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Dr. José Carlos Garcia Jr.

Especialista em cirurgia de ombro, cotovelo e artroscopia

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Tratamento artroscópico do os-acromiale

Apresentado no congresso da Associação de Artroscopia da América do Norte

Os Acromiale : Arthroscopic Treatment
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Jose Carlos Garcia Jr, MD, Roberto Bongiovanni, MD, Luciano Pascarelli, MD, Ricardo Myrrha, MD

Introduction: Os acromiale is a condition related to the nonunion of the acromium’s growing cartilage. It can be associated to higher rates of shoulder pain and rotator cuff lesions. Some patients with this condition can present a pain due to the dynamic minimization of the subacromial space causing an impingement syndrome. The surgical treatment of the symptomatic os acromiale is the open acromium ostheosyntesis. This study will report the arthroscopic technique to the os acromiale’s treatment and its preliminary results.

Methods: All surgeries were performed in the beach chair position. The posterior portal was stablished and a lateral portal just under the point where the surgeon can feel the os acromiale. With these two portals the surgeon will be able to shave the region of the condition until it is possible to see the marrow bone. The coracoacromial ligament is released in order to minimize the anteroinferior traction of the acromium. Two small portals are made in the anterior acromium to insert 2 cannulated Herbert screws. A needle is inserted under the acromium to ensure the correct position and way of the screws. The fragments are compressed and the osteossintesis is done. We performed 12 surgeries in patients with symptomatic os acromiale from Evaluations were made by using the UCLA before and 4 months after surgeries.

Results: Twelve surgeries were performed to correct the symptomatic os acromiale. Two surgeries have less than 4 months and were not evaluated, in a case the acromium was broken and andarthroscopic excision was performed successfully, these patients were withdrawn of the study. The remain 8 surgeries presented a pre operative UCLA’s average of 21,25, the 4th month post operative UCLA’s average was 29,75. Our worst result happened in a patient with the anterior fragment osteolisis, it was corrected by the open procedure.
Conclusion: The arthroscopic os acromiale’s osteossintesis is a difficult and challenging issue in shoulder surgery. We are presenting a new technique that have evolved during this survey. The results have encouraged our team to continue using this technique. It is a minimally invasive procedure that can allow the surgeon to better access many other areas of the shoulder as well as release the coracoacromial ligament. Several improvements and new materials for this technique may be necessary for its future improvement and acceptance. In this moment does not seem evident that there are long term differences between opne versus arthroscopic techniques. 
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