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Bedeir YH, Grawe BM. Critical Shoulder Angle and Acromial Index do not Influence Functional Outcomes After Repair of Massive Rotator Cuff Tears. J ISAKOS 2024:S2059-7754(24)00147-0. [PMID: 39098590 DOI: 10.1016/j.jisako.2024.07.008] [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: 04/20/2024] [Revised: 07/28/2024] [Accepted: 07/30/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVES Critical shoulder angle (CSA) and acromial index (AI) are two radiographic signs that can influence the risk of rotator cuff tears and the outcomes of repair. The purpose of this study was to determine the influence of CSA and AI on massive cuff tears and on the functional outcomes after repair. The hypothesis was that CSA and AI will be higher in posterosuperior compared to anterosuperior tears. METHODS CSA and AI were retrospectively measured on radiographs of patients who underwent repair of two rotator cuff tendons. Functional outcomes were evaluated using American Shoulder and Elbow Surgeons (ASES) score and Simple Shoulder Test (SST) at least six months postoperatively. Patients were divided according to the tendons repaired into anterosuperior group and posterosuperior group. Radiographic measurements and functional outcomes were compared. Patients in the posterosuperior group were subdivided into low or high CSA (cut-off value= 39), and into low or high AI (cut-off value = 0.75). All available preoperative magnetic resonance images were reviewed and graded according to Goutallier classification. Multivariate analysis was used to determine the influence of CSA, AI and Goutallier grade on functional outcomes. RESULTS Eighty six patients were included. Both CSA and AI were statistically significantly higher in the posterosuperior group (p=0.0143 and 0.0052 respectively). After a mean follow up of 33 months, ASES and SST were significantly better in patients with Goutallier grades 0-1 than grades>1 (multivariate p = 0.03 and 0.009 respectively). No statistically significant differences were found between low and high CSA and AI groups in terms of functional outcomes of the posterosuperior group after repair (multivariate p = 0.9). CONCLUSION Higher critical shoulder angle and acromial index seem to increase the risk of posterosuperior more than anterosuperior rotator cuff tears. Neither of these radiographic parameters influenced the functional outcomes of massive posterosuperior tears after repair. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yehia H Bedeir
- Department of Orthopaedic Surgery, Alexandria University, Egypt; El-Hadara University Hospital, Alexandria, EG.
| | - Brian M Grawe
- Department of Orthopaedic Surgery, University of Cincinnati Medical Center, 200 Albert Sabin Way, Cincinnati, OH 45220
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Darbandi A, Credille K, Darbandi A, Hevesi M, Dandu N, Bodendorfer BM, Wang Z, Garrigues G, Verma N, Yanke A. Fatty Infiltration, Tear Size, and Retraction Size Are Significant Risk Factors for Retear following Arthroscopic Rotator Cuff Repair: A Systematic Review. Arthroscopy 2024:S0749-8063(24)00488-2. [PMID: 38986851 DOI: 10.1016/j.arthro.2024.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/11/2024] [Accepted: 06/19/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE To assess the consistency and quality of risk factor reporting for rotator cuff repair (RCR) retear and identify risk factors most frequently associated with retear. METHODS A systematic review with PRISMA guidelines was performed. Of the initial 3,158 titles, a total of 31 studies met the following inclusion criteria: (1) clinical studies regarding RCR failure, (2) arthroscopic procedures involving RCR, (3) reporting clinical outcomes (4) performed within 5 years (5) and studies investigating pre-operative risk factors for retear. After full-text review, 18 risk factors were analyzed. RESULTS The most consistently significant risk factors were acromiohumeral distance (AHD) (80%), critical shoulder angle (CSA) (67%), tear size (63%), anterior/posterior (AP) dimension (60%), fatty infiltration (FI, 58%), and retraction size (56%). FI was analyzed using different methods between studies with 63% finding significant results and 50% of all studies performing ordinal analysis. Tear size was inconsistently analyzed quantitatively or qualitatively, with 58% finding significant results and 63% of all studies analyzing quantitatively. Risk factors consistently found to be non-significant included age, sex, diabetes mellitus (DM), symptom duration, hand dominance, repair technique, smoking and body mass index (BMI). CONCLUSIONS Tear size, fatty infiltration, and retraction size were found to be significant risk factors in the majority of included studies evaluating rotator cuff retear. Risk factors less likely reported as predictive included repair technique, age, sex, DM, symptom duration, hand dominance, repair technique, smoking, and BMI. Risk factors that require further investigation include CSA, AHD, and AP tear dimension. Level III, systematic review of Level III-V studies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Adam Yanke
- Midwest Orthopedics at Rush, Chicago, IL.
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Yang S, Pang L, Zhang C, Wang J, Yao L, Li Y, Huang Y, Tang X. Lower Reoperation Rate and Superior Patient-Reported Outcome Following Arthroscopic Rotator Cuff Repair With Concomitant Acromioplasty: An Updated Systematic Review of Randomized Controlled Trials. Arthroscopy 2024:S0749-8063(24)00408-0. [PMID: 38876445 DOI: 10.1016/j.arthro.2024.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/13/2024] [Accepted: 05/18/2024] [Indexed: 06/16/2024]
Abstract
PURPOSE To systematically assess the postoperative outcomes in patients undergoing arthroscopic rotator cuff repairs with or without concomitant acromioplasty through a rigorous systematic review of randomized controlled trials (RCTs). METHODS This systematic review, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, aimed to identify RCTs comparing clinical outcomes of patients with full-thickness rotator cuff tears undergoing arthroscopic rotator cuff repair with acromioplasty versus those without at a minimum 12-month follow-up. Databases searched included PubMed, Web of Science, Embase, and the Cochrane Library. The risk of bias in the included studies was assessed using the revised Cochrane Risk of Bias 2. Meta-analysis was conducted for outcomes with at least 3 studies reporting, with pooled effect estimates calculated using either fixed-effect or random-effects models based on heterogeneity levels. Results were presented as the weighted mean difference or odds ratio with 95% confidence intervals (CIs). For outcomes with fewer than 3 studies reporting, a Fisher exact test was conducted, with continuity correction applied if necessary. Primary outcomes included rates of retear and reoperation, whereas secondary outcomes included improvement in American Shoulder and Elbow Surgeons (ASES) score, range of motion (ROM), and complication rate. RESULTS Five high-quality RCTs, with low bias risk, involving 409 patients, revealed demographics of 58.4% males, mean age of 58.4 years, and the following acromion types: 12.2% type I, 70.7% type II, and 17.1% type III. Mean follow-up was 52.2 months. Retear (12.5% vs 16.1%, P = .536) and complication rates (odds ratio, 3.11; 95% CI, 0.31-30.73; P = .33) were comparable between the 2 groups. However, reoperation rate (5.3% vs 15.9%, P < .001) and improvement in ASES score (weighted mean difference, 3.99; 95% CI, 1.00-6.99; P = .009) favored the acromioplasty group. Both groups showed significant improvements in ROM, but insufficient data prevented a comparison. CONCLUSIONS Compared with arthroscopic rotator cuff repair alone, arthroscopic rotator cuff repair with acromioplasty demonstrated similar rates of retear and complications but had a significantly lower reoperation rate and superior improvement in ASES score. The available data were insufficient to draw a definitive conclusion regarding ROM. This conclusion is fragile due to a limited sample size. LEVEL OF EVIDENCE Level II, systematic review of Level I and II studies.
