The Coracoacromial Ligament: Anatomy, Function, and Clinical Significance

Overview

Journal Orthop J Sports Med

Specialty Orthopedics

Date 2017 May 17

PMID 28508008

Citations 17

Authors

Adam Rothenberg

Gregory Gasbarro

Jesse Chlebeck

Albert Lin

Affiliations

Soon will be listed here.

Abstract

The coracoacromial ligament (CAL) was first described as a pain generator by Dr Charles Neer in the early 1970s. Since that time, considerable controversy regarding CAL management during acromioplasty has persisted. This review aims to better understand the role of the CAL in shoulder physiology and pathology. Sixty-six articles from 1958 to 2016 were identified using an electronic search of PubMed, Cochrane Library, AccessMedicine, and MD Consult for case series as well as cohort and prospective studies. The authors used "coracoacromial ligament" and "coracoacromial veil" as medical subject headings (MeSH). In addition, reference lists from all identified articles were reviewed for studies that the search terms may have omitted. The CAL plays an important role in shoulder biomechanics, joint stability, and proprioception. Morphological variance of the CAL is evident throughout the literature. Age-dependent changes due to chronic stress and cellular degradation cause thickening and stiffening of the CAL that may contribute to a spectrum of shoulder pathology from capsular tightness to rotator cuff tear arthropathy and impingement syndrome. The CAL is an integral component of the coracoacromial arch. CAL release during acromioplasty remains controversial. Future clinical outcomes research should endeavor to advance the understanding of the CAL to refine clinical and intraoperative decision making regarding its management.

Citing Articles

The elastic properties of the tendinous and capsular layers of the rotator cuff complex using fresh tissue-a biomechanical study.

Cronje J, Mogale N, Govender S, de Beer M, Oberholster A, McDuling C Eur J Orthop Surg Traumatol. 2025; 35(1):68.

PMID: 39932599 PMC: 11814050. DOI: 10.1007/s00590-024-04168-2.

Coracoacromial ligament integrity influences scapular spine strain after reverse shoulder arthroplasty.

Fleet C, Kerrigan A, Langohr G, Johnson J, Athwal G JSES Int. 2025; 9(1):283-289.

PMID: 39898219 PMC: 11784478. DOI: 10.1016/j.jseint.2024.10.012.

Anatomic factors associated with degeneration and fraying of the coracoacromial ligament.

Lopez R, Singh J, Ghoraishian M, Nicholson T, Gates S, Namdari S Clin Shoulder Elb. 2023; 27(1):26-31.

PMID: 38147873 PMC: 10938016. DOI: 10.5397/cise.2023.00661.

Changes in Scapular Function, Shoulder Strength, and Range of Motion Occur After Latarjet Procedure.

van de Kuit A, Verweij L, Priester-Vink S, Veeger H, van den Bekerom M Arthrosc Sports Med Rehabil. 2023; 5(6):100804.

PMID: 37822673 PMC: 10562159. DOI: 10.1016/j.asmr.2023.100804.

Association of Coracoacromial Ligament Degeneration With Rotator Cuff Tear Patterns and Retear Rate.

Chuang H, Hong C, Hsu K, Kuan F, Chen Y, Yen J Orthop J Sports Med. 2023; 11(6):23259671231175873.

PMID: 37347016 PMC: 10280534. DOI: 10.1177/23259671231175873.

References

Bigliani L, Kelkar R, Flatow E, Pollock R, Mow V . Glenohumeral stability. Biomechanical properties of passive and active stabilizers. Clin Orthop Relat Res. 1996; (330):13-30. View

Tillmann B, Tichy P . [Functional anatomy of the shoulder]. Unfallchirurg. 1986; 89(9):389-97. View

Kopuz C, Baris S, Yildirim M, Gulman B . Anatomic variations of the coracoacromial ligament in neonatal cadavers: a neonatal cadaver study. J Pediatr Orthop B. 2002; 11(4):350-4. DOI: 10.1097/00009957-200210000-00015. View

Hockman D, Lucas G, Roth C . Role of the coracoacromial ligament as restraint after shoulder hemiarthroplasty. Clin Orthop Relat Res. 2004; (419):80-2. DOI: 10.1097/00003086-200402000-00014. View

