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1. www.shoulder.gr
E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection
Verona 13.06.2017
How to do a subacromial
decompression and distal
clavicle resection
Manos Antonogiannakis
Orthopaedic Surgeon
Director of 3rd Orthopaedic Department
Centre for Arthroscopy & Shoulder Surgery
Hygeia General Hospital
ESSKA Advanced Shoulder Arthroscopy Course
All About Rotator Cuff & Other Subacromial Disorders
Verona, 13-14 June 2017 .

2. www.shoulder.gr
E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection
Verona 13.06.2017
History of acromioplasty
Neer JBJS 1972. Anterior acromioplasty for impingement syndrome
Bigliani 1986 the morphology of acromion
ELMAN Arthroscopy 1987 .Arthroscopic subacromial decompresion
Gaspari 1992 Presicion cutting block technique
Nirschl 1989 Is acromioplasty nessecery ?
Matsen JBJS 2005 no need for acromioplasty in rot cuff repair
Tibone CORR 1985 no indication for subacromial decompression in young athletes

3. www.shoulder.gr
E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection
Verona 13.06.2017
New conceps
Critical Shoulder Angle (Gerber)
>35 degrees increased danger of
RC tears
<35 degrees increased danger of
OA

4. www.shoulder.gr
E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection
Verona 13.06.2017
 Type 1: Flat
 Type 2: Curved
 Type 3: Hooked
Acromial types (Bigliani)
Type 3
Type 2
Type 1

5. www.shoulder.gr
E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection
Verona 13.06.2017
Positioning the patient
Lateral decubitus
My preferred position

6. www.shoulder.gr
E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection
Verona 13.06.2017
Subacromial decompression
• Posterior portal
• Lateral portal
P
L
AS
AI
N

7. www.shoulder.gr
E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection
Verona 13.06.2017
Portals for subacromial arthroscopy
 Create the Lateral portal
 3-4cm distal to the lateral acromion

8. www.shoulder.gr
E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection
Verona 13.06.2017
Subacromial decompression
Bursoscopy /Bursectomy
OP Goal: Type 3
Type 1
Lichtenberg, Habermeyer, Magosch

9. www.shoulder.gr
E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection
Verona 13.06.2017
Subacromial decompression
 do not cut the Lig. coracoacromiale
 localize the anterior and lateral edge
of acromion
 resect from lateral, the acromion
hooked spur (anterior more than
posterior)
 resect the lateral edge of acromion
Lichtenberg, Habermeyer, Magosch

10. www.shoulder.gr
E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection
Verona 13.06.2017
Subacromial decompression
 change portals, look
from lateral
 cutting-block technique Lichtenberg, Habermeyer, Magosch

11. www.shoulder.gr
E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection
Verona 13.06.2017
Subacromial decompression – remove Bursa

12. www.shoulder.gr
E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection
Verona 13.06.2017
Subacromial decompression – find the
landmarks

13. www.shoulder.gr
E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection
Verona 13.06.2017
Subacromial decompression – Acromioplasty
Landmarks:
Anterior edge of the acromion
Lateral edge of the acromion
Anterolateral corner
Ac joint

14. www.shoulder.gr
E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection
Verona 13.06.2017
Distal clavicle resection
 Zanka View
 T2-coronar MRI picture

15. www.shoulder.gr
E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection
Verona 13.06.2017
AC pathology that can be treated by arthroscopy
 AC arthritis
 AC ganglion
 AC dislocation

16. www.shoulder.gr
E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection
Verona 13.06.2017
Distal clavicle resection
• Posterior portal
• Lateral portal
• Anterior portal (anterior from
from ACJ)
• Anterosuperior portal

17. www.shoulder.gr
E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection
Verona 13.06.2017
Distal clavicle resection
 look from posterior, resect from
lateral
 resect 6-8 mm (2/3 from clavicle,
1/3 from acromion)
resect parallel to the ACJ
Kohn, Pohlemann

18. www.shoulder.gr
E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection
Verona 13.06.2017
Distal clavicle resection
 do not resect the posterosuperior
capsule (stability function)
 denervate the rest bone
 look from anterior
Lichtenberg, Habermeyer, Magosch

19. www.shoulder.gr
E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection
Verona 13.06.2017
 use 70˚ scope to complete excision

20. www.shoulder.gr
E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection
Verona 13.06.2017
 check distance in abduction and external rotation

21. www.shoulder.gr
E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection
Verona 13.06.2017
Distal clavicle resection
resect denervatecheck

22. www.shoulder.gr
E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection
Verona 13.06.2017
Distal clavicle resection – start
from lateral

23. www.shoulder.gr
E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection
Verona 13.06.2017
Distal clavicle resection – anterior portal

24. www.shoulder.gr
E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection
Verona 13.06.2017
Distal clavicle resection

25. www.shoulder.gr
E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection
Verona 13.06.2017
Distal clavicle resection

26. www.shoulder.gr
E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection
Verona 13.06.2017
Distal clavicle resection – final check
8-10 mm space

27. www.shoulder.gr
E. Antonogiannakis How to do a subacromial decompression and distal clavicle resection
Verona 13.06.2017
Thank you for your attention!!!
Save the date: 1-3 February 2018