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Affiliation(s)
- Songyun Yang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Department of Orthopedics, People's Hospital of Santai County, Santai, People's Republic of China
| | - Long Pang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Chunsen Zhang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jiapeng Wang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Lei Yao
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yinghao Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yizhou Huang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Xin Tang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
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Oladimeji AE, Amoo-Achampong K, Ode GE. Impact of critical shoulder angle in shoulder pathology: a current concepts review. JSES Int 2024; 8:287-292. [PMID: 38464445 PMCID: PMC10920144 DOI: 10.1016/j.jseint.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Background This review aims to describe the origin and development of critical shoulder angle (CSA) and its correlation with different shoulder pathologies. Current literature is inconclusive in characterizing the role of CSA in predicting pathology and surgical outcomes. Methods A literature search of both historical and more contemporary research articles on CSA was conducted to compare data points on the impact of CSA on shoulder pathology and postoperative clinical outcomes. This compilation of studies ranges from retrospective reviews to case series as well as cadaveric imaging studies. Results The CSA is a reliable radiographic measure in predicting shoulder pathology in correctly oriented radiographs. Surgically modifying the CSA with arthroscopic lateral acromioplasty and results has largely shown improved recovery of strength postoperatively as with no increase in postsurgical complication rates. However, it remains unclear whether surgical alteration of CSA has a role in preventing clinical failure after arthroscopic procedures such as acromioplasty and rotator cuff repair as well as following shoulder arthroplasty. Discussion Stronger conclusions regarding the prognostic utility of CSA are limited by the fact that most studies evaluating CSA are smaller retrospective cohorts. Moving forward, randomized controlled trials being conducted may offer greater insight as to how CSA can improve patient-reported outcomes postoperatively.
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Affiliation(s)
- Akinola E Oladimeji
- Sports Medicine and Shoulder Surgery Division, Hospital for Special Surgery, New York, NY, USA
| | - Kelms Amoo-Achampong
- Sports Medicine and Shoulder Surgery Division, Hospital for Special Surgery, New York, NY, USA
| | - Gabriella E Ode
- Sports Medicine and Shoulder Surgery Division, Hospital for Special Surgery, New York, NY, USA
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Schiefer M, Naliato E, Oliveira R, Carmo LTD, Fontenelle CRDC, Motta Filho GDR. MRI is a Reliable Method for Measurement of Critical Shoulder Angle and Acromial Index. Rev Bras Ortop 2023; 58:e719-e726. [PMID: 37908539 PMCID: PMC10615611 DOI: 10.1055/s-0043-1776136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/05/2023] [Indexed: 11/02/2023] Open
Abstract
Objective The objectives of this study are to compare absolute values of acromial index (AI) and critical shoulder angle (CSA) obtained in both radiographs and magnetic resonance image (MRI) of the shoulder; and to compare the interobserver and intra-observer agreement for AI and CSA values measured in these image modalities. Methods Patients who had medical indication of investigating shoulders conditions through radiographs and MRI were included. Images were taken to two fellowship-trained shoulder surgeons, which conducted measurements of AI and CSA in radiographs and in MRI. Twelve weeks after the first evaluation, a second evaluation was conducted. Inter- and intra-observer reliability was presented as an Intraclass Correlation Coefficient (ICC) and agreement was classified according to Landis & Koch criteria. The differences between two measurements were evaluated using Bland-Altman plots. Results 134 shoulders in 124 subjects were included. Mean intra-observer ICC for CSA in X-rays and in MRI were 0.936 and 0.940, respectively; for AI, 0.908 and 0.022. Mean inter-observer ICC for CSA were 0.892 and 0.752 in X-rays and MRI respectively; for AI, ICC values were 0.849 and 0.685. All individual analysis reached statistical power ( p < 0.001). Mean difference for AI values measured in X-rays and in MRI was 0.01 and 0.03 for observers 1 and 2, respectively. Mean difference for CSA values obtained in X-rays and MRI was 0.16 and 0.58 for observers 1 and 2, respectively. Conclusion Both MRI and X-rays provided high intra- and interobserver agreement for measurement of AI and CSA. Absolute values found for AI and CSA were highly correlated in both image modalities. These findings suggest that MRI is a suitable method to measure AI and CSA. Level of Evidence II , Diagnostic Study.
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Affiliation(s)
- Márcio Schiefer
- Professor adjunto, Departamento de Ortopedia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
- Cirurgião ortopédico, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| | - Erika Naliato
- Professor adjunto, Departamento de Ortopedia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Roberto Oliveira
- Cirurgião ortopédico, ex-membro do Grupo de Ombro e Cotovelo do Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| | - Leonardo Tadeu do Carmo
- Cirurgião ortopédico, ex-membro do Grupo de Ombro e Cotovelo do Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
| | - César Rubens da Costa Fontenelle
- Professor adjunto, Departamento de Ortopedia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
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Cho SH, Kim YS. Prediction of Retear After Arthroscopic Rotator Cuff Repair Based on Intraoperative Arthroscopic Images Using Deep Learning. Am J Sports Med 2023; 51:2824-2830. [PMID: 37565449 DOI: 10.1177/03635465231189201] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
BACKGROUND It is challenging to predict retear after arthroscopic rotator cuff repair (ARCR). The usefulness of arthroscopic intraoperative images as predictors of the ARCR prognosis has not been analyzed. PURPOSE To evaluate the usefulness of arthroscopic images for the prediction of retear after ARCR using deep learning (DL) algorithms. STUDY DESIGN Cohort study (Diagnosis); Level of evidence, 2. METHODS In total, 1394 arthroscopic intraoperative images were retrospectively obtained from 580 patients. Repaired tendon integrity was evaluated using magnetic resonance imaging performed within 2 years after surgery. Images obtained immediately after ARCR were included. We used 3 DL architectures to predict retear based on arthroscopic images. Three pretrained DL algorithms (VGG16, DenseNet, and Xception) were used for transfer learning. Training and test sets were split into 8:2. Threefold stratified validation was used to fine-tune the hyperparameters using the training data set. The validation results of each fold were evaluated. The performance of each model in the test set was evaluated in terms of accuracy, area under the receiver operating characteristic curve (AUC), F1-score, sensitivity, and specificity. RESULTS In total, 1138 and 256 arthroscopic images were obtained from 514 patients and 66 patients in the nonretear and retear groups, respectively. The mean validation accuracy of each model was 83% for VGG16, 89% for Xception, and 91% for DenseNet. The accuracy for the test set was 76% for VGG16, 87% for Xception, and 91% for DenseNet. The AUC was highest for DenseNet (0.92); it was 0.83 for VGG16 and 0.91 for Xception. For the test set, the specificity and sensitivity were 0.93 and 0.84 for DenseNet, 0.89 and 0.84 for Xception, and 0.70 and 0.80 for VGG16, respectively. CONCLUSION The application of DL algorithms to intraoperative arthroscopic images has demonstrated a high level of accuracy in predicting retear occurrences.
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Affiliation(s)
- Sung-Hyun Cho
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yang-Soo Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
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Credille KT, Wang ZRC, Horner NS, Regan DP, Gadomski BC, Easley JT, Garrigues GE, Yanke AB. Biphasic Interpositional Allograft for Rotator Cuff Repair Augmentation Is Safe in an Ovine Model. Arthroscopy 2023; 39:1983-1997. [PMID: 37001743 DOI: 10.1016/j.arthro.2023.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 03/04/2023] [Accepted: 03/09/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE To perform a preclinical histologic assessment of a biphasic acellular interpositional cancellous allograft in an ovine model of rotator cuff repair (RCR) designed to better understand its safety profile and effects on tendon healing after RCR. METHODS Thirty skeletally mature sheep with clinically normal shoulders with an artificially created degenerative infraspinatus tendon tear were randomized to control and treatment groups. Animals were euthanized at 3 weeks, 6 weeks, and 12 weeks. After gross dissection, rotator cuff specimens were fixed with formalin and polymerized for sectioning and staining. Blinded histologic scores evaluated inflammatory cell infiltrates, signs of degradation, particulate debris, collagen arrangement, neovascularization, and enthesis qualitative measures. RESULTS There were no treatment specimens that exhibited histologic signs of a significant infection, inflammatory infiltrate, or foreign body reaction such as granuloma or fibrous capsule formation. Histologic scores in all categories were not significantly different at all time points, including the primary end point mean cumulative inflammatory score (control: 3.66 ± 1.21 vs treated: 4.33 ± 1.51, P = .42), when comparing the treatment and control RCR groups. In general, the degree of tendon healing and host tissue response was essentially equivalent between the 2 groups with observation of low overall levels of inflammation and progressive improvements in collagen organization, reduced tenocyte activity, and fibrocartilaginous enthesis reformation. CONCLUSIONS This histologic study demonstrated the use of a biphasic interpositional allograft for RCR augmentation in an ovine model does not generate an inflammatory response or foreign body reaction. Use of the biphasic interpositional allograft resulted in a histological profile that was essentially equivalent to that of a standard RCR at 3-, 6-, and 12-week postoperative timepoints. These findings suggest that a biphasic interpositional allograft is safe for further clinical investigation in humans before broader clinical application. CLINICAL RELEVANCE Patch augmentation of RCR is a popular technique that has shown clinical success in improving the likelihood of a successful repair in patients at elevated risk for retear. Newer augmentation technologies are being developed to address the biology at the interface between the bone and soft tissue where failure typically occurs.
