Open Acromioplasty

Described by Neer / modified by Rockwood

 

Two Step Acromioplasty

 

1.  Anterior acromioplasty

- resect anterior acromion back to ACJ

- prevent impingement in flexion

 

2.  Resect anteroinferior acromion 

 

Technique

 

Position

- beach chair 

- mark anatomy

- limb draped free

 

Incision 

- along anterolateral border acromion

- curve into anterolateral incision

 

Superficial Dissection 

- expose deltoid to ACJ

- find fibrous raphe at anterolateral corner acromion 

- marks anterior & middle parts of deltoid

- split raphe 3cm, ensure protect underlying cuff

- bursa is now exposed, separate subdeltoid space

 

Deep Dissection

- detach deltoid from anterior acromion to ACJ 

- release CA ligament 

- place retractor under acromion to protect cuff

- tablespoon, Langerhan's retractor turned on side

 

2 stage acromion resection with microsagittal saw

- anterior acromion level with ACJ

- antero-inferior acromion

- ensure surface smooth

 

Resect distal 2cm clavicle if OA

- < 4% of patients

- only if pain referable to ACJ 

- confirmed by LA preoperatively

 

Bursectomy

- inspect cuff & repair defects

- abduct & rotate humerus

- biceps tenodesis if > 50% torn

 

Closure

- ? repair CA ligament

- reattach Deltoid No. 2 ethibond intraosseous sutures

 

Post Op

- rendulum exercises & passive flex

- sling for comfort

- no active abduction for 6/52 to protect deltoid