Acromioplasty Indications and Considerations

Introduction to Acromioplasty

The American Academy of Orthopaedic Surgeons recommends that acromioplasty is not indicated as a routine procedure in rotator cuff repair, as level II studies demonstrate it does not provide clinically significant benefits compared to rotator cuff repair without acromioplasty 1, 2

Acromioplasty may be considered after 3-6 months of failed conservative treatment, including therapeutic exercises and non-steroidal anti-inflammatory drugs, for patients with refractory subacromial impingement syndrome 3
The presence of a Bigliani type 2 or 3 acromion alone does not justify acromioplasty, as level II studies show no significant differences in outcomes between patients with type 2 or 3 acromions who underwent rotator cuff repair with or without acromioplasty 1, 2, 4

Acromioplasty is not recommended as a routine procedure during rotator cuff repair, as it is not required for managing normal acromial bone 1, 2
Acromioplasty is not recommended as a first-line treatment for subacromial impingement syndrome, as conservative treatment should be attempted first 3

The current evidence does not support surgical subacromial decompression as a first-line treatment, as it does not provide clinically significant improvements in pain, function, or quality of life compared to other treatments 3, 5