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Multiplanar Analysis of Acromion Morphology

John D. MacGillivray, MD, Stephen Fealy, MD, Hollis G. Potter, MD and Stephen J. O’Brien, MD

Department of Sports Medicine and Shoulder Service, The Hospital For Special Surgery, Cornell University Medical Center, New York, New York

Presented at the 22nd annual meeting of the AOSSM, Lake Buena Vista, Florida, June 1996.

Address correspondence and reprint requests to Stephen J. O’Brien, MD, The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021

To more completely describe acromion morphology and its relationship to impingement syndrome, we performed three-dimensional magnetic resonance imaging (N = 111) or computed tomography (N = 27) on 132 symptomatic shoulders. The mean patient age was 46.2 years (range, 14 to 86). Four parameters were evaluated: the angle of anterior slope of the acromion in the midsagittal and lateral-sagittal planes, lateral acromial angulation in the coronal plane, and the presence or absence of medial encroachment in the acromioclavicular joint. Twenty-five asymptomatic, age-matched shoulders were used as controls. All imaging data were combined because no significant differences existed between the two imaging techniques. The mean acromion angle was 19.4° in the midsagittal plane and 20° in the lateral-sagittal plane. In the coronal plane, 97 (73%) acromions were neutral and 35 (27%) were downward sloping. Medial encroachment was present in 31 (24%) shoulders. Age distribution from the 2nd to 8th decade demonstrated a consistent and gradual transition from a flat acromion in the younger decades to a more hooked acromion in the older decades that was significant in both the midsagittal and lateral-sagittal planes. Furthermore, a greater percentage of patients were found to have downward angulating acromions with increasing age. Ninety-eight patients (74%) had stage II or III impingement. Of these shoulders, 39 (40%) had type I acromions, 51 (52%) type II, and 8 (8%) type III. Twenty-eight of 33 acromions with coronal lateral downward sloping had impingement, and all 31 shoulders with medial encroachment had impingement.

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