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Affiliation(s)
- Kevin T Credille
- Midwest Orthopedics at Rush University Medical Center, Chicago, Illinois
| | - Zachary R C Wang
- Midwest Orthopedics at Rush University Medical Center, Chicago, Illinois
| | - Nolan S Horner
- Midwest Orthopedics at Rush University Medical Center, Chicago, Illinois
| | - Daniel P Regan
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, U.S.A
| | - Benjamin C Gadomski
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, Colorado, U.S.A
| | - Jeremiah T Easley
- Preclinical Surgical Research Laboratory, Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, U.S.A
| | - Grant E Garrigues
- Midwest Orthopedics at Rush University Medical Center, Chicago, Illinois
| | - Adam B Yanke
- Midwest Orthopedics at Rush University Medical Center, Chicago, Illinois.
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Ye Z, Qiao Y, Wu C, Chen C, Su W, Xu C, Dong S, Xu J, Zhao J. Effect of Anterior Acromial Coverage on Functional and Radiological Outcomes After Arthroscopic Repair of Anteroposterior Massive Rotator Cuff Tears. Am J Sports Med 2023; 51:2831-2841. [PMID: 37593843 DOI: 10.1177/03635465231187900] [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] [Indexed: 08/19/2023]
Abstract
BACKGROUND Rotator cuff tear size, fatty infiltration, and scapular morphology are correlated with tendon healing and functional outcomes after arthroscopic repair; however, the association between anteroposterior acromial coverage and the clinical outcomes of anteroposterior massive rotator cuff tears (AP-MRCTs; involving all 3 tendons) remains unclear. PURPOSE To identify the association between AP acromial coverage and functional and radiological outcomes after arthroscopic repair of AP-MRCTs. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 98 patients who underwent arthroscopic repair of AP-MRCTs between January 2015 and December 2020 were included in the study and classified according to whether anterior acromial coverage (AAC) was anterior (46 patients; positive AAC group) or posterior (52 patients; negative AAC group) to the scapular line on true lateral shoulder radiographs. Demographic characteristics, surgical details, and functional outcomes were prospectively collected. Acromial morphological features, global tear extension (GTE), the global fatty infiltration index (GFII), tendon integrity after repair, proximal humeral migration, and glenohumeral abduction were measured and calculated on radiographs or magnetic resonance imaging scans preoperatively and at 2 years postoperatively. Multivariate logistic regression was performed to identify the independent risk factors of a rotator cuff retear. RESULTS The positive AAC group showed larger AAC, posterior acromial tilt, and anterior acromial slope as well as smaller posterior acromial coverage compared with the negative AAC group. Postoperatively, the American Shoulder and Elbow Surgeons score (82.5 ± 8.3 vs 77.2 ± 11.5, respectively; P = .013), active abduction (157.8°± 27.1° vs 142.7°± 39.6°, respectively; P = .048), and glenohumeral abduction (45.6°± 10.4° vs 39.7°± 14.9°, respectively; P = .041) in the positive AAC group were significantly higher than those in the negative AAC group, while the retear rate (23.9% vs 44.2%, respectively; P = .035) and proximal humeral migration (1.7 ± 1.0 vs 2.3 ± 1.2 mm, respectively; P = .006) were significantly lower in the positive AAC group than in the negative AAC group. Smaller AAC (odds ratio [OR], 0.93 [95% CI, 0.87-1.00]; P = .040), larger GTE (OR, 1.03 [95% CI, 1.01-1.06]; P = .017), and a higher GFII (OR, 3.49 [95% CI, 1.09-11.19]; P = .036) were associated with an increased risk of a rotator cuff retear. CONCLUSION Increased AAC was associated with a lower retear rate and better functional outcomes after arthroscopic repair of AP-MRCTs. A preliminary risk evaluation integrating GTE, the GFII, and AAC is recommended to consider the necessity of additional procedures for patients in need of arthroscopic rotator cuff repair.
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Affiliation(s)
- Zipeng Ye
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Qiao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenliang Wu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chang'an Chen
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Su
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Caiqi Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shikui Dong
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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9
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Long Y, Hu H, Zhou C, Hou J, Wang Z, Zhou M, Cui D, Xu X, Yang R. The Critical Shoulder Angle Can be Accurately and Reliably Determined from Three-Dimensional Computed Tomography Images. Orthop Surg 2023; 15:2052-2061. [PMID: 36660945 PMCID: PMC10432459 DOI: 10.1111/os.13652] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/03/2022] [Accepted: 12/10/2022] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Anteroposterior (AP) radiographs do not necessarily offer the optimal approach to measuring the critical shoulder angle (CSA) due to the malposition of the scapula. Three-dimensional computed tomography (3D-CT) may offer some advantages, including the ability to rotate the scapula for position alignment and pre-operative planning for reducing CSA. This study aimed to investigate the accuracy and reliability of CSA measurement in 3D-CT and to determine whether there is an association between CSA and rotator cuff tears (RCTs). METHODS In this retrospective study we identified 200 patients who received shoulder arthroscopy from 2019 to 2021, including 142 patients (81 females, 61 males) with RCTs and 58 patients (14 females, 44 males) with non-RCTs. For each participant, CSA was measured from standard shoulder AP radiographs and anterior views of 3D-CT of the scapula by two independent assessors. Inter- and intra-observer agreements were assessed by the intraclass correlation coefficient (ICC). The relationship between the two measurement methodologies was determined by Spearman's correlation coefficient and Bland-Altman plots. Discriminative capacity was calculated by using receiver operating curve (ROC) analyses in the whole cohort and age sub-groups above and below 45 years. RESULTS We found perfect inter-observer (ICC >0.96) and intra-observer (ICC >0.97) reliabilities for CSA measurements obtained from the standard AP radiographs and the 3D-CT. There was a strong correlation between the two methods (r = 0.960, P < 0.001). The mean CSA was 31.7° ± 4.2° in the standard AP radiographs and 31.8° ± 4.4° in the 3D-CT (mean difference 0.02°, P = 0.940; bias 0.02°, limits of agreement -2.29° to +2.33°). ROC analysis of the whole cohort showed that the CSA measured in the standard AP radiographs (area under the ROC curve [AUC] = 0.812, P < 0.001) and the 3D-CT (AUC = 0.815, P < 0.001) predicted RCT with high confidence. ROC analysis of patients aged ≥45 years showed that the CSA measured from the standard AP radiographs (AUC = 0.869, P < 0.001) and the 3D-CT (AUC = 0.870, P < 0.001) were very good at predicting RCTs. CONCLUSION CSA measured from standard AP radiographs and 3D-CT showed high consistency, and the CSA could be accurately and reliably measured using 3D-CT. CSAs measured from standard AP radiographs and 3D-CT could predict RCTs, especially in patients aged ≥45 years.
