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