Fixation of os acromiale using polyester sutures: a novel surgical treatment

Abstract

Background: Patients with unstable os acromiale often complain of shoulder pain. Numerous surgical treatment options have been introduced with inconsistent clinical results. In this study, a novel surgical treatment using polyester sutures to fix unstable os acromiale was introduced, and clinical results were reported.Methods: We retrospectively studied 10 shoulders that were diagnosed with os acromiale from January 2014 to January 2016. All 10 cases were of the meso-acromion type. Except for the first case in our series, cases of os acromiale were fixed using polyester sutures arthroscopically. The standardized scores and visual analog scale (VAS) were recorded preoperatively and at each follow-up. A computed tomography (CT) scan was ordered at the follow-up of 12 months. Results:The average follow-up length was 28.7 months, ranging from 26 to 33 months. The average Constant score before surgery was 40.50±4.53 points, which significantly improved to 75.60±5.17 points after surgery. The average VAS score was reduced from 5.20±1.14 points to 1.60±0.84. At the follow-up of 12 months, a CT scan was ordered. All the patients showed a bony union of the os acromiale. On the CT scan, two small pits could be seen on the medial and lateral side of the acromion, which indicated the level of the os acromiale. The position of the os acromiale was good, and no evident sclerosis was found on the edges of the fragments.Conclusions: Polyester sutures could provide reliable strength for the fixation of os acromiale without any irritation from hardware.

Arthroscopic Fixation of Symptomatic Meso-Type Os Acromiale: Technical Note

“…It is less time consuming and it allows improved bone contact with possible increased compression across the nonunion [ 12 ]. All suture circulage technique was reported by Guo et al [ 1 ] with reported bony fusion for all cases. Our technique has the advantage of a fully arthroscopic procedure with no need for open intervention.…”

“…Os acromiale is a developmental condition which results from failure of fusion of the secondary ossification centre. Four different ossification centres have been identified; failure of fusion of any of them results in mobile Os acromiale [ 1 ]. Its prevalence is estimated between 1 and 15% based on different studies.…”

“…Multiple treatment strategies have been tried; no surgical management rarely result in complete cure of the condition due to the structural nature of the condition. Symptomatic meso-type Os acromiale is usually treated surgically; subacromial decompression, excision, or fixation were reported with mixed results, with the majority of surgical techniques open procedures [ 1 , 4 , 5 ]. Due to advances in arthroscopic techniques and surgical implants, we developed all arthroscopic surgical fixation technique for meso-type Os acromiale.…”

Surgical treatment of a symptomatic os acromiale by arthroscopy-assisted double-button fixation: a case report

“…This process of bone formation is usually completed by around 25 years of age [1,5,[7][8][9][10]. Nevertheless, the reported incidence of deficient osseous fusion, leading to a disunited fragment ranged from 1 to 30% [2,4,5,8,[10][11][12].…”

“…In the majority of unfused cases, an os acromiale is asymptomatic and incidentally detected on shoulder radiographs [ 6 – 8 , 11 , 13 ]. Alternately, painful conditions including tenderness on palpation, complaints during overhead activities, pain due to sleeping on the affected shoulder, positive signs of impingement and weakness of the rotator cuff muscles [ 6 , 7 , 10 – 12 ] frequently occur after trauma or may have atraumatic origins [ 4 , 6 – 8 ]. Symptomatic patients should initially receive conservative management involving physiotherapy, analgesia and supplementary corticoid injections for at least 6 months [ 2 , 6 – 9 , 11 , 12 ].…”