Type of Article:  Original Research

Volume 6; Issue 3.3 (Septmber 2018)

Page No.: 5621-5624

DOI: https://dx.doi.org/10.16965/ijar.2018.293


Surekha Jadhav 1, Shilpa Gosavi *2.

1 Professor, Department of Anatomy, Dr. Vithalrao Vikhe Patil Foundation Medical College, Ahmednagar, Maharashtra, India.

*2 Professor, Department of Anatomy, Bharati Vidyapeeth (Deemed to be University)  Medical College, Pune, Maharashtra, India.

Correspondence author: Dr. Shilpa Gosavi, Professor, Department of Anatomy, Bharati Vidyapeeth (Deemed to be University) Medical College,  Pune, Maharashtra, India, 411043. Mobile no. – +91 9822218073 E-Mail: sngosavi@yahoo.com


Introduction: The coraco-acromial ligament forms coraco-acromial arch along with acromion and coracoid process of scapula which prevent the superior humeral head displacement. It plays a key role in the patho-etiology of sub-acromial impingement syndrome when there are no significant bony abnormalities.

Material and Methods:  In the present study we have studied 120 formalin preserved upper limbs (right: 60; left: 60) of unknown age and sex. Each shoulder was dissected carefully to see coraco-acromial ligament.  The CAL was identified with careful blunt dissection to prevent overlooking any thinner bands. We observed the number of bands present and shape of the ligament. Photographs were taken.

Results: Different morphological subtypes of coraco-acromial ligament were observed and classified according to Kesmezacar et al. Type II (28.33 %) was the most common then type I (25 %), type IV (17.5 %), type V (15 %),   type III (11.66%). Anterolateral band of ligament extended antero-laterally to form coracoacromial falx in 51%.

Discussion: Coraco-acromial ligament shows different morphological variations in Indian population. Knowledge of morphological variations of coraco-acromial ligament will be helpful for orthopedic surgeon for clinical and intraoperative decision while dealing with sub-acromial impingement syndrome.

Key words: Coraco-Acromial Ligament, Sub-Acromial Impingement Syndrome, Acromion, Coracoid, Coraco-Acromial Arch, Morphology.


  1. Chambler AF, Pitsillides AA, Emery RJ. Acromial spur formation in patients with rotator cuff tears. J Shoulder Elbow Surg 2003;12:314-321.
  2. Standring S. Gray’s Anatomy: the anatomical basis of clinical practice. 40th ed. Elsevier Churchill Livingstone, London, 2009;795.
  3. Neer CS 2nd. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am 1972;54: 41-50.
  4. Fremerey R, Bastian L, Siebert W E. The coracoacromial ligament: Anatomical and biomechanical properties with respect to age and rotator disease. Knee Surg Sports Traumatol Arthrosc 2000; 8: 309-313.
  5. 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: 350-354.
  6. Sarkar K, Taine W, Uhthoff H K. The ultrastructure of the coracoacromial ligament in patient with chronic impingement syndrome. Clin Orthop Relat Res 1990; 49-54.
  7. Fealy S, April EW, Khazzam M, Armengol-Barallat J, Bigliani LU. The coracoacromial ligament: morphology and study of acromial enthesopathy. J Shoulder Elbow Surg 2005;14: 542-548.
  8. Kesmezacar H, Akgun I, Ogut T, Gokay S, Uzun I. The coracoacromial ligament: the morphology and relation to rotator cuff pathology. J Shoulder Elbow Surg 2008;17:182-188.
  9. Lie S, Mast W A. Subacromial bursography. Technique and clinical application. Radiology 1982;144: 626-630.
  10. Williams A, Calvert P, Bayley I. The bifurcate coraco-acromial ligament: an arthroscopic variant. Arthroscopy 1997;13: 233-234.
  11. Pieper HG, Radas CB, Krahl H, Blank M. Anatomic variation of the coraco-acromial ligament: a macroscopic and microscopic cadaveric study. J Shoulder Elbow Surg 1997;6: 291-296.
  12. Hockman DE, Lucas GL, Roth CA. Role of the coracoacromial ligament as restraint after shoulder hemiarthroplasty. Clin Orthop Relat Res 2004;419: 80-82.
  13. Hunt JL, Moore RJ, Krishnan J. The fate of the coracoacromial ligament in arthroscopic acromioplasty: an anatomical study. J ShoulderElbow Surg 2009;9: 491-494.
  14. Jadhav S D, Gosavi S N, Zambare B R. An anatomical study of coraco-acromial falx in Indian population. Indian Journal of Clinical Anatomy and Physiology 2017; 4(1):104-105.
  15. Johnson L L. The shoulder joint: an arthroscopist’s perspective of anatomy and pathology. Clinical Orthopedics and Related Research 1997; 223:113-125.
  16. Holt EM, Allibone RO. Anatomic variants of the coracoacromial ligament. J Shoulder Elb Surg 1995;4: 370–375.
  17. Salter GE, Nasca RJ, Shelly BS. Anatomical observations in the acromioclavicular joint and supporting ligaments. Am J Sports Med 1987;15: 199–206.
  18. Gagey N, Ravaud E, Lassau JP. Anatomy of the acromial arch: correlation of anatomy and magnetic resonance imaging. Surg Radiol Anat 1993; 15: 63–70.
  19. Moon K, Hwang YS, Kim KT, Kim WJ, Chae JH. Ossification of the coraco-acromial ligament in subacromial impingement syndrome Clinics in Shoulder and Elbow 2017; 20 (3): 167-171.
  20. Alraddadi A, Alashkhan A, Lamb C, Soames R. Variability in attachment of the coracoacromial ligament in relation with its morphology. Surg and Radiol Anat.2017;39 (12): 1323–1330.

Cite this article: Surekha Jadhav, Shilpa Gosavi. MORPHOLOGICAL VARIATIONS OF THE CORACO-ACROMIAL LIGAMENT: A CADAVERIC STUDY. Int J Anat Res 2018;6(3.3):5621-5624. DOI: 10.16965/ijar.2018.293