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Affiliation(s)
- Yi Long
- Department of Orthopaedics, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Huijun Hu
- Department of Radiology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Chuanhai Zhou
- Department of Orthopaedics, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Jingyi Hou
- Department of Orthopaedics, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Zhiling Wang
- Department of Orthopaedics, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Min Zhou
- Department of Orthopaedics, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Dedong Cui
- Department of Orthopaedics, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Xiaoding Xu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Rui Yang
- Department of Orthopaedics, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
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Patterson BM, Bozoghlian MF. Modifiable and Nonmodifiable Risk Factors Associated with the Development of Recurrent Rotator Cuff Tears. Orthop Clin North Am 2023; 54:319-326. [PMID: 37271560 DOI: 10.1016/j.ocl.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Nonoperative and operative strategies exist to manage rotator cuff pathology. Although surgical repair is successful for most patients, others may experience retear or nonhealing of the rotator cuff. Several modifiable and nonmodifiable risk factors are associated with an increased retear rate. The literature shows consistency and agreement regarding many of these risk factors, most notably, patient age, tear size, and rotator cuff muscular atrophy, whereas others remain controversial. It is important that shoulder surgeons are familiar with modifiable and nonmodifiable risk factors associated with retear, to better advise patients and optimize their chances of success following rotator cuff repair surgery.
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Affiliation(s)
- Brendan M Patterson
- Department of Orthopedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA.
| | - Maria F Bozoghlian
- Department of Orthopedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
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11
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Gould HP. CORR Insights®: High Acromial Slope and Low Acromiohumeral Distance Increase the Risk of Retear of the Supraspinatus Tendon After Repair. Clin Orthop Relat Res 2023; 481:1171-1173. [PMID: 36812065 PMCID: PMC10194537 DOI: 10.1097/corr.0000000000002600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/27/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Heath P Gould
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
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Caffard T, Kralewski D, Ludwig M, Dornacher D, Fuchs M, Kappe T, Reichel H, Sgroi M. High Acromial Slope and Low Acromiohumeral Distance Increase the Risk of Retear of the Supraspinatus Tendon After Repair. Clin Orthop Relat Res 2023; 481:1158-1170. [PMID: 36623210 PMCID: PMC10194550 DOI: 10.1097/corr.0000000000002520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/15/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Retearing of the supraspinatus (SSP) tendon after repair is relatively common, but its cause is rarely clear. Although the role of acromion morphology and glenoid orientation in the pathogenesis of primary SSP tendon tears have frequently been analyzed, their association with the risk of rerupture of a repaired SSP tendon is poorly understood. QUESTIONS/PURPOSES (1) Is acromial morphology associated with the risk of retear after SSP tendon repair? (2) Is there an association between inclination and version of the glenoid and the odds for retear of the SSP tendon after repair? (3) Are there differences in outcome scores between patients who had intact cuff repairs and those who had retears? METHODS Between August 2012 and December 2015, we treated 92 patients for SSP tendon tears; all of these patients were considered for inclusion in the present study. We considered patients with complete tear of the SSP that was reconstructed with a double-row repair and a minimum follow-up of 2 years as potentially eligible. Based on these criteria, 28% (26 of 92) were excluded because they had a partial rupture and did not receive a double-row reconstruction. A further 9% (eight of 92) were excluded because of missing planes or slices (such as sagittal, axial, or frontal) on MRI, and another 3% (three of 92) were lost before the minimum study follow-up interval or had incomplete datasets, leaving 60% (55 of 92) for inclusion in the present analysis. All included patients had a minimum follow-up of 2 years; follow-up with MRI occurred at a mean duration of 2.3 ± 0.4 years postoperatively. All patients were asked to complete the Western Ontario Rotator Cuff Index and Oxford Shoulder Scores, and they underwent MRI of the operated-on shoulder. Preoperative true AP radiographs and MR images of the affected shoulders were retrospectively assessed by measuring the acromiohumeral interval, critical shoulder angle, acromial slope, acromial tilt, acromial index, lateral acromial angle, and glenoid version and inclination. The patients also underwent acromioplasty, in which the underface of the acromion was flattened. To rule out any change in the above parameters because of acromioplasty, these parameters were compared using preoperative and postoperative MR images and showed no difference. In addition, the tendon integrity and quality on postoperative MRI were analyzed independently of one another by the same two observers using the Sugaya and Castricini classifications, accounting for atrophy and fatty degeneration of the SSP muscle. To assess interobserver reliability, the two observers took measurements independently from each other. They were orthopaedic residents who completed a training session before taking the measurements. All measurements had excellent intrarater (Cronbach alpha 0.996 [95% confidence interval (CI) 0.99 to 1.00; p > 0.01) and interrater (interrater correlation coefficient 0.975 [95% CI 0.97 to 0.98]; p > 0.01) reliabilities. To answer the study's first question, SSP integrity on postoperative MRI was compared with acromial morphologic parameters measured on preoperative AP radiographs and MR images. To answer the second question, the postoperative integrity and quality of the SSP tendon were correlated with glenoid inclination and glenoid version. To answer our third question, we compared outcome scores between patients with intact SSP tendons and those with reruptured SSP tendons. To investigate any correlation among the acromial morphology, glenoid orientation, and postoperative outcomes, a binomial logarithmic regression analysis was performed. Receiver operating characteristic curves were used to determine cutoff points for the radiologic parameters that showed a correlation in the binomial regression analysis. RESULTS After controlling for potentially confounding variables such as acromioplasty or preoperative fatty infiltration as well as muscle atrophy, the only morphological parameters associated with a higher risk (adjusted odds ratio) of SSP tendon rerupture were the acromiohumeral interval (adjusted OR 0.9 [95% CI 0.9 to 0.99]; p < 0.01) and acromial slope (adjusted OR 1.4 [95% CI 1.1 to 1.8]; p < 0.01). The critical shoulder angle, acromial tilt, acromial index, and lateral acromial angle were not associated with the risk of rerupture. The cutoff values for acromial slope and acromiohumeral interval were 24.5° and 7.4 mm, respectively. Patients with an acromiohumeral interval smaller than 7.4 mm or an acromial slope greater than 24.5° had higher odds (acromiohumeral interval: OR 11 [95% CI 2 to 46]; p = 0.01 and acromial slope: OR 9 [95% CI 2 to 46]; p = 0.04) for rerupture of the SSP. No difference was found between patients with intact SSP tendons and those with reruptured SSP tendons in terms of glenoid inclination (6° ± 4° versus 6° ± 3°, mean difference 0.8° [-1° to 3°]; p < 0.48) and glenoid version (-2° ± 3° versus -3° ± 3°, mean difference 1° [-1° to 3°]; p < 0.30). No difference was found between the intact and reruptured SSP groups regarding clinical outcomes (Western Ontario Rotator Cuff Index: 98 ± 2 versus 97 ± 3, mean difference 0.73 [95% CI -0.30 to 0.31]; p = 0.96; Oxford Shoulder Score: 26 ± 13 versus 23 ± 10, mean difference 2.80 [95% CI -4.12 to 9.72]; p = 0.41). CONCLUSION The preoperative acromiohumeral interval and acromial slope are associated with SSP tendon rerupture after repair. Conversely, the critical shoulder angle, acromial tilt, lateral acromial angle, and acromial index had no association with the postoperative outcome. Additionally, glenoid inclination and version were not associated with the rerupture rate after SSP tendon repair. A detailed analysis of the acromiohumeral interval and acromial slope is recommended in clinical practice in patients undergoing SSP tendon repair. Surgeons should consider measuring the acromiohumeral interval and acromial slope preoperatively when performing SSP repair, especially in the context of planned acromioplasties. Future studies should investigate the role of acromioplasty during SSP repair in patients with a pathologic acromial slope and acromiohumeral interval. In this context, it should be determined whether a more-radical acromioplasty could reduce the risk of rerupture of the SSP in these patients. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Thomas Caffard
