#4. ACROMIOPLASTY SAMPLE

PREOPERATIVE DIAGNOSIS: Impingement syndrome, left shoulder.

POSTOPERATIVE DIAGNOSIS: Impingement syndrome, left shoulder, with acromioclavicular spurs.

OPERATION: Arthroscopic evaluation of the glenohumeral joint, followed by arthroscopic bursectomy and anterior acromioplasty with co-planing of the acromioclavicular joint spurs.

ANESTHESIA: General.

SURGEON: Andrew Jackson, M.D.

ASSISTANT: A. Lincoln, S.A.

SUMMARY: The patient was given a general anesthetic and placed in the beach-chair position with the head rest. He was secured and strapped down. His shoulder was prepped and draped free in a standard sterile fashion.
A posterior approach was made to the glenohumeral joint and the probe and shaver were introduced through an anterior portal which was just medial to the coracoid. The shoulder was inspected and no undersurface tears were identified. There was some redundant synovitis in the joint superiorly along the labral attachment and that was debrided back. The long head was intact. We then withdrew and went into the subacromial space. A portal was established at the anterolateral corner and a shaver was introduced laterally. The shaver was introduced laterally and used to debride the bursa. The debridement was swept anteriorly and the subacromial space was opened up. The Bovie electrocautery instrument was introduced from the lateral portal and we started in the center of the acromion and worked our way anteriorly and medially to the acromioclavicular joint. The acromioclavicular joint was exposed because we knew that he had spurs there that needed debriding. The anterior edge of the anterior acromial space was identified and opened up. The coracoacromial ligament was divided. Hemostasis was achieved with the ArthroCare wand. Once the anterior acromial spur and the acromioclavicular joint spurs were well identified, the portals were switched and we placed the bur from the posterior portal and the scope anteriorly. The flat spot of the acromion was identified and an anterior acromioplasty was done, removing about 5-6 mm anteriorly. The ridge of spurs on the acromioclavicular joint were also debrided with the bur. We did the majority of the bony burring from the posterior portal and then switched the bur laterally to round off the anterior edge of the acromion and smooth out the acromioclavicular joint. The exterior of the rotator cuff was inspected and no defects or tears were encountered.
The wound was flushed out and the portals were closed with a single stitch. A sterile dressing was applied and the patient was recovered from his anesthetic and taken to the recovery room in good condition.