1
|
Zhou Y, Kang J, Yang Q. Clinical effect of modified anterolateral acromioarthroplasty during arthroscopic rotator cuff repair. BMC Musculoskelet Disord 2024; 25:508. [PMID: 38951861 PMCID: PMC11218212 DOI: 10.1186/s12891-024-07619-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 06/21/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND This study aimed to compare the clinical effect of modified anterolateral and traditional acromioplasty in arthroscopic rotator cuff repair. METHODS The clinical data of 92 patients with total rotator cuff tears admitted to the Department of Joint Surgery of Jinhua Central Hospital from January 2016 to December 2019 were retrospectively analyzed. Among them, 42 patients underwent traditional acromioplasty during arthroscopic rotator cuff repair, and 50 underwent modified anterolateral acromioplasty. Patients were evaluated for preoperative and postoperative shoulder function, pain and critical shoulder angle, and incidence of rotator cuff re-tear at 12 months postoperatively. RESULTS The preoperative general data of patients in the classic and modified anterolateral acromioplasty groups did not differ significantly (P > 0.05) and were comparable. The UCLA, ASES, and Constant shoulder joint scores were significantly improved in both groups. The VAS score was significantly decreased at 12 months postoperative than preoperative, with a statistically significant difference (P ≤ 0.05). Shoulder function and pain scores did not differ significantly between the two groups at 12 months postoperatively (P > 0.05). The CSA did not differ significantly between preoperative and postoperative 12 months in the traditional acromioplasty group (P > 0.05). However, 12 months postoperative CSA in the modified anterolateral acromioplasty group was significantly smaller than the preoperative CSA, with a statistically significant difference (P ≤ 0.05). The rates of rotator cuff re-tears were 16.67% (7/42) and 4% (2/50) in the two groups at 12 months postoperatively, respectively, with statistically significant differences (P ≤ 0.05). CONCLUSIONS Traditional and modified anterolateral acromioplasty while treating total rotator cuff tears using arthroscopic rotator cuff repair significantly improves shoulder joint function. However, modified anterolateral acromioplasty significantly reduced the CSA value and decreased the incidence of rotator cuff re-tears.
Collapse
Affiliation(s)
- Yongwei Zhou
- The Orthopedics Department, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, No. 365 Renmin East Road, Jinhua City, Zhejiang Province, 321000, China
| | - Jiayu Kang
- The Orthopedics Department, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, No. 365 Renmin East Road, Jinhua City, Zhejiang Province, 321000, China
| | - Qining Yang
- The Orthopedics Department, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, No. 365 Renmin East Road, Jinhua City, Zhejiang Province, 321000, China.
| |
Collapse
|
2
|
Rojas W, Vargas P, Droppelmann G, Jorquera C, Stöwhas K, Godoy A, García N. The Critical Shoulder Angle: A Significant Radiological Measure in Rotator Cuff vs. Glenohumeral Osteoarthritis in Chilean Patients-A Descriptive Cross-Sectional Study. J Clin Med 2024; 13:3408. [PMID: 38929939 PMCID: PMC11204370 DOI: 10.3390/jcm13123408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Shoulder pain is one of the most important musculoskeletal conditions affecting the upper extremities. Glenohumeral osteoarthritis (GHOA) and rotator cuff injuries (RCIs) are notable for their high prevalence. The critical shoulder angle (CSA) is a significant radiological measure for determining the diagnosis and progression of patients with these conditions. Although there are reports in the international literature about this measure, in our country, guideline values considering these two pathologies are unknown. Objective: Our objective was to assess patients diagnosed with GHOA and RCI using an AP X-ray view and the CSA. Methods: To conduct this, we identified differences between sexes and age categories. Fifty-nine adult patients with GHOA and RCI were included. CSA grades varied depending on the age category and type of injury evaluated. Results: Significant differences between the age ranges of 40 and 54 (p = 0.05), 55-69 (p = 0.001), and 70-84 (p = 0.017) were observed. Conclusions: Patients with RCI tended to be younger and have a higher CSA compared to those with GHOA. It is important to have more normative values and to continue monitoring the critical shoulder angle in these patients.
