Profile of Current Opinion on Arthroscopic Acromioplasty: A Video Survey Study

PURPOSE

To provide a baseline profile of current opinion on use of arthroscopic acromioplasty and evaluate the consistency of surgical decision making on whether or not to perform acromioplasty across different surgeon practices.

METHODS

Twenty-two fellowship-trained orthopaedic shoulder surgeons from the Association of Clinical Elbow and Shoulder Surgeons completed an Internet-based survey on practices associated with acromioplasty, including questions related to 15 arthroscopic videos. Based on video cases, interobserver and intraobserver agreement regarding clinically based decisions related to acromioplasty were assessed.

RESULTS

Acromioplasty was uncommonly performed in isolation among this group and was most commonly performed in conjunction with repair of full-thickness rotator cuff tears. Nineteen of 22 (86%) surgeons favored an arthroscopic approach for acromioplasty. Depth of bony resection was determined most commonly based on clinical judgment and experience (68%). The video portion of the survey revealed slight interobserver agreement for classification of acromion morphology (κ = 0.099), need for acromioplasty (κ = 0.020), and adequacy of decompression (κ = 0.1). In contrast, there was fair intraobserver reliability regarding acromion morphology (κ = 0.370) and decision whether to perform acromioplasty in a given case (κ = 0.348) whereas there was moderate intraobserver reliability in the presence of a reparable rotator cuff tear (κ = 0.507) and assessment of the adequacy of decompression (κ = 0.453).

CONCLUSIONS

Although surgeons had similarities regarding principles of acromioplasty, including indications, surgical approach, and technique, there was lack of consensus when surgeons reviewed the video of clinical cases. Although surgeons may have similar goals in terms of treatment of pathology related to subacromial impingement, individual surgeon thresholds for the need and adequacy of decompression are varied and are not standardized.

LEVEL OF EVIDENCE

Level V, expert opinion.

Shoulder Conditions: Diagnosis and Treatment Guideline

The following guideline covers a wide array of shoulder conditions seen in the workers' compensation, as well as the nonworkers' compensation, population. The guideline is intended to help establish work relatedness and aid in making the diagnosis of shoulder injuries and degenerative conditions. It also provides a nonoperative and operative guideline for the treatment of several shoulder conditions, not limited to rotator cuff tears, subacromial impingement syndrome, acromioclavicular arthritis and dislocations, as well as glenohumeral arthritis.

Results of resurfacing a native patella in patients with a painful total knee arthroplasty

Between 1990 and 2003, 24 patients (28 knees) who had a total knee arthroplasty (TKA) and underwent subsequent patella resurfacing without revision of the tibial or femoral components to alleviate pain were identified. Patient charts were reviewed retrospectively and patients were interviewed after average 2.9-year follow-up (range: 1-12 years) to assess function, pain, and satisfaction with the procedure. Average patient age at revision surgery was 68 years, and the average time from the index TKA was 9.8 years. Mean Knee Society function and pain scores were 68+/-28 and 45+/-16, respectively. Average preoperative range of motion was 102 degrees (range: 65 degrees-130 degrees), and average postoperative range of motion was 106 degrees (range: 65 degrees-130 degrees). Only 52% of patients would undergo revision surgery again given their current levels of pain and function. Revision of only the patella for patients with a painful TKA who did not undergo patella resurfacing at the initial surgery provides 52% satisfactory results. Surgeons should look for other causes of pain in this patient population and reconsider their indications for not resurfacing the patella in TKA.