Near-Normal Shoulder Function 10 Years After Complete Acromionectomy: A Case Report

In 2010, Vitale et al demonstrated the rising rate of acromioplasties being performed in New York State, which increased from 5571 in 1996 to 19,743 in 2006. Despite the high rate of acromioplasties currently performed, the precise role of the acromion remains incompletely understood. With intimate attachment to the deltoid, the acromion provides a lever arm for strength in shoulder abduction. However, numerous reports have implicated the acromion in the development of shoulder pain from impingement and rotator cuff tears. Reginald Watson-Jones reported the first acromial excision in 1939 for the treatment of supraspinatus tendon lesions at a meeting of the British Orthopaedic Association. In 1949, Armstrong reported a series of 95 patients with supraspinatus syndrome thought to be the result of abnormal compression of the rotator cuff tendons and subacromial bursa between the humeral head and acromion. All patients underwent complete excision of the acromion to the acromioclavicular joint, with 84.2% (80/95) showing satisfactory results. In 1962, Hammond reported goodexcellent outcomes in 85.7% (18/21) of patients after complete acromionectomy for the diagnosis of supraspinatus syndrome/tendinitis. In 1991, Bosley described 34 shoulders treated with total acromionectomy for chronic impingement syndrome. At a minimum 2-year follow-up, 85.3% (29/34) of shoulders had good-excellent function in terms of pain, strength, range of motion (ROM), and patient satisfaction. Despite initially promising results, complete/radical acromionectomy is subject to poor outcomes in some patients. In 1981, Neer and Marberry reported a series of 30 consecutive patients who had poor results after complete acromionectomy. They identified 8 patients with serious wound complications, 27 with persistent pain, and all 30 exhibiting marked shoulder weakness with an inability to raise the arm above 90 . They advocated for partial excision of the anterior one-third of the acromion with release of the coracoacromial ligament to prevent impingement. Jeon et al reported on 10 patients requiring deltoid/acromion reconstruction after failed acromionectomy. All patients complained of disabling persistent symptoms, all exhibited deltoid muscle retraction with cosmetic deformities, and none of the patients could actively raise the arm above 90 . We present the clinical history and outcomes of a 26-year-old man who underwent complete acromionectomy at the age of 16 years for pain secondary to an aneurysmal bone cyst (ABC). The findings demonstrate that the absence of the acromion may not significantly impair function, provided the deltoid is intact.