Collapse
Affiliation(s)
- Walter Rojas
- Clínica MEDS, Santiago 7691236, Chile; (W.R.); (P.V.); (K.S.); (N.G.)
- Escuela de Medicina, Facultad de Medicina, Universidad de Valparaíso, Valparaíso 2540064, Chile;
| | - Pablo Vargas
- Clínica MEDS, Santiago 7691236, Chile; (W.R.); (P.V.); (K.S.); (N.G.)
| | - Guillermo Droppelmann
- Clínica MEDS, Santiago 7691236, Chile; (W.R.); (P.V.); (K.S.); (N.G.)
- Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Carlos Jorquera
- Facultad de Ciencias, Escuela de Nutrición y Dietética, Universidad Mayor, Santiago 8580745, Chile;
| | - Katherine Stöwhas
- Clínica MEDS, Santiago 7691236, Chile; (W.R.); (P.V.); (K.S.); (N.G.)
- Facultad de Medicina, Escuela de Kinesiología, Universidad Finis Terrae, Santiago 7501014, Chile
| | - Alejandro Godoy
- Escuela de Medicina, Facultad de Medicina, Universidad de Valparaíso, Valparaíso 2540064, Chile;
| | - Nicolás García
- Clínica MEDS, Santiago 7691236, Chile; (W.R.); (P.V.); (K.S.); (N.G.)
| |
Collapse
|
3
|
Smith AF, Schmidt CM, Tabbaa A, Gutiérrez S, Simon P, Mighell MA, Frankle MA. Glenoid-based reference system to differentiate shoulder pathologies on plain radiographs. J Shoulder Elbow Surg 2024; 33:S111-S121. [PMID: 37777046 DOI: 10.1016/j.jse.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/07/2023] [Accepted: 08/27/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Shoulder radiographs are used for evaluation and the planning of treatment of various pathologies. Making a diagnosis of these pathologies on plain radiographs occurs by recognizing the relationship of the humeral head on the registry of the glenoid. Quantification of these changes in registry does not currently exist. We hypothesize that a geometric relationship of the humeral head and the glenoid exists that is defined on an anteroposterior Grashey view radiograph by the relationship of the best-fit circle of the humeral head relative to the best-fit circle of the glenoid such that relative measurements will define the normal shoulder and the pathologic shoulder. METHODS One hundred fifty-six shoulders were included: 53 normal shoulders, 51 with primary glenohumeral osteoarthritis (GHOA), and 52 with cuff tear arthropathy (CTA). Humeral head best-fit circle was used to define the circle of the humeral head (cHH). A glenoid best-fit circle (cG) was defined by the following rules: (1) best fit of the glenoid articular surface and (2) was limited by the acromion such that either (a) it reaches maximal interaction with the inferior surface of the acromion or (b) the perimeter of the circle is at the lateralmost point of the acromion. The relationship between cHH and cG is defined by measurement of cHH in horizontal and vertical planes relative to the glenoid circle reference. The horizontal displacement angle (HDA) measures the horizontal position of cHH relative to cG, representing the degree of medialization toward the glenoid. The vertical displacement angle (VDA) measures the vertical position of cHH relative to cG, representing the degree of superiorization toward the acromion. Angles were compared by diagnosis and sex. RESULTS The mean HDA was 61.0° (95% confidence interval [CI] 60.3°-61.7°) in normal shoulders, 79.9° (95% CI 76.9°-82.9°) in GHOA, and 63.4° (95% CI 61.7°-65.1°) in CTA (P < .001). The mean VDA was 43.1° (95% CI 42.2°-44.0°) in normal shoulders, 40.9° (95% CI 39.9°-42.0°) in GHOA, and 59.7° (95% CI 57.6°-61.7°) in CTA (P < .001). Interobserver reliability was 0.991 (95% CI 0.94-1.0) and intraobserver reliability was 0.998 (95% CI 0.99-1.0). The geometric relationship of cHH to the glenoid circle reference was plotted for each group. CONCLUSION A geometric relationship exists of the humeral head in reference to the glenoid circle. Together, the HDA and the VDA distinguish between a normal shoulder and those with GHOA or CTA. This suggests that this novel methodology may provide a preoperative planning tool that is easily accessible.
