Acromion reconstruction after failed subacromial decompression in shoulders with os acromiale (meso-acromion): the tongue-and-groove assembly

 In some patients, resection of the fragment of an os acromiale or overzealous acromioplasty of the meso-acromion can result in a situation equivalent to an acromionectomy. This procedure, proposed in the past for rotator cuff disease treatment, has negative consequences on shoulder function, which have been described by Neer and Marberry.4, 7, 8, 14 and 17 The clinical consequences (pain and loss of strength and function) are related to the insufficiency of the anterior and lateral portions of the deltoid.

The therapeutic options are dependent on the repair of the deltoid. To obtain a good clinical result, it is necessary to achieve a reconstruction of the bony acromial arch. Only a few cases of acromion reconstruction have been reported in the literature after acromionectomy in the treatment of rotator cuff disease.1, 5 and 11

We report the clinical condition of deltoid insufficiency after failed arthroscopic subacromial decompression of an os acromiale (meso-acromion) and describe a variation for the reconstruction of the acromion with a tricortical iliac crest graft, which provides good primary stability and more contact area for graft healing.

CITA DEL ARTÍCULO  J Shoulder Elbow Surg. 2014 Oct;23(10):e261-5. doi: 10.1016/j.jse.2014.07.002.