- Department of Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
| | | | - Marius Ludwig
- Department of Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
| | - Daniel Dornacher
- Department of Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
| | - Michael Fuchs
- Department of Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
| | - Thomas Kappe
- Department of Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
| | - Heiko Reichel
- Department of Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
| | - Mirco Sgroi
- Department of Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
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Özer M, Yaka H, Türkmen F, Kaçira BK, Kaptan AY, Kanatli U. Evaluation of the relationship between scapula morphology and anterior shoulder dislocation accompanying greater tuberosity fracture. Injury 2023:S0020-1383(23)00397-2. [PMID: 37183089 DOI: 10.1016/j.injury.2023.05.002] [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: 01/24/2023] [Revised: 04/27/2023] [Accepted: 05/01/2023] [Indexed: 05/16/2023]
Abstract
INTRODUCTıON: It is estimated that 5-30% of traumatic anterior shoulder dislocations are accompanied by greater tuberosity fracture (GTF), and the pathomechanism of these fractures is not yet clear. Our hypothesis is to examine the relationship between the scapula morphology and anterior shoulder dislocation (ASD) accompanying GTF. MATERıALS AND METHODS: The patients were divided into two groups according to the accompanying GTF. 40 patients with isolated traumatic ASD and 31 patients with accompanying GTF were included in the study. Critical shoulder angle (CSA), glenoid inclination (GI), acromial index (AI) and greater tuberosity angle (GTA) values were measured in two sessions by two independent observers in the standard antero-posterior radiographs of the patients in both groups. RESULTS: The mean CSA was 40.82°±3.19° and 35.49°±2.19° in accompanying GTF group and the isolated ASD group, respectively. The mean CSA was significantly higher in accompanying GTF group than isolated ASD group(P<0.001). The GI was significantly higher in the isolated ASD than in accompanying GTF group (P = 0.001). The mean GI was 18.7°±6.85° and 10.45°±4.87° in accompanying GTF group and the isolated ASD, respectively. Cut-off value of CSA and GI was 38° (88.2% sensitivity,88.9% specificity) and 14.5° (70.6% sensitivity and 72.2% specificity), respectively. There was no significant difference regarding the mean GTA and AI values between GTF group and the isolated ASD group (P = 0.98, P = 0.63). CONCLUSıONS: Increased CSA and GI values are associated with traumatic anterior shoulder dislocation accompanied by greater tuberosity fracture.
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Affiliation(s)
- Mustafa Özer
- Konya City Hospital, Department of Orthopaedics & Traumatology, Konya 42020, Turkey
| | - Haluk Yaka
- Necmettin Erbakan University School of Medicine, Department of Orthopaedics & Traumatology, Konya, Turkey.
| | - Faik Türkmen
- Necmettin Erbakan University School of Medicine, Department of Orthopaedics & Traumatology, Konya, Turkey
| | | | - Ahmet Yiğit Kaptan
- Harran University Hospital, Department of Orthopaedics & Traumatology, Şanlıurfa, Turkey
| | - Ulunay Kanatli
- Gazi University School of Medicine, Department of Orthopaedics & Traumatology, Ankara, Turkey
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Sheth MM, Shah AA. Massive and Irreparable Rotator Cuff Tears: A Review of Current Definitions and Concepts. Orthop J Sports Med 2023; 11:23259671231154452. [PMID: 37197034 PMCID: PMC10184227 DOI: 10.1177/23259671231154452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/09/2022] [Indexed: 05/19/2023] Open
Abstract
Background While massive and irreparable rotator cuff tears (MIRCTs) have been abundantly studied, inconsistent definitions in the literature and theories about pain and dysfunction related to them can be difficult to navigate when considering an individual patient. Purpose To review the current literature for definitions and critical concepts that drive decision-making for MIRCTs. Study Design Narrative review. Methods A search of the PubMed database was performed to conduct a comprehensive literature review on MIRCTs. A total of 97 studies were included. Results Recent literature reflects added attention to clarifying the definitions of "massive, "irreparable," and "pseudoparalysis." In addition, numerous recent studies have added to the understanding of what generates pain and dysfunction from this condition and have reported on new techniques for addressing them. Conclusion The current literature provides a nuanced set of definitions and conceptual foundations on MIRCTs. These can be used to better define these complex conditions in patients when comparing current surgical techniques to address MIRCTs, as well as when interpreting the results of new techniques. While the number of effective treatment options has increased, high-quality and comparative evidence on treatments for MIRCTs is lacking.
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Affiliation(s)
- Mihir M. Sheth
- Baylor College of Medicine, Houston, Texas, USA
- Mihir M. Sheth, MD, Baylor College of Medicine, 7200 Cambridge Street, Suite 10A, Houston, TX 77030, USA () (Twitter: @mihirmsheth)
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15
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Effect of arthroscopic subacromial decompression during arthroscopic repair of small to medium-sized rotator cuff tears. JSES Int 2023; 7:296-300. [PMID: 36911774 PMCID: PMC9998726 DOI: 10.1016/j.jseint.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Although arthroscopic subacromial decompression (ASD) is a commonly used procedure during arthroscopic rotator cuff repair (ARCR), the effect of ASD on the clinical outcomes for ARCR is controversial. The purpose of this study was to compare the clinical outcomes of ARCR with or without ASD. Methods Patients (n = 315 with 320 shoulders) who underwent ARCR for small to medium-sized rotator cuff tears were followed for at least 24 months. ARCR was performed with ASD (180 shoulders, group A) or without ASD (140 shoulders, group N). There were no significant differences in patient demographics, including mean age and mean follow-up time. Rotator cuff repair was performed using the suture-bridge technique in all shoulders, and all patients were treated using the same rehabilitation protocol after surgery. University of California at Los Angeles score, Constant score, re-tear rates, revision surgery rates, and operating time were compared between groups. Re-tear was defined as Sugaya classification Types 4 and 5 using postoperative magnetic resonance imaging at more than 12 months. Results There was no statistically significant difference in clinical outcomes before and after ARCR between groups. However, the University of California at Los Angeles scores and Constant scores significantly improved in both groups after surgery (P < .001). Furthermore, there was no major difference in the re-tear rates between groups A (7/180 shoulders, 3.9%) and N (11/140 shoulders, 7.9%) (P = .146). Revision surgeries were performed on 3/180 shoulders (1.7%) in group A (due to postoperative deep infection in one shoulder and revision ARCR for re-tear in two shoulders). No revisions surgeries were needed in group N patients (P = .259). The mean surgical time for group A was 62.0 ± 27.0 minutes (29-138 min.) and 52.4 ± 26.1 minutes (17-124 min.) for group N (P = .007). Conclusion These results suggest that ASD has a limited effect on clinical outcomes of ARCR for small to medium-sized rotator cuff tears.
