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Arthroscopic subacromial decompression

An anatomical study

Baylor College of Medicine, Division of Orthopaedic Surgery, Houston, Texas

Major E. Blair, JR, MD

Baylor College of Medicine, Division of Orthopaedic Surgery, Houston, Texas

Philip C. Noble, MS

Baylor College of Medicine, Division of Orthopaedic Surgery, Houston, Texas

James B. Bennett, MD

Baylor College of Medicine, Division of Orthopaedic Surgery, Houston, Texas

Hugh S. Tullos, MD

Baylor College of Medicine, Division of Orthopaedic Surgery, Houston, Texas

Anterior acromioplasty as described by Neer has been an effective procedure for shoulder impingement syn drome. Recent presentations by Ellman suggest that an effective acromioplasty may be performed arthros copically. These clinical reports have not been sup ported by any laboratory experience. The purpose of our study was to examine the feasibility and attempt to quantitate the results of arthroscopic subacromial de compressions.

Six acromioplasties were performed according to the recommended technique of Dr. Neer to create a stand ard for comparison. Fourteen fresh postmortem speci mens were studied. In seven shoulders a standard acromioplasty was performed with an osteotome. In seven shoulders an acromioplasty was performed using standard arthroscopic approaches and motorized in struments. In five shoulders an isolated division of the coracoacromial ligament was performed arthroscopi cally. The coracoacromial ligament was completely di vided in all five cases. In the osteotome group adequate bone was resected in 75% (21/28) measured locations. In the arthroscopic group adequate bone was removed at 86% (24/28) location. This difference is not statisti cally significant.

In the cadaver, anterior acromioplasty was performed effectively and predictably with arthroscopic instru ments. This compared favorably to a conventional os teotome acromioplasty. It was concluded that coraco acromial ligament division can be accomplished.

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