AcromioplastyEdit

Acromioplasty is a surgical procedure that reshapes the acromion to relieve impingement in the subacromial space of the shoulder. It is most often performed as part of arthroscopic treatment for painful movement and limited function associated with shoulder impingement syndromeimpingement syndrome or with rotator cuff pathology. By addressing bony prominences and osteophytes on the undersurface of the acromion, the operation aims to reduce mechanical contact between the humeral head and the acromion during arm elevation. The acromion itself is a bony extension of the scapula that forms the superior boundary of the subacromial arch, where the tendons of the rotator cuffrotator cuff pass beneath it. The procedure is typically performed with precision tools in the context of arthroscopyarthroscopy or, less commonly, via an open approach.

Historically, acromioplasty has been integrated into a broader strategy for addressing shoulder pain attributed to mechanical impingement. As understanding of shoulder anatomy and pathology evolved, surgeons have increasingly emphasized individualized treatment planning that weighs the morphology of the acromion, the status of the [rotator cuff], and patient-specific functional goals. In some patients, a simple removal of problematic osteophytes and smoothing of the undersurface suffices, while in others, more extensive reshaping of the anterolateral acromion is performed to expand the subacromial space. The decision to perform acromioplasty is guided by clinical examination, imaging studies, and intraoperative assessment of impingement.

Techniques

Arthroscopic acromioplasty

The dominant modern approach is arthroscopic acromioplasty. Through small incisions, the surgeon gains access to the subacromial space, identifies sites of impingement, and removes bony overgrowth and osteophytes from the undersurface of the acromion. The goal is to achieve a smooth, non-irritating undersurface while preserving the deltoid origin and the integrity of surrounding soft tissues. The amount and pattern of bone resection are tailored to the patient’s anatomy and to the specific impingement mechanism. Associated procedures, such as debridement of frayed rotator cuff tissue or repair of a full-thickness rotator cuff tear, may be performed in the same session. See arthroscopy and acromion for background on the techniques and anatomy involved.

Open acromioplasty

In some settings, an open approach is used, particularly when concurrent procedures require extended exposure. Open acromioplasty provides direct visualization of the acromial undersurface but typically involves a larger incision and a careful balance between adequate decompression and protection of soft tissue structures. See open surgery as a general reference to how some shoulder procedures are performed.

Indications and decision-making

Refractory symptoms: Acromioplasty is most commonly considered when shoulder pain and impingement persist despite a course of standardized nonoperative management, including physical therapy and activity modification. See nonoperative management for broader context.
Mechanical impingement: Imaging or intraoperative findings that reveal osteophytes, spurs, or a hooked (pronounced) acromial morphology contributing to subacromial contact support the rationale for decompression. Acromial morphology has historically been described in classifications such as the Bigliani system, which helps guide surgical planning in some cases. See Bigliani classification and acromion for related concepts.
Coexisting rotator cuff pathology: When a rotator cuff tear or degenerative tendon changes are present, acromioplasty may be combined with repair or debridement to optimize outcomes, depending on tear size and quality. See rotator cuff and rotator cuff repair for broader context.
Individualized risk-benefit assessment: Given variability in anatomy and clinical response, surgeons weigh potential benefits against risks such as stiffness, deltoid irritation, or over-resection that could weaken the abduction mechanism.

Evidence and controversies

The use of acromioplasty has been the subject of substantial debate in the medical literature. Earlier iterations of subacromial decompression that included routine acromioplasty were widely adopted, but later randomized trials and meta-analyses questioned whether acromioplasty adds meaningful benefit beyond relief achieved by decompression or rotator cuff procedures alone. Across multiple studies, a number of analyses concluded that, for many cases of primary impingement, adding acromioplasty to subacromial decompression did not produce superior functional outcomes compared with decompression without acromioplasty. See randomized controlled trial and systematic review for methodological discussions of this evidence base.

Despite these findings, the controversy remains nuanced. Subgroups of patients with certain acromial morphologies—most notably more pronounced hooked or Type III acromions—may derive greater benefit from targeted reshaping to reduce mechanical contact. In such cases, the decision to perform acromioplasty is often individualized, taking into account patient age, activity level, integrity of the [rotator cuff], and intraoperative assessment of space in the subacromial corridor. See acromion and Bigliani classification for related context.

Critics of routine acromioplasty argue that it can be an unnecessary component of surgery in many patients, potentially increasing operative time, cost, and risk without reliably improving outcomes. Proponents contend that when a clear mechanical source of impingement is present, targeted acromioplasty can reduce irritative contact and support a more durable recovery, particularly when combined with appropriate rotator cuff management. In debates over policy and practice, the emphasis tends to fall on evidence-based selection, patient-centered goals, and cost-conscious care, rather than blanket application of a single technique. See subacromial decompression for the broader treatment landscape.

Outcomes and complications

Reported outcomes indicate that, for appropriately selected patients, acromioplasty can contribute to pain relief and improved arm function, especially when part of a comprehensive treatment plan that addresses rotator cuff pathology. However, results vary with the underlying pathology, the quality of tissue, and the extent of resection. Potential complications include stiffness, persistent pain, and, in rare cases, issues related to deltoid function or incomplete decompression. Meticulous surgical technique and disciplined postoperative rehabilitation are important determinants of success. See shoulder, rotator cuff, and deltoid for related anatomy and potential complications.

History

Acromioplasty emerged as a standard element of shoulder impingement management as understanding of the subacromial space and the mechanics of arm elevation deepened. Over time, the procedure has evolved from open techniques to predominantly arthroscopic approaches, guided by ongoing assessment of when reshaping the acromion genuinely improves outcomes versus when it adds unnecessary intervention. See shoulder impingement syndrome for historical context.