The critical acromial point: the anatomic location of the lateral acromion in the critical shoulder angle

Background: Acromioplasty has been proposed as a means of altering elevated critical shoulder angles (CSAs). We aimed to localize the critical acromion point (CAP) responsible for the acromial contribution of the CSA and determine whether resection of the CAP can alter the CSA to a normal range. Methods: The CAP and 3-dimensional (3D) CSAs were determined on 3D computed tomography reconstructions of 88 cadaveric shoulders and compared with corresponding CSAs on digitally reconstructed radiographs. The position of the CAP was fluoroscopically isolated in 20 of these specimens and the resulting fluoroscopic CSA compared with the corresponding 3D CAP and 3D CSA. We investigated the CSA before and after a virtual acromioplasty of 2.5 and 5 mm at the CAP in specimens with a CSA greater than 35 degrees. Results: The mean CAP was 21% +/- 10% of the acromial anterior-posterior length from the anterolateral corner. There was no difference between the mean 3D CSA and the CSA on digitally reconstructed radiographs (32 degrees vs 32 degrees, P = .096). No difference between the mean fluoroscopic CSA and 3D CSA was found (31 degrees vs 31 degrees, P = .296). A 2.5-mm acromial resection failed to reduce the CSA to 35 degrees or less in 7 of 13 shoulders, whereas a 5-mm resection reduced the CSA to 35 degrees or less in 12 of 13. Conclusion: The CAP was localized to the anterolateral acromial edge and was easily identified fluoroscopically. A 5-mm acromial resection was effective in reducing the CSA to 35 degrees or less. These data can guide surgeons in where and how to alter the CSA if future studies demonstrate a clinical benefit to surgically modifying this radiographic parameter. (C) 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.