Old shoulder-surgery habits die hard, despite numerous reports of unwelcome side effects. A study published in the January 2016 Journal of Shoulder and Elbow Surgery has shown that adding an acromioplasty surgery to a surgery to repair a torn rotator cuff appears to place stress on the rotator cuff.

Every joint in your body needs to make sure that its surfaces are aligned with millimeter precision while you move. To do this, your body uses two systems. The first system is made up of muscles that actively maintain that alignment. The second consists of ligaments, which act like duct tape to hold the joint passively together. Both systems have to work to allow normal and efficient movement. If you get rid of one of these systems, there eventually will be problems in the joint as the surfaces undergo too much wear and tear. When this happens, osteoarthritis sets in.

The shoulder depends on certain ligaments for stability. These ligaments—called the coracoclavicular (CC) and coracoacromial (CA) ligaments—hold the acromioclavicular joint together.

The most common shoulder surgery performed in the United States today is a shoulder rotator cuff repair with acromioplasty. The surgery involves surgically sewing together the torn rotator cuff, which makes up the active stability system for the shoulder. Since surgeons believe that in many patients the rotator cuff tear happened because of extra pressure placed on the muscle, they usually also cut the CA ligament to try and give the rotator cuff more breathing room. This procedure is called an acromioplasty.

Most patients have no idea that their rotator cuff repair involves cutting this important stabilizing ligament. When they later seek treatment for osteoarthritis in their shoulder, they are surprised to learn that their shoulder was destabilized at the time of surgery when this structure was cut.

The study in the Journal of Shoulder and Elbow Surgery examined what happens when surgeons cut this critical ligament. The researchers looked at nine shoulders of cadavers where the forces on various structures could be measured before and after the ligament was cut. As expected, when the ligament no longer is able to stabilize the shoulder, the muscles have to work harder. The researchers were able to observe the effects of extra forces on the rotator cuff after acromioplasty.

Given that most of these surgeries also involve repairing the rotator cuff, extra tugging on that muscle because the surgeon cuts a stabilizing muscle is not helpful. This likely explains why many of these patients later develop osteoarthritis of the shoulder. After acromioplasty, the patient is left with an overloaded rotator cuff that tries to keep up with the extra stability demands. At some point, the rotator cuff is unable to maintain stability. The joint eventually suffers osteoarthritis from the extra wear and tear.

If you’re scheduled for a rotator cuff repair, it’s highly likely that your surgeon plans an acromioplasty at the same time. Don’t allow your shoulder to be destabilized because the surgeon is used to cutting this ligament

Regenexx doctors have experienced good results healing rotator cuffs without invasive surgery, using instead a precise injection of the patient’s own stem cells.

The body doesn’t come with spare parts. For decades orthopedic surgeons have been removing or cutting critical parts and pieces of the musculoskeletal system without much scientific justification or much information on the consequences of the surgeries. As our research improves, we’re seeing that these surgeries often do more harm than good. Acromioplasty is a case in point. If your surgeon wants to cut your CA ligament, consider finding another doctor.

 

“Shoulder Surgery Side Effects” first appeared as a post on the Regenexx blog.
Like all medical procedures, Regenexx procedures have a success and failure rate.
Not all patients will experience the same results.

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