Collapse
Affiliation(s)
- Austin F Smith
- Florida Orthopaedic Institute, Shoulder & Elbow Department, Tampa, FL, USA; OrthoArizona, Phoenix, AZ, USA
| | - Christian M Schmidt
- Department of Orthopaedics and Sports Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Ameer Tabbaa
- Foundation for Orthopaedic Research and Education, Tampa, FL, USA
| | - Sergio Gutiérrez
- Foundation for Orthopaedic Research and Education, Tampa, FL, USA
| | - Peter Simon
- Foundation for Orthopaedic Research and Education, Tampa, FL, USA
| | - Mark A Mighell
- Florida Orthopaedic Institute, Shoulder & Elbow Department, Tampa, FL, USA; Department of Orthopaedics and Sports Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Mark A Frankle
- Florida Orthopaedic Institute, Shoulder & Elbow Department, Tampa, FL, USA; Department of Orthopaedics and Sports Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
| |
Collapse
|
4
|
Schamberger CT, Grossner T, Fischer C, Findeisen S, Ferbert T, Suda AJ, Schmidmaier G, Stein S. The Modified Ultrasound-Assisted Method: A Study of the Correlation between Magnetic Resonance Imaging and the Ultrasound-Assisted Evaluation of the Critical Shoulder Angle. Diagnostics (Basel) 2024; 14:486. [PMID: 38472958 DOI: 10.3390/diagnostics14050486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/24/2024] [Accepted: 02/01/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND An increased or decreased critical shoulder angle (CSA) is a known risk factor for osteoarthritis, lesions, and re-ruptures in the rotator cuff. A CSA greater than 35° correlates with degenerative rotator cuff tears, while a CSA of less than 30° correlates with osteoarthritis in the glenohumeral joint. The diagnostic gold standard for its determination is X-ray or MRI. OBJECTIVES The primary objective of this research was to assess the viability of utilizing sonography imaging as a diagnostic tool to determine the modified critical shoulder angle (mCSA). This study aimed to investigate the feasibility and effectiveness of sonographic techniques in accurately diagnosing CSA compared to MRI. STUDY DESIGN AND METHODS A cohort study was carried out (level of evidence 3). The CSA (MRI) and the mCSA (ultrasound) were assessed retrospectively by two independent board-certified investigators in 109 patients with shoulder pain by MRI and musculoskeletal sonography. The CSA in the MRI dataset was determined using routine protocols and then compared to the values assessed using the modified sonography-assisted method (mCSA). Both results were analyzed with linear regression to determine a possible correlation. All investigations were performed by a DEGUM (German Society for Medical Ultrasound)-certified specialist in musculoskeletal sonography. RESULTS A total of 112 patients were included in this study, namely 40 female patients and 72 male patients with a mean age of 54.7 years at the time of the investigation. The mean CSA in MRI was 31.5° ± 3.899, and the mCSA in sonography was 30.1° ± 4.753. The inter- and intraobserver reliability for the CSA was factual with values of 0.993 and 0.967. The inter- and intraobserver reliability for mCSA was factual as well, with values of 0.989 and 0.948. The ANOVA analysis did not reveal a significant difference between the CSA and the mCSA values, and linear regression determined the R2 value to be 0.358 with p < 0.05. CONCLUSIONS Diagnosing the mCSA using sonography is a safe and valid method. No statistically significant differences between the results in MRI and sonography could be seen. Although this is a retrospective, single-center study including only Caucasian mid-Europeans, and with the known limitations of ultrasound imaging, it nevertheless shows that sonography can be used as a simple, cheap, and fast technique to assess a modified CSA, which shows very good correlation with the standard CSA without losing the diagnostic quality.
