Management of Type 2 Acromion

Introduction to Type 2 Acromion

The American Academy of Orthopaedic Surgeons notes that Type 2 acromion has been theoretically linked to increased risk of subacromial impingement, but treatment should focus on underlying pathology rather than acromial morphology alone 1, 3
The Bigliani classification categorizes acromion morphology into three types, including Type 3: Hooked 2

The American Academy of Orthopaedic Surgeons recommends that routine acromioplasty is not required for Type 2 acromion, as Level II randomized studies show no significant difference in outcomes between rotator cuff repair with acromioplasty versus repair alone 1, 2, 3, 6
One study of 47 patients with Type 2 acromion showed no difference in ASES scores between those who had repair with acromioplasty versus repair alone 1, 3
Another study of 80 patients with Type 2 or 3 acromion showed no significant differences in Constant-Murley or DASH scores between repair with or without acromioplasty 1, 3
For irreparable rotator cuff tears, partial repair, debridement, or muscle transfers may be considered, with level IV studies showing improvement in pain and function 1, 3

The American College of Radiology recommends initial radiographic evaluation to include standard shoulder radiographs, including AP and lateral views, and a suprascapular outlet view or Rockwood view to evaluate acromial morphology 7
For further evaluation when radiographs are noncontributory, MRI without contrast or ultrasound are appropriate for evaluating associated soft tissue pathology 8
MR arthrography may be considered if labral pathology is suspected 7

The American Academy of Orthopaedic Surgeons notes that simply having a Type 2 acromion does not necessitate surgical intervention, and adequate conservative treatment should be considered before surgery 1, 3
The American Academy of Orthopaedic Surgeons also notes that the American Academy of Orthopaedic Surgeons (AAOS) has conflicting evidence regarding the efficacy of subacromial corticosteroid injections 5