnetic resonance imaging (MRI) and arthroscopic examination has revealed some new information to consider. And that is the fact that mechanical impingement isn't the only problem causing rotator cuff degeneration.
It seems that changes are taking place within the rotator cuff tendons that may have nothing to do with rubbing against the acromion. And studies showing the outcomes after acromioplasty have not been that positive. It's starting to look like conservative (nonoperative) care may yield just as good of results as surgery with good pain control and improved function.
If that's the case, then the use of acromioplasties for rotator cuff problems should be re-evaluated more carefully. At least that's the conclusion of this report. The authors used medical records and orthopedic physician board certification reports just within the state of New York. But a review of data collected by the American Board of Orthopaedic Surgery (ABOS) showed a similar increase on a national level.
Analysis of the data collected in this study also showed an expansion of the types of patients treated with an acromioplasty. In 1996, most of the 5,571 patients had a diagnosis of impingement syndrome. By 2006, there were many more cases of sprains and strains of the rotator cuff, shoulder bursitis, labral tears, and rotator cuff ruptures.
Acromioplasties were done 2.4 times more often compared with other orthopedic procedures for ambulatory outpatients (able to walk in and leave the same day). The expansion of diagnostic reasons for using this operation might explain that increase.
Other reasons included better surgical techniques, improved technology, and more advanced surgeon training in medical schools (especially in the area of shoulder surgery). Patient preference may be a bigger factor than we realize. It's possible that patients don't want to spend six weeks to six months in rehab and opt for the faster surgical approach.
In conclusion, it's clear that the number of acromioplasty procedures being done in the United States each year has increased dramatically. The reasons for this are many and varied but may be justified. This is the first study to bring the increased utilization of acromioplasties into focus. Further evaluation of the need for so many acromioplasties will be the topic of future studies.
Mark A. Vitale, MD, MPH, et al. The Rising Incidence of Acromioplasty. In The Journal of Bone and Joint Surgery. August 2010. Vol. 92-A. No. 9. Pp. 1842-1850.
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