Holt E, Allibone R . Anatomic variants of the coracoacromial ligament. J Shoulder Elbow Surg. 1995; 4(5):370-5. DOI: 10.1016/s1058-2746(95)80021-2. View

Moorman C, Warren R, Deng X, Wickiewicz T, Torzilli P . Role of coracoacromial ligament and related structures in glenohumeral stability: a cadaveric study. J Surg Orthop Adv. 2013; 21(4):210-7. DOI: 10.3113/jsoa.2012.0210. View

Wu C, Wang Y, Wang H, Chen W, Wang T . Evaluating displacement of the coracoacromial ligament in painful shoulders of overhead athletes through dynamic ultrasonographic examination. Arch Phys Med Rehabil. 2010; 91(2):278-82. DOI: 10.1016/j.apmr.2009.10.012. View

Chambler A, Pitsillides A, Emery R . Acromial spur formation in patients with rotator cuff tears. J Shoulder Elbow Surg. 2003; 12(4):314-21. DOI: 10.1016/s1058-2746(03)00030-2. View

Eid A, Dwyer A, Chambler A . Mid-term results of arthroscopic subacromial decompression in patients with or without partial thickness rotator cuff tears. Int J Shoulder Surg. 2012; 6(3):86-9. PMC: 3507329. DOI: 10.4103/0973-6042.102558. View

10.

Uhthoff H, Hammond D, Sarkar K, Hooper G, Papoff W . The role of the coracoacromial ligament in the impingement syndrome. A clinical, radiological and histological study. Int Orthop. 1988; 12(2):97-104. DOI: 10.1007/BF00266972. View

11.

Neer 2nd C . Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am. 1972; 54(1):41-50. View

12.

Hansen U, Levy O, Even T, Copeland S . Mechanical properties of regenerated coracoacromial ligament after subacromial decompression. J Shoulder Elbow Surg. 2004; 13(1):51-6. DOI: 10.1016/j.jse.2003.09.016. View

13.

Wellmann M, Petersen W, Zantop T, Schanz S, Raschke M, Hurschler C . Effect of coracoacromial ligament resection on glenohumeral stability under active muscle loading in an in vitro model. Arthroscopy. 2008; 24(11):1258-64. DOI: 10.1016/j.arthro.2008.01.015. View

14.

Muraki T, Yamamoto N, Zhao K, Sperling J, Steinmann S, Cofield R . Effect of posteroinferior capsule tightness on contact pressure and area beneath the coracoacromial arch during pitching motion. Am J Sports Med. 2009; 38(3):600-7. DOI: 10.1177/0363546509350074. View

15.

Putz R, Liebermann J, Reichelt A . [The function of the coracoacromial ligament]. Acta Anat (Basel). 1988; 131(2):140-5. View

16.

Michener L, McClure P, Karduna A . Anatomical and biomechanical mechanisms of subacromial impingement syndrome. Clin Biomech (Bristol). 2003; 18(5):369-79. DOI: 10.1016/s0268-0033(03)00047-0. View

17.

Panni A, Milano G, Lucania L, Fabbriciani C, Logroscino C . Histological analysis of the coracoacromial arch: correlation between age-related changes and rotator cuff tears. Arthroscopy. 1996; 12(5):531-40. DOI: 10.1016/s0749-8063(96)90190-5. View

18.

Altchek D, Warren R, Wickiewicz T, Skyhar M, Ortiz G, Schwartz E . Arthroscopic acromioplasty. Technique and results. J Bone Joint Surg Am. 1990; 72(8):1198-207. View

19.

Fealy S, April E, Khazzam M, Armengol-Barallat J, Bigliani L . The coracoacromial ligament: morphology and study of acromial enthesopathy. J Shoulder Elbow Surg. 2005; 14(5):542-8. DOI: 10.1016/j.jse.2005.02.006. View

20.

Dietrich T, Jonczy M, Buck F, Sutter R, Puskas G, Pfirrmann C . Ultrasound of the coracoacromial ligament in asymptomatic volunteers and patients with shoulder impingement. Acta Radiol. 2015; 57(8):971-7. DOI: 10.1177/0284185115610930. View