Rotator cuff degeneration and tear are common causes of shoulder pain, often induced by multiple factors. Two theories are widely accepted to explain the mechanism of this injury: the mechanical (extrinsic) theory, which suggests symptoms arise from changes in the anatomical shape of the acromion, and the degenerative (intrinsic) theory, which suggests symptoms arise from degeneration of the rotator cuff tissue. The anatomical changes in the acromion lead to impingement between the acromion and rotator cuff, which is the theoretical basis of acromioplasty. Since Neer first reported this, many open or arthroscopic acromioplasty has been performed, aiming to reduce the pressure between the acromion and rotator cuff by partially reshaping the acromion. However, in recent years, more and more studies have questioned the necessity of acromioplasty in treating rotator cuff injuries. McCallister et al. repaired full-thickness rotator cuff tears without performing acromioplasty and significantly improved shoulder joint range of motion (ROM) and other clinical functions after surgery. Subsequent prospective randomized controlled studies have also not found any benefits of acromioplasty in treating full-thickness rotator cuff injuries.Furthermore, some studies have found that partial release of the coracohumeral ligament during acromioplasty can increase the risk of anterior superior instability of the glenohumeral joint. Based on these observations, many surgeons have begun to reassess the role of acromioplasty and the concept of extrinsic impingement in treating rotator cuff injuries. In addition to common causes of rotator cuff injuries, such as age-related degeneration, overuse of the shoulder joint, smoking, diabetes, etc., some patients can recall a history of shoulder joint trauma before the onset of shoulder joint symptoms. Studies have discussed the relationship between trauma and rotator cuff injuries. Braune et al. compared the postoperative outcomes of traumatic and non-traumatic rotator cuff injuries and found that patients with traumatic rotator cuff injuries had higher Constant-Murley scores, better ROM, and lower visual analogue scale (VAS) scores for pain. Tan et al. sequentially compared 1,300 patients with rotator cuff injuries and found that patients with traumatic tears had more restricted ROMs. In a retrospective study, Kang Jianguo et al. found that acromioplasty did not further improve joint function after rotator cuff repair and may not be a common choice for rotator cuff repair. Therefore, it is still unclear whether a history of trauma affects the functional results of rotator cuff injuries and their surgical repair.

To retrospectively evaluate the effect of acromioplasty or subacromial bursectomy on postoperative clinical outcomes in patients with arthroscopic repair of traumatic and non-traumatic rotator cuff injuries.

The patients with rotator cuff injury who received arthroscopic rotator cuff repair from January 2016 to July 2020 were retrospectively divided into trauma group or non-trauma group according to the history of trauma. Each patient underwent acromioplasty or subacromial bursectomy. The patients were followed up regularly for at least 12 months. Constant-Murley score, ASES score, UCLA score, VAS pain score, and shoulder range of motion were recorded before and after surgery. The preoperative and postoperative clinical functions of patients with traumatic and nontraumatic rotator cuff injuries, or acromioplasty and subacromial bursectomy, were compared with those who underwent acromioplasty.

One hundred fourteen patients were enrolled in this study, including 50 in the trauma group and 64 in the non-trauma group. Among the trauma group, 41 patients (82.0%) received acromioplasty during rotator cuff repair surgery, while 43 (67.2%) in the non-trauma group received acromioplasty. The remaining patients underwent subacromial bursectomy. At 12 months postoperatively, the Constant-Murley score, ASES score, VAS pain score, and shoulder joint range of motion significantly improved compared to preoperative values in both the trauma and non-trauma groups. There was no significant difference in postoperative function and range of motion in the trauma group between patients who received acromioplasty and those who underwent subacromial bursectomy. However, in the non-trauma group, patients who received acromioplasty had significantly better Constant-Murley scores (83.6 points vs. 81.6 points, P = 0.03), ASES score (89.0 points vs. 80.1 points, P <0.01), UCLA score (31.1 points vs. 29.2 points, P= 0.03), VAS pain score (1.2 points vs. 2.1 points, P <0.01), external rotation angle (160.0°vs. 151.7°, P= 0.03), and abduction angle (60.1° vs. 53.3°, P= 0.03) compared to patients who underwent subacromial bursectomy.

In the arthroscopic repair of non-traumatic rotator cuff injuries, acromioplasty results in better joint function and range of motion than subacromial bursectomy.