Collapse
Affiliation(s)
- Christian T Schamberger
- Clinic for Trauma- and Reconstructive Surgery, University Clinic Heidelberg, 69120 Heidelberg, Germany
| | - Tobias Grossner
- Clinic for Trauma- and Reconstructive Surgery, University Clinic Heidelberg, 69120 Heidelberg, Germany
| | | | - Sebastian Findeisen
- Clinic for Trauma- and Reconstructive Surgery, University Clinic Heidelberg, 69120 Heidelberg, Germany
| | - Thomas Ferbert
- Clinic for Trauma- and Reconstructive Surgery, University Clinic Heidelberg, 69120 Heidelberg, Germany
| | - Arnold J Suda
- Department of Orthopaedics and Trauma Surgery, AUVA Trauma Center Salzburg, 5010 Salzburg, Austria
| | - Gerhard Schmidmaier
- Clinic for Trauma- and Reconstructive Surgery, University Clinic Heidelberg, 69120 Heidelberg, Germany
| | - Stephan Stein
- Clinic for Trauma- and Reconstructive Surgery, University Clinic Heidelberg, 69120 Heidelberg, Germany
| |
Collapse
|
5
|
Zhao J, Zeng L, Liang G, Luo M, Yang W, Liu J, Pan J. Risk factors for symptomatic rotator cuff tears: a retrospective case-control study. Front Med (Lausanne) 2024; 10:1321939. [PMID: 38239617 PMCID: PMC10794627 DOI: 10.3389/fmed.2023.1321939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/14/2023] [Indexed: 01/22/2024] Open
Abstract
Background The incidence and diagnostic rate of rotator cuff tears (RCTs) have increased significantly. The purpose of this study was to investigate and analyze the risk factors for symptomatic RCTs to provide a basis for their prevention and treatment. Methods We retrospectively analyzed the relevant clinical indicators of 193 randomized clinical trial (RCT) patients and 161 non-RCT patients hospitalized with shoulder pain as the main complaint from January 1, 2017, to August 31, 2021. Univariate analysis and multivariate logistic regression analysis were used to analyze the differences in potential risk factors between the two groups. Results Univariate analysis revealed that age (p < 0.001), body mass index (BMI) (p = 0.036), hypertension (p < 0.001), coronary heart disease (p = 0.028), history of shoulder trauma (p < 0.001), hyperlipidemia (p = 0.025), type III acromion (p = 0.012) and critical shoulder angle (CSA) (p < 0.001) increased the risk of RCTs. Multivariate logistic regression analysis revealed that age ≥ 60 years (OR = 2.61, 95% CI = 1.23 to 5.12), CSA ≥ 35° (OR = 4.24, 95% CI = 1.60 to 11.22), hypertension (OR = 2.34, 95% CI = 1.33 to 4.11) and history of shoulder trauma (OR = 5.20, 95% CI = 2.87 to 9.45) were independent risk factors for symptomatic RCTs. Conclusion The results of this study showed that age ≥ 60 years, CSA ≥35°, hypertension and history of shoulder trauma are independent risk factors for symptomatic RCTs and can provide directions for further development of prevention and treatment strategies. Future studies need to clarify the mechanism underlying the association between these risk factors and symptomatic RCTs.
Collapse
Affiliation(s)
- Jinlong Zhao
- State Key Laboratory of Traditional Chinese Medicine Syndrome/The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Lingfeng Zeng
- State Key Laboratory of Traditional Chinese Medicine Syndrome/The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Guihong Liang
- State Key Laboratory of Traditional Chinese Medicine Syndrome/The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Minghui Luo
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Weiyi Yang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Jun Liu
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- The Fifth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Second Traditional Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), Guangzhou, China
| | - Jianke Pan
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| |
Collapse
|
6
|
Yıldız AE, Yaraşır Y, Huri G, Aydıngöz Ü. Optimization of the Grashey View Radiograph for Critical Shoulder Angle Measurement: A Reliability Assessment With Zero Echo Time MRI. Orthop J Sports Med 2022; 10:23259671221109522. [PMID: 35982832 PMCID: PMC9380228 DOI: 10.1177/23259671221109522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/11/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Suboptimal positioning on Grashey view radiographs may limit the
prognosticating potential of the critical shoulder angle (CSA) for shoulder
disorders. Purpose: To investigate whether radiography optimized according to the latest research
is reliable for measuring CSA in comparison with magnetic resonance imaging
(MRI) featuring 3-dimensional (3D) zero echo time (ZTE) sequencing, which
accentuates the contrast between cortical bone and surrounding soft tissue
with high fidelity. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients with shoulder pain were prospectively and consecutively enrolled.
