Editorial Commentary: Acromioplasty Does Not Improve Clinical Outcome of Arthroscopic Rotator Cuff Repair: The Game Is Over!

Acromioplasty is a well-known, simple, and reproducible surgical technique that is used in isolation or in combination with other arthroscopic procedures. The clinical value of acromioplasty combined with arthroscopic rotator cuff repair has been largely investigated. Main theoretical benefits lie in the opportunity to improve the visualization, decrease abrasive wear with prominent acromial morphology, and release natural growth factors. On the other hand, acromioplasty and release of the coracoacromial ligament may weaken the insertion of the deltoid muscle, induce scar formation in the subacromial space, theoretically limiting shoulder mobility, and increase risk of anterior-superior humeral escape, especially in patients with large to massive rotator cuff tears. Clinical studies report conflicting results. My results show no differences in clinical outcomes in rotator cuff repairs with or without subacromial decompression, regardless of the acromial morphology. At the same time, I do believe that confirmatory studies are always necessary, especially if the aim is to disprove the usefulness of a common practice.     

Editorial Commentary: Adolescent Patients Undergoing Hip Arthroscopy Require a Considerable Improvement in Postoperative Outcomes Scores to Achieve Substantial Clinical Benefit: The International Hip Outcome Tool-33 Seems Optimal for Measuring Substantial Clinical Benefit In Young,Active Patients

Arthroscopic treatment of femoroacetabular impingement syndrome in adolescents is increasing, with evidence supporting similarly improved outcomes as in adult populations. Adolescent patients present unique challenges compared with adult counterparts, often with greater demands on their hips and greater baseline functional statuses. Further, elective surgery in adolescents demands long-lasting outcomes for treatment success. There is increased effort in the orthopaedic literature to define improvements in outcomes that are significant to the patient, including minimal clinically important difference, substantial clinical benefit, and patient acceptable symptomatic state. Delineation of these benchmarks in the adolescent population is important for measuring the success of arthroscopic hip surgery as indications are refined. The international Hip Outcome Tool (iHOT)-33 seems optimal for measuring substantial clinical benefit in young, active patients. Finally, the iHOT-12 has been shown to lose little information compared with the iHOT-33 and it is less burdensome for patients.