title: Coracoacromial ligament section under ultrasonographic control: a cadaveric study on 20 cases.
abstract: BACKGROUND
  The coracoacromial ligament is a complex anatomical structure involved in the development of subacromial impingement; treatment is founded on sectioning the ligament, with or without associated arthroscopic acromioplasty and debridement.
  
  
  OBJECTIVE
  Complete coracoacromial ligament section can be performed under ultrasound, without lesion to surrounding structures.
  
  
  METHODS
  The coracoacromial ligament was sectioned on the coracoid side, under ultrasound navigation, in 10 cadavers donated to science: i.e. 20 shoulders. After ultrasound location of the shoulder structures, sectioning was performed with a skin incision at the level of the deltopectoral sulcus. Secondary surgical control checked conservation of the acromial branch of the thoracoacromial artery, and the quality of the procedure.
  
  
  RESULTS
  Mean surgery duration was 18.5 minutes (±5 min). Seventeen sections were complete (85%). Artery location was hampered by the impossibility of using Doppler on these cadavers, yet even so there were only 2 vascular lesions. There were no accidental rotator cuff or cartilaginous lesions.
  
  
  CONCLUSIONS
  This relatively non-invasive technique is quick and less heavy than open surgery, opening up new treatment perspectives. It could be indicated in coracoid and subacromial impingement before opting for surgery, or as a complement to surgery. It does, however, involve a learning curve and requires solid ultrasound skills.
authors.affiliation: Département d'orthopédie-traumatologie, CHU de Caen, avenue Côte-de-Nacre, 14000 Caen, France. Electronic address: delforge-s@chu-caen.fr.
authors.forename: S
authors.initials: S
authors.lastname: Delforge
authors.affiliation: Service de rhumatologie, CHU de Caen, avenue Côte-de-nacre, 14000 Caen, France.
authors.forename: B
authors.initials: B
authors.lastname: Lecoq
authors.affiliation: Département d'orthopédie-traumatologie, CHU de Caen, avenue Côte-de-Nacre, 14000 Caen, France.
authors.forename: C
authors.initials: C
authors.lastname: Hulet
authors.affiliation: Service de rhumatologie, CHU de Caen, avenue Côte-de-nacre, 14000 Caen, France.
authors.forename: C
authors.initials: C
authors.lastname: Marcelli
mesh_terms: D002102:Cadaver; D005240:Feasibility Studies; D006801:Humans; D008023:Ligaments, Articular / Q000000981:diagnostic imaging* / Q000601:surgery*; D019534:Shoulder Impingement Syndrome / Q000601:surgery; D012785:Shoulder Joint / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000601:surgery*; D018084:Ultrasonography, Interventional
keywords: Coracoacromial ligament; Coracoid impingement; Impingement syndrome; Subacromial impingement; Ultrasound