All patients had Grashey view radiographs as well as 3.0-T MRI scans with
isotropic 3D ZTE sequencing. Acceptable positioning on the radiographs was
determined using the ratio of the transverse to longitudinal (RTL) diameter
of the lateral glenoid outline; radiographs with an RTL ≥0.25 were repeated.
Two observers independently measured the CSA on the radiographs and the
coronal oblique reformatted ZTE images, the latter including verification of
measurement points by cross-referencing against images from other planes.
Reliability of measurements between observers and modalities was analyzed
with the intraclass correlation coefficient (ICC). The paired-samples
t test was used to compare the differences between
imaging modalities. Results: Enrolled were 65 patients (35 female and 30 male; mean age, 40.2 years;
range, 25-49 years). Radiographs with optimal positioning (RTL < 0.25)
were attained after a mean of 1.6 exposures (range, 1-4); the mean RTL was
0.09 (range, 0-0.20). Interobserver agreement of CSA was excellent for
radiographs (ICC = 0.91; 95% CI, 0.84-0.94) and good for ZTE MRI scans (ICC
= 0.85; 95% CI, 0.71-0.92). Intermodality agreement of CSA between
radiographs and ZTE MRI scans was moderate (ICC = 0.66; 95% CI, 0.48-0.73).
The CSA was significantly different between an optimal radiograph (30.7° ±
4.3°) and ZTE MRI scan (31.8° ± 3.8) (P = .005). Subgroup
analysis revealed no significant differences in CSA measurement between ZTE
MRI scans and Grashey view radiographs with an RTL of <0.1
(P = .08). Conclusion: CSA measurement on ZTE MRI scans with anatomic point cross-referencing was
significantly different from that on Grashey view radiographs, even with
optimal positioning, and radiography may necessitate more than 1 exposure.
An RTL of <0.1 ensured reliability of radiographs when other standards of
sufficient x-ray exposure were met.
Collapse
Affiliation(s)
- Adalet Elçin Yıldız
- Department of Radiology, Hacettepe University School of Medicine,
Ankara, Turkey
- Adalet Elçin Yıldız, MD, Department of Radiology, Hacettepe
University School of Medicine, Sihhiye, 06230 Ankara, Turkey (
)
| | - Yasin Yaraşır
- Department of Radiology, Hacettepe University School of Medicine,
Ankara, Turkey
| | - Gazi Huri
- Department of Orthopedics and Traumatology, Hacettepe University
School of Medicine, Ankara, Turkey
| | - Üstün Aydıngöz
- Department of Radiology, Hacettepe University School of Medicine,
Ankara, Turkey
| |
Collapse
|
7
|
Aylanç N, Ertem ŞB. Could radio-morphological changes in humerus greater tuberosity be an early indicator of rotator cuff tendon injuries? Skeletal Radiol 2022; 51:649-657. [PMID: 34309691 DOI: 10.1007/s00256-021-03864-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/03/2021] [Accepted: 07/04/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To reveal the possible relationship between greater tuberosity volume with rotator cuff tendon injuries. MATERIALS AND METHODS In our study, the morphology of the greater tuberosity was evaluated retrospectively by using radiographs and MR images of 335 cases. While critical shoulder angle (CSA) was measured on radiographs, greater tuberosity (GT) area and volume were calculated, and also supraspinatus, infraspinatus, and teres minor tendons were evaluated, on MR images. The relationship of the measurements with the tendon injuries was analyzed statistically. RESULTS Among 188 female and 147 male patients, no statistically significant relationship was found between tendon injuries in terms of gender. The relationships between supra and infraspinatus tendon injuries and GT angle, area, and volume measurements were statistically significant. There was a statistically significant relationship between teres minor injury and GT angle, but no significant correlation with GT area and volume. Finally, there was no statistically significant correlation between all three tendon pathologies and CSA. CONCLUSION Area, and especially volume measurements, which are morphological features of the GT, may reflect tendon damage without significant degenerative changes in the bone structure. In examinations before tendon damage progresses, GT volume is a morphological feature that needs to be evaluated and may facilitate early recognition of tendinopathies and be an early marker of rotator cuff injuries.
