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.

Keywords: Shoulder; arthroscopy; os acromiale.

Figure 1

MR images. (A) Os acromiale on axial plane; (B) os acromiale on oblique sagittal plane.

Figure 2

Open reduction of os acromiale and fixation with polyester sutures.

Figure 3

Arthroscopic fixation of os acromiale. (A) A rasp was used to prepare the two fragments; (B) evident punctate bleeding was seen on both edges; (C) A PDS II was shuttled through a spinal needle underneath the acromion; (D) arthroscopic view of the two Ethibond sutures underneath the acromion.

Figure 4

Suture management. (A) Outside look after two #5 Ethibond sutures were pulled inside out; (B) a small incision of about 5 mm was made above the acromion for retrieving the sutures; (C) the margin between the two fragments was gone.

Figure 5

CT scan 12 months after the surgery, showing bony union of the os acromiale.