Successful osteosynthesis of an unstable mesoacromion in 6 shoulders: a new technique

Six patients with impingement syndrome associated with an unstable mesoacromion underwent successful acromial fusion performed with a new technique. Preoperative symptoms included pain from a combination of 3 sources: movement at the mesoacromial cleft, junction of the medial cleft with the distal clavicle, and dynamic impingement of the unstable anterior acromion on the underlying rotator cuff. Two patients reported the onset of pain after a blow to the top of the acromion that supposedly rendered the mesoacromion unstable. Three patients had a tear of the supraspinatus tendon. The operative technique utilized 4.5-mm cannulated Herbert screws for fixation, a dorsal wedge osteotomy of the nonunion site, a dorsal bone graft fashioned from an anterior acromion cut, a figure-of-eight suture, and a postoperative abduction brace. Tilting the anterior acromial fragment up and fusing it together worked to relieve impingement. An acromioplasty was not performed. The 3 rotator cuff tears were repaired. After 3 to 6 years of follow-up, all 6 shoulders were rated as excellent according to criteria similar to that of the American Shoulder and Elbow Surgeons.