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Matsui Y, Momma D, Suenaga N, Urita A, Yoshioka C, Oizumi N, Iwasaki N. Computed tomography revealed the correlation between radiolucency and alignment of all-polyethylene pegged glenoid component more than 10 years after total shoulder arthroplasty in the Japanese population. J Orthop Sci 2023; 28:131-137. [PMID: 34838411 DOI: 10.1016/j.jos.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/24/2021] [Accepted: 10/28/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Anatomical total shoulder arthroplasty (TSA) provides successful long-term outcomes but complications can occur after 10 years that require revision. Computed tomography (CT) is a useful tool for assessing radiolucent lines around the glenoid component of TSA; however, the merits of long-term post-TSA follow up with CT are unclear. The purpose of this study was to evaluate the long-term outcomes after TSA of Japanese population and to identify factors related to radiolucency around the glenoid component using CT. METHODS A retrospective review was conducted of TSA patients who had completed at least 10 years of clinical follow up. Radiographs and CT images of the affected shoulder obtained at the last follow up were evaluated for radiolucent lines around the stem and each peg, superior inclination and retroversion of the glenoid component, subluxation index, and critical shoulder angle (CSA). Shoulder ROM, Constant-Murley score and UCLA score were compared between the preoperative and last follow up period. RESULTS Eighteen shoulders in 16 patients met the inclusion criteria. Mean patient age was 61 years, mean follow up period was 137 months, and mean Yian CT score was 19%. CT score was significantly highest in pegs located inferiorly (p < 0.05). Mean glenoid superior inclination was 12.6°, retroversion was -0.3°, subluxation index was 46%, and CSA was 33.7°. Glenoid superior inclination was significantly lower (p = 0.007) in shoulders with possible loosening than in cases with no loosening (5.0° vs 15.6°). Mean Constant score and UCLA score improved significantly after TSA, from 25.8 to 10.7 points preoperatively to 70.1 and 28.9 points postoperatively, respectively. Mean shoulder flexion, internal rotation, and external rotation also showed improvement postoperatively. CONCLUSION TSA provides good long-term outcomes. Radiolucency was present most frequently around the inferior pegs of the glenoid component. Glenoid superior inclination may affect the formation of radiolucent lines around glenoid pegs. LEVEL OF EVIDENCE Level IV; Case Series; Treatment study.
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Affiliation(s)
- Yuki Matsui
- Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
| | - Daisuke Momma
- Center for Sports Medicine, Hokkaido University Hospital, Sapporo, Japan.
| | | | - Atsushi Urita
- Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
| | | | | | - Norimasa Iwasaki
- Faculty of Medicine and Graduate School of Medicine, Department of Orthopaedic Surgery, Hokkaido University, Sapporo, Japan
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Morgan CN, Bonner KF, Griffin JW. Augmentation of Arthroscopic Rotator Cuff Repair: Biologics and Grafts. Clin Sports Med 2023; 42:95-107. [DOI: 10.1016/j.csm.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chatterjee M, Acosta A, Taub PJ, Andarawis-Puri N. Enhanced healing outcomes in MRL/MpJ mouse tissues conserved in insertion site following surgical repair. J Shoulder Elbow Surg 2022; 31:e593-e602. [PMID: 35598836 DOI: 10.1016/j.jse.2022.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 04/13/2022] [Accepted: 04/18/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Surgical repair of supraspinatus tendons (SSTs) has a high failure rate at the insertion site. A significant hurdle to therapeutic development is that effective intrinsic healing mechanisms are unknown. The MRL/MpJ (MRL) mouse exhibits tissue-specific enhanced healing; however, these tissues exhibit disparate properties from the complex SST. The extent of SST healing in the complex environment of the rotator cuff is unknown. We hypothesized that MRL mice would exhibit enhanced restoration of the structurally complex insertion site, resulting in functional improvements. METHODS B6 and MRL mice underwent SST detachment and immediate surgical repair. Mice were analyzed for gait assessment after either 2 or 6 weeks and were then killed humanely for immunohistologic analysis. RESULTS MRL SSTs demonstrated enhanced recovery of zonal architecture and bone structure compared with B6 SSTs. MRL SSTs exhibited decreased levels of type III collagen at 2 weeks and increased levels of type I procollagen at 6 weeks compared with B6 SSTs. MRL mice experienced initial gait deficits at 2 weeks that had recovered by 6 weeks. DISCUSSION The temporal balance of collagen in MRL mice suggests recovery toward naive composition. Initial gait deficits in MRL mice may provide a protective loading environment that is ultimately beneficial. The mechanisms of enhanced healing observed previously in MRL mice may be conserved in the complex SST, providing a platform to interrogate specific aspects of improved healing.
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Affiliation(s)
- Monideepa Chatterjee
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | - Ashley Acosta
- Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter J Taub
- Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nelly Andarawis-Puri
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA; Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA; Hospital for Special Surgery, New York, NY, USA.
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19
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Billaud A, Lacroix PM, Carlier Y, Pesquer L. How much acromial bone should be removed to decrease the critical shoulder angle? A 3D CT acromioplasty planning study. Arch Orthop Trauma Surg 2022; 142:3909-3915. [PMID: 35088167 DOI: 10.1007/s00402-021-04292-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 11/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND A high critical shoulder angle (CSA) is associated with rotator cuff tear (RCT) and retear rate after repair. CSA reduced to less than 33° by acromioplasty is correlated with better clinical results and healing. But up to 24% of patients retain a CSA above 35° after acromioplasty. The objective of the study was to evaluate the use of 3D when planning acromioplasty and measure acromial bone removal volume dimensions. METHODS Computed tomography (CT) scans from 45 patients with RCT and CSA ≥ 38° were retrospectively included. A 33° CSA cutting plane was positioned. Acromion was divided into 5 mm slices and acromial bone resection measured on each slice. RESULTS Intra- and inter-observer reproducibility measurements were rated strong or very strong. Patients' mean preoperative CSA was 40° (38°, 49° ± 2.3°). Measurements of acromial resection were: anteroposterior length: 32.7 mm (20, 50 ± 7.4); inferior width: 7.6 mm (4.2, 19 ± 2.9); superior width: 4.1 mm (0, 16 ± 3.0); height: 6.1 mm (1.7, 6.7 ± 1.6); and cutting angle: 74° (46, 91 ± 8.0). Maximum width of acromial resection was located 10.6 mm (5, 17.5 ± 0.6) from the acromion's anterior edge and decreased gradually moving posteriorly. Preoperative CSA was linearly correlated with width (P < 0.0001, R = 84%) and length (P = 0.0001, R = 28%) of acromioplasty; the higher the CSA, the greater the width and length. CONCLUSIONS 3D CT reconstructions are valid for planning a CSA decreasing acromioplasty. To reduce CSA to 33°, acromioplasty must be performed anterolaterally and resection is at least 2 cm long anteroposteriorly. For higher CSAs, acromioplasty may require lateral resection over 1 cm in width and up to 5 cm in length. To decrease the CSA efficiently, acromioplasty must be adapted to patient anatomy and 3D planning could be considered. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Anselme Billaud
- Clinique du Sport, 2 rue Georges Negrevergne, 33700, Mérignac, France.
| | | | - Yacine Carlier
- Clinique du Sport, 2 rue Georges Negrevergne, 33700, Mérignac, France
| | - Lionel Pesquer
- Centre d'Imagerie Ostéo-Articulaire, 2 rue Georges Negrevergne, 33700, Mérignac, France
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Acromion morphology affects lateral extension of acromion: A three-dimensional computed tomographic study. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2022. [DOI: 10.1016/j.jrras.2022.100471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Thiesemann S, Kirchner F, Fal MF, Albers S, Kircher J. Anterolateral Acromioplasty Does Not Change the Critical Shoulder Angle and Acromion Index in a Clinically Relevant Amount. Arthroscopy 2022; 38:2960-2968. [PMID: 35777676 DOI: 10.1016/j.arthro.2022.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 02/22/2022] [Accepted: 06/08/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Assessment on whether radiographic parameters of the acromion measured in radiographs change significantly after anterolateral acromioplasty. METHODS This retrospective study included patients that underwent an arthroscopic anterolateral acromioplasty between January 2014 and September 2020. n = 435 subjects with high-quality preoperative and postoperative radiographs according to Suter-Henninger criteria were included in the final assessment. All measurements were independently performed by the first and second author in a blinded fashion using dicomPACS software: acromion index (AI), critical shoulder angle (CSA), lateral acromial angle (LAA), beta angle, acromio-humeral distance (AHD), Aoki angle, frontal supraspinatus outlet angle (FSOW), and acromion type, according to Bigliani. SPSS software was used for statistical analysis. RESULTS The beta angle and the CSA did not significantly change after operation (alpha power 0.32 and 0.11, respectively). In a subgroup analysis of patients with a pathological CSA >35° (n = 194), the CSA changed from 38.62 (range: 35.08-47.52, SD 2.83) to 38.04 (range: 29.18-48.12, SD 3.77) postoperatively (P = .028) (Fig 8). All other parameters changed significantly after operation (AI, AHD, FSOW, and Aoki; P = .001, LAA; P = .039) (Fig. 9). The interobserver and intraobserver reliability was good to excellent in the majority of measured values. Mean patient age was 59.2 years (range: 18.1-87.1; SD 11.3), mean height was 1.73 meters (range: 1,50-1.98, SD 0.09), mean weight was 80.2 kg (range: 37.0-133.0, SD 16.68), and mean body mass index was 26.6 (range: 0.0-46.1, SD 4.73). CONCLUSION Anterolateral acromioplasty producing a flat acromion undersurface did not result in a significant change of the CSA in the study population. Pathological preoperative CSA values of >35° were significantly reduced but not to normal values, but only by a small amount that puts the clinical relevance into question. LEVEL OF EVIDENCE IV, diagnostic study, case series.