Collapse
Affiliation(s)
- Nilüfer Aylanç
- Faculty of Medicine, Department of Radiology, Çanakkale Onsekiz Mart University, 17100, Çanakkale, Turkey.
| | - Şenay Bengin Ertem
- Faculty of Medicine, Department of Radiology, Çanakkale Onsekiz Mart University, 17100, Çanakkale, Turkey
| |
Collapse
|
8
|
Critical shoulder angle (CSA): age and gender distribution in the general population. J Orthop Traumatol 2022; 23:10. [PMID: 35157156 PMCID: PMC8844324 DOI: 10.1186/s10195-022-00627-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Objective
Anatomical parameters and pathologies that can affect the critical shoulder angle (CSA) are subjects of discussion. To date, we do not know if the CSA value changes in the different decades of life in a population characterized by the same ethnicity, nor if there are differences related to gender or side. This study hypothesizes that age and gender may affect the CSA.
Methods
Patients older than 15 years old affected by a shoulder trauma and who were discharged with a diagnosis of shoulder contusion were enrolled. A true AP view of the shoulder was obtained as well as data regarding age and gender of all participants. The CSA was measured by three authors, and interoperator reliability was assessed. Eight subcategories, according to decades of life, were considered. Finally, the studied population was divided into three subcategories according to CSA values (< 30°; 30–35°; ≥ 35°).
Results
The initial sample comprised 3587 shoulder X-rays. The interobserver reproducibility was high, with an intraclass correlation coefficient of 0.865 (95% CI 0.793–0.915).
Two thousand eight hundred seventy-three radiograms were excluded. The studied group comprised 714 patients [431 females, 283 males; mean age (SD): 47.2 (20.9) years, range: 11–93 years]. The mean CSA was 33.6° (range: 24–50°; SD: 3.9°). The mean CSA values in females and males were 33.7°and 33.5°, respectively. The mean CSA values of the right and left shoulders were 33.3° and 33.9°, respectively (p > 0.05). Linear regression analysis showed a CSA increase by 0.04° every year. The mean CSA in subjects aged between 15 and 19 years was significantly lower than all the other groups, except for patients older than 80 years.
No significant differences were found between CSA subcategories, gender, or side.
Conclusions
In the general population, the mean CSA value was 33.6°. No significant differences were found regarding the mean CSA value according to gender or side. A significant positive linear correlation between CSA and age was detected. In each decade of life, the CSA value, which is genetically determined, shows a large variability.
Level of evidence: IV.
Collapse
|
9
|
Critical shoulder angle does not influence retear rate after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2021; 29:3951-3955. [PMID: 34255134 DOI: 10.1007/s00167-021-06652-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The critical shoulder angle (CSA) has been implicated as a potential risk factor for failure following arthroscopic rotator cuff repair (RCR). However, there is conflicting evidence regarding the clinical usefulness of this measurement. Given these discrepancies and limited comparisons to clinical outcomes, the aim of the current study was to determine whether higher CSAs correlated with an increased retear rate after arthroscopic rotator cuff repair and to determine if any association between CSA and patient-reported outcomes (PROs) exists. It was hypothesized that there would be no correlation between CSA and retear rate or PROs after arthroscopic rotator cuff repair. METHODS A total of 164 patients who underwent arthroscopic RCR were retrospectively reviewed. CSA was measured for each patient. Patients were then divided into a retear group of 18 patients and a non-retear group of 146 patients. Patient-reported outcomes (PROs), including PROMIS 10 score, American Shoulder and Elbow Surgeons (ASES) score, Brophy score, and visual analog pain scores (VAS) were recorded post-operatively. RESULTS The average CSA was 31.2 ± 4.5° for the retear group and 32.2 ± 4.7° for the non-retear group (n.s.). No correlations were found between CSA and PROMIS score (n.s.), ASES score (n.s.), Brophy score (n.s.), or VAS (n.s.). CONCLUSION Critical shoulder angle had no correlation to retear rate or patient-reported outcomes. CSA should not be used as a clinical predictor to assess rotator cuff retear risk after arthroscopic RCR. LEVEL OF EVIDENCE Level III.
Collapse
|