Review articleSurgical management of the symptomatic os acromiale*
Section snippets
Anatomy
The acromion develops from 3 separate ossification centers. The preacromion, meso-acromion, and meta-acromion typically fuse to each other between the 15th and 18th year10 (Figure 1).Osseous union between the acromial apophysis and the spine of the scapula may occur as late as the 25th year. Persistence of the unfused acromial apophysis is called an os acromiale. Failure of ossification is most common between the
Diagnosis
Patients frequently describe symptoms similar to subacromial impingement,19 including difficulty in overhead activities and trouble sleeping on the affected side. Physical examination reveals positive impingement signs, rotator cuff weakness, and loss of active forward elevation. Furthermore most patients will have pain on palpation directly over the acromion in the region of the os acromiale, and gross motion is occasionally detectable.28 Although symptoms may occur after minor or repetitive
Treatment options
All patients with a symptomatic unstable os acromiale should be given a trial of conservative treatment for at least 6 months. Physiotherapy similar to a standard subacromial impingement protocol should be prescribed in addition to nonsteroidal anti-inflammatory agents and 1 to 2 subacromial corticosteroid injections over a 6-month period. The regimen will allow some patients to avoid surgical intervention. Contraindications to these guidelines include large or acute rotator cuff tears that may
Summary
Treatment options for the unstable meso-acromion include fragment excision, open reduction internal fixation, and arthroscopic subacromial decompression. Open excision has had mixed results primarily related to deltoid dysfunction. In addition, open reduction internal fixation is technically difficult, has a moderate nonunion rate, and often requires reoperation for hardware irritation. In contrast, arthroscopic subacromial decompression with complete or nearly complete resection of the
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Cited by (36)
Os acromiale: systematic review of surgical outcomes
2020, Journal of Shoulder and Elbow SurgeryOs acromiale open reduction and internal fixation: a review of iliac crest autogenous bone grafting and local bone grafting
2018, Journal of Shoulder and Elbow SurgeryCitation Excerpt :Table II lists the complications. Surgical treatment of symptomatic os acromiale is well documented, with various techniques ranging from excision to acromioplasty through to fusion.1,5,7,10-12,14,15 Fusion of the os acromiale has been associated with variable results in union rates and function.
Biomechanical evaluation of internal fixation techniques for unstable meso-type os acromiale
2015, Journal of Shoulder and Elbow SurgeryCitation Excerpt :The clinical relevance of this finding remains unclear as the loading that acts on the repair site due to the deltoid muscle contraction is unknown. However, a wide range of union rates after surgical repair of os acromiale (25% to 100%) has been reported,1,13,21 perhaps indicating that some techniques were not able to produce sufficient biomechanical stability. Furthermore, more stable fixation would theoretically permit a more aggressive postoperative rehabilitation protocol.
Acromion reconstruction after failed subacromial decompression in shoulders with os acromiale (meso-acromion): The tongue-and-groove assembly
2014, Journal of Shoulder and Elbow SurgeryCitation Excerpt :Various options have been reported in the treatment of symptomatic os acromiale, including open excision of the bone fragment,3,12,18 arthroscopic acromioplasty (resulting in complete or nearly complete excision of the fragment),19 or open fixation and bone grafting.9,16,18 Arthroscopic subacromial decompression has yielded variable results from satisfactory to unsatisfactory outcomes.10,15,19 Open fixation–internal fixation with concomitant bone grafting is the most-documented treatment option.
Os acromiale. A review and an introduction of a new surgical technique for management.
2013, Orthopedic Clinics of North AmericaCitation Excerpt :Because complications arise from the fragment excision, many surgeons advocate internal fixation of the unfused os acromiale with bone grafting. Techniques to provide stability include the use of tension-band wires, sutures, or cannulated screws with or without the use of bone graft.34 Peckett and colleagues3 reviewed 26 patients presenting with symptomatic meso os acromiale that were treated with either K-wires or screws and a tension band.
Os acromiale, a cause of shoulder pain, not to be overlooked
2013, Orthopaedics and Traumatology: Surgery and ResearchCitation Excerpt :A painless os acromiale becomes symptomatic when it is unstable. The diagnosis of painful os acromiale in the presence of scapulalgia is based on a radiological and clinical examination that should confirm the role of os acromiale as the source of pain [21] and exclude the main differential diagnoses [22] (rotator cuff damage and subacromial impingement of an “aggressive” acromion). A causative factor should be looked for including direct or indirect trauma to the shoulder or a history of surgery, even if this is not always found (four cases in our series, two cases in the series by Pagnani et al. [11] and 58% in the series by Abboud et al. [23]).
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