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Affiliation(s)
- Sophie Thiesemann
- ATOS Klinik Fleetinsel Hamburg, Department of Shoulder and Elbow Surgery, Hamburg, Germany
| | - Florian Kirchner
- ATOS Klinik Fleetinsel Hamburg, Department of Shoulder and Elbow Surgery, Hamburg, Germany.
| | - Milad Farkhondeh Fal
- University Hospital Hamburg Eppendorf, Department of Trauma and Orthopaedic Surgery, Martinistraße 52, 20251 Hamburg, Germany
| | - Sebastian Albers
- ATOS Klinik Fleetinsel Hamburg, Department of Shoulder and Elbow Surgery, Hamburg, Germany
| | - Jörn Kircher
- ATOS Klinik Fleetinsel Hamburg, Department of Shoulder and Elbow Surgery, Hamburg, Germany
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Does the critical shoulder angle influence retear and functional outcome after arthroscopic rotator cuff repair? A systematic review and meta-analysis. Arch Orthop Trauma Surg 2022; 143:2653-2663. [PMID: 36194254 DOI: 10.1007/s00402-022-04640-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 09/25/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE This systematic review and meta-analysis aimed to evaluate the correlation between increased critical shoulder angle (CSA) and higher retear rates and functional outcomes after arthroscopic rotator cuff repair (ARCR). METHODS PubMed, Embase, Web of Science, and Cochrane Library databases published before January 2022 were comprehensively searched. Two reviewers independently reviewed the titles and abstracts using the specified criteria. Studies were included if the authors clearly described the correlation between the CSA and rotator cuff repair. Data on patient characteristics, mean CSA, retear rate, and the functional score was pooled from the selected articles. A meta-analysis was performed using Review Manager (RevMan) 5.4.1 software, 2020 (Cochrane Collaboration, Copenhagen, Denmark). RESULTS Eleven articles involving 1449 patients from 7 countries were included. The ages of the patients ranged from 45 to 75 years. The follow-up period ranged from 6 to 96 months. The mean CSA was greater in the retear group than in the non-retear group after ARCR (mean difference 2.73°; 95% confidence interval [CI] 0.69-4.77) (p = 0.009). Three studies evaluated the association between increased CSA and the postoperative retear rate. All three studies showed a higher postoperative retear rate in patients with an increased CSA (odds ratio 5.35; 95% CI 2.02-14.15; p = 0.0007). No association was found between CSA and Constant-Murley (Constant), the University of California at Los Angeles (UCLA), or Visual Analog Scale (VAS) scores during the follow-up period of 24-96 months (p > 0.05). CONCLUSIONS This systematic review and meta-analysis showed that CSA correlates highly with rotator cuff retear after ARCR. In addition, the postoperative retear rate of the rotator cuff increased with increased CSA. CSA appeared to not affect worse functional outcomes in patients after ARCR.
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Joo MS, Kim JW. Significant radiologic factors related to clinical outcomes after arthroscopic rotator cuff retear repair. Clin Shoulder Elb 2022; 25:173-181. [PMID: 36102050 PMCID: PMC9471812 DOI: 10.5397/cise.2022.01046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/16/2022] [Indexed: 11/25/2022] Open
Abstract
Background Healing of the tendon itself is not always related to successful clinical outcomes after rotator cuff repair. It was hypothesized that certain radiologic factors affecting clinical outcomes could exist in case of the retear after arthroscopic rotator cuff repair (ARCR) and the radiologic factors could help predict clinical process. The purpose of this study was to identify the radiologic factors associated with clinical outcomes of the retear after ARCR. Methods Between January 2012 and December 2019, among patients with sufficient footprint coverage for ARCR, 96 patients with Sugaya classification 4 or higher retear on follow-up magnetic resonance imaging were included. The association between clinical outcomes such as American Shoulder and Elbow Surgeons (ASES) score, Constant score and range of motion and radiologic variables such as initial tear dimension, retear dimension, variance of tear dimension, critical shoulder angle, acromial index, and acromiohumeral distance was analyzed. Results Preoperatively, the ASES and Constant scores were 59.81±17.02 and 64.30±15.27, respectively. And at the last follow-up, they improved to 81.56±16.29 and 78.62±14.16, respectively (p<0.01 and p<0.01). In multiple linear regression analysis, the variance of the mediolateral dimension of tear had statistically significant association with the ASES and Constant scores (p<0.01 and p=0.01). Conclusions In patients with the retear after ARCR, the variance in the mediolateral dimension of tear had significantly negative association with the clinical outcomes. This could be considered to be reference as relative criteria and needed more sample and mechanical study.
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Oishi T, Kobayashi N, Yukizawa Y, Takagawa S, Honda H, Inaba Y. Radiographs Are Comparable With 3-Dimensional Computed Tomography-Based Models as a Modality for the Preoperative Planning of the Arthroscopic Lateral Acromioplasty: A Retrospective Comparative Study. Arthrosc Sports Med Rehabil 2022; 4:e1799-e1806. [PMID: 36312715 PMCID: PMC9596903 DOI: 10.1016/j.asmr.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose To compare plain radiographs with 3-dimensional (3D) computed tomography (CT) data for preoperative planning of arthroscopic lateral acromioplasty (ALA) for patients in whom ALA was performed along with arthroscopic rotator cuff repair (ARCR). Methods Patients older than 25 years old who underwent ALA along with ARCR in our institution between October 2019 and February 2021 were included in this study. Preoperative ALA simulations were performed on plain radiographs and 3D models based on CT data. The critical shoulder angle (CSA) was compared between simulations based on radiographs and those based on 3D models. The ALA procedure was performed using the 3D model simulation, along with ARCR. The CSA after surgery was investigated using radiographs. Results We evaluated 11 shoulders in 10 patients. There was no significant difference between the mean preoperative CSA on radiographs and 3D models (38.0° ± 2.6° vs 38.6° ± 1.8°, respectively; P = .55). The mean CSA after 4-mm ALA simulation using radiographs was not significantly different to that using 3D models (34.1° ± 2.6° vs 34.3° ± 2.5°, respectively; P = .84). Four cases (36.4%) required 8-mm ALA to reduce the CSA to <35° on radiographic analysis, and 2 (18.2%) required 8-mm ALA on 3D model analysis. The mean CSA on postoperative radiographs was significantly smaller than that on preoperative radiographs (32.1° ± 2.7° vs 38.0° ± 2.6°, respectively; P < .01). Conclusions There was no significant difference between the mean CSA after a 4-mm ALA simulation using radiographs and that using 3D models based on preoperative CT data, which suggests that radiographs are comparable with 3D CT data models as a reliable modality for the preoperative simulation of ALA. Level of Evidence III, retrospective comparative study.
