Stabilization of os acromiale with cannulated screws and high-resistance sutures

259 ABSTRACT Os acromiale is defined as the absence of fusion of any of the primary acromial ossification centres with the basal acromion. Affected patients usually present nonspecific symptoms such as pain (generally nocturnal), difficulty performing activities involving abduction above 90°, and weakness. First line treatment should not consist of surgery; instead, the administration of nonsteroidal anti-inflammatory drugs or local corticosteroid infiltrations are indicated. Nevertheless, surgery often proves necessary due to high refractoriness to conservative management. Many surgical techniques have been described, though agreement is lacking as to which option is best for the fixation of mesoacromion type unstable symptomatic os acromiale. The present technical note describes our preferred surgical approach for such cases, based on the use of cannulated screws reinforced by a high-resistance suture tension band distributed in an "8" pattern, without added bone grafting and employing a transacromial medial to lateral surgical approach with minimum disinsertion of the deltoid muscle. The advantages and limitations of the procedure are also described, and the key aspects to be taken into account when performing the technique are commented.