Editorial Commentary: Long-Term, Clinical Outcome of Arthroscopic Rotator Cuff Repair May Be Improved With Concomitant Acromioplasty in Patients With a Type III Acromion

In theory, extrinsic anterolateral acromial impingement of the rotator cuff can contribute to cuff tearing. Thus, acromioplasty may be performed concomitantly with arthroscopic rotator cuff repair (ARCR). A review of recent randomized controlled trials confirms that patient long-term outcomes after ARCR are superior when acromioplasty is performed when compared to no concomitant acromioplasty, while complication and retear rates are similar. This is in contrast to previous reviews identifying no significant clinical differences in postoperative functional outcomes, patient-reported outcomes, or reoperation rates in the short to medium term. In sum, emerging evidence suggests that we start to observe differences in outcomes in the longer term in favor of acromioplasty. From our point of view, both patient and surgical factors determine outcome. There is growing evidence that ARCRs with acromioplasties may contribute to superior functional outcomes and reduced reoperation rates in the long-term postoperation. However, postoperative outcomes of such procedures remain dependent on both patient and surgical factors. Patient factors include acromial morphology, comorbidities, and tear pattern, size, and repairability. Type III acromial morphology is a risk factor for poor outcome absent acromioplasty. Surgical factors include repair technique and surgeon experience.