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Affiliation(s)
- Takayuki Oishi
- Department of Orthopedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Naomi Kobayashi
- Department of Orthopedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
- Address correspondence to Naomi Kobayashi M.D., Ph.D., Department of Orthopedic Surgery, Yokohama City University Medical Center, Yokohama, Japan.
| | - Yohei Yukizawa
- Department of Orthopedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Shu Takagawa
- Department of Orthopedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Hideki Honda
- Department of Orthopedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Yutaka Inaba
- Department of Orthopedic Surgery, Yokohama City University, Yokohama, Japan
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He R, Sun X, Yu X, Xia H, Chen S. Static Model of Athlete's Upper Limb Posture Rehabilitation Training Indexes. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9353436. [PMID: 35898674 PMCID: PMC9313996 DOI: 10.1155/2022/9353436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/07/2022] [Accepted: 06/26/2022] [Indexed: 11/17/2022]
Abstract
With the gradual expansion of the development of sports, the level of sports has been rapidly improved. Athletes have to carry out high-intensity and systemic technical movements in training and competition. Some sports have the greatest burden on the shoulder joint. From the observation and investigation of the injured parts of athletes, it is found that the shoulder joint is the most common sports injury, which is the most typical sports injury. Based on the problem of insufficient strength and endurance reserve after rehabilitation of shoulder external rotator injury, it will cause muscle tension and poor extensibility. To prove the improvement effect of functional training and posture index calibration on the poor posture of the shoulder, considering the measurement of global passive torque, this paper uses a limited set of joint angles and corresponding passive torque data in the upper arm lifting trajectory to train the neural network and uses the trained network to predict the passive torque in other upper arm trajectories. The kinematics model of the shoulder joint is established, and the human-computer interaction experiment is designed on the platform of the gesture index manipulator. The passive and active torque components of the shoulder joint in the human-computer interaction process are calculated by measuring the man-machine interaction force of the subjects in the motion state, which is used as the basis for evaluating the active motion intention of the subjects. Surface electromyography (SEMG) was used to calibrate and verify the attitude index of shoulder active torque. The method proposed in this paper is helpful to achieve more efficient on-demand assisted rehabilitation training exercises, which is of great significance to improve the level of rehabilitation training.
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Affiliation(s)
- Ruihua He
- Capital University of Physical Education and Sports, Beijing 100191, China
- Hebei University of Engineering, Handan, 056038 Hebei, China
| | - Xinyu Sun
- Handan Maternal and Child Health Hospital, Handan, 056038 Hebei, China
| | - Xuedou Yu
- Hebei University of Engineering, Handan, 056038 Hebei, China
| | - Hongtao Xia
- Hebei University of Engineering, Handan, 056038 Hebei, China
| | - Shuaijie Chen
- Hebei University of Engineering, Handan, 056038 Hebei, China
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Smith GC, Sawang M. Lateral Acromioplasty With the Aim of Reducing the Critical Shoulder Angle Using Techniques Based on the Lateral Acromial Border Result in Larger-Than-Necessary Resections. Arthrosc Sports Med Rehabil 2022; 4:e1059-e1066. [PMID: 35747621 PMCID: PMC9210476 DOI: 10.1016/j.asmr.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 03/02/2022] [Indexed: 11/27/2022] Open
Abstract
Purpose Methods Results Conclusions Clinical relevance
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Xie L, Xu X, Ma B, Liu H. A high acromion-greater tuberosity impingement index increases the risk of retear after arthroscopic rotator cuff repair. J Orthop Surg (Hong Kong) 2022; 30:10225536221092219. [PMID: 35430906 DOI: 10.1177/10225536221092219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND No evaluation has been done on the relationship of the acromion-greater tuberosity impingement index (ATI) with retear after arthroscopic rotator cuff repair (ARCR). Our purpose was to evaluate whether a higher ATI is associated with retear after ARCR. METHODS 132 patients received ARCR and underwent MRI scan at a one year follow-up to assess tendon healing, and the findings were graded no retear (NR), partial-thickness retear (PR) or full-thickness retear (FR). The ATI, the critical shoulder angle (CSA), acromion index (AI) and lateral acromial angle (LAA) were measured with postoperative radiographs. Functional scores were obtained preoperatively and at a one year follow-up. RESULTS Postoperative Constant scores and ASES scores were significantly different between groups with inferior outcomes in the FR group (p < 0.05 for all). The UCLA score was significantly better in the NR group compared with the PR and FR groups (p < 0.05), and in the PR group compared with the FR group (p < 0.05). For ATI and CSA, the values of the PR and FR groups were larger than the NR group (p < 0.05 for all), but there were no significant differences between the PR and FR groups (p > 0.05 for all). No significant differences were observed with regard to the AI and LAA (p > 0.05, respectively). The repair integrity was positively related to the ATI (0.304, p < 0.05) and CSA (0.252, p < 0.05), but not related to the AI or LAA (p > 0.05 for both). ATI was not related to any functional scores (p > 0.05 for all). CONCLUSION This study revealed that the ATI was positively related to rotator cuff retear. Patients with retears had significantly greater ATIs after ARCR. Level of Evidence: III, case-control study.
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Affiliation(s)
- Linghui Xie
- The Department of Radiology, 364242Wenzhou Seventh Hospital, Wenzhou, Zhejiang, China
| | - Xinxian Xu
- The Department of Sports Medicine, 26452The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Baoxiang Ma
- The Department of Radiology, 364242Wenzhou Seventh Hospital, Wenzhou, Zhejiang, China
| | - Haixiao Liu
- The Department of Sports Medicine, 26452The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Cunningham G, Cocor C, Smith MM, Young AA, Cass B, Moor BK. Implication of bone morphology in degenerative rotator cuff lesions: A prospective comparative study between greater tuberosity angle and critical shoulder angle. Orthop Traumatol Surg Res 2022; 108:103046. [PMID: 34487909 DOI: 10.1016/j.otsr.2021.103046] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/17/2021] [Accepted: 05/26/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Degenerative rotator cuff tear is a frequent and multifactorial pathology. The role of bone morphology of the greater tuberosity and lateral acromion has been validated, and can be measured with two plain radiographic markers on true anteroposterior views: the greater tuberosity angle (GTA) and the critical shoulder angle (CSA). However, the interdependence of both markers remains unknown, as well as their relationship with the level of professional and sports activities involving the shoulder. The aim of this prospective comparative study was to describe the correlation between the GTA and CSA in patients with degenerative rotator cuff tears. HYPOTHESIS GTA and CSA are independent factors from one another and from demographic factors, such as age, dominance, sports, or professional activities. PATIENT AND METHODS All patients presenting to a shoulder specialized clinic were assigned to two groups. The first consisted of patients with a symptomatic degenerative rotator cuff tear visible on MRI and the control group consisted of patients with any other shoulder complaints and no history or visible imaging of any rotator cuff lesion. RESULTS There were 51 shoulders in 49 patients in the rotator cuff tear group (RCT) and 53 shoulders in 50 patients in the control group. Patient demographics were similar in both groups. Mean GTA was 72.1°±3.7 (71.0-73.1) in the RCT group and 64.0°±3.3 (63.1-64.9) in the control group (p<0.001). Mean CSA was 36.7°±3.7 (35.7-37.8) in the RCT group, and 32.1°±3.7 (31.1-33.1) in the control group (p<0.001). A summation of GTA and CSA values over 103° increased the odds of having a rotator cuff tear by 97-fold (p<0.001). There was no correlation between GTA and CSA, nor between GTA or CSA and age, sex, tear size, or dominance. Patients with different levels of professional and sports activities did not have significantly different GTA or CSA values. CONCLUSION GTA and CSA are independent radiologic markers that can reliably predict the presence of a degenerