title: Acromionectomy and deltoid deficiency: a solution.
abstract: Deltoid insufficiency after iatrogenic or traumatic acromionectomy results from separation of the deltoid from its origin and mechanical fulcrum. Subsequent retraction of the tendon and formation of subdeltoid adhesions to the cuff and humerus result in stiffness and pain. We evaluated clinical outcomes of patients treated with autogenous tricortical iliac crest bone graft combined with deltoid reconstruction or deltoidplasty for deltoid insufficiency after acromionectomy. We retrospectively reviewed four patients, three males, and one female treated with deltoidplasty reconstructions as revision surgery. Their mean age was 41 years, and the minimum followup was 41 months (mean, 50 months; range, 41-66 months). There were three work-related injuries. Outcomes evaluated were pain relief (visual analog score), American Shoulder and Elbow Surgeons score, cosmesis, and complications. The mean pain score improved from 8 (range, 3-10) preoperatively to 1 (range, 0-3) postoperatively. The mean American Shoulder and Elbow Surgeons score improved from 31 +/- 14 to 68 +/- 13. One patient required revision deltoidplasty for abductor weakness. Three patients underwent hardware removal. One patient who underwent concurrent latissimus dorsi transfer had limited functional improvement but decreased pain. Two patients had improved cosmesis. All had CT scans with three-dimensional reconstructions documenting union. All patients stated they would undergo the procedure again.
  
  
  METHODS
  Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Harvard Shoulder Service, Massachusetts General Hospital, 55 Fruit Street, Suite 3200, 3G, Room 3-044, Boston, MA 02114, USA. JWARNER@partners.org
authors.forename: Brian
authors.initials: B
authors.lastname: Forsythe
authors.forename: Kyle P
authors.initials: KP
authors.lastname: Lavery
authors.forename: Jon J P
authors.initials: JJ
authors.lastname: Warner
mesh_terms: D000174:Acromion / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D001132:Arm / Q000503:physiopathology; D016025:Bone Transplantation / Q000009:adverse effects; D001915:Braces; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D007085:Ilium / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology / Q000601:surgery*; D009135:Muscular Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D026201:Musculoskeletal Manipulations; D010027:Osteotomy / Q000009:adverse effects*; D010147:Pain Measurement; D017060:Patient Satisfaction; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000601:surgery; D012720:Severity of Illness Index; D012782:Shoulder / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D020069:Shoulder Pain / Q000209:etiology / Q000517:prevention & control; D013709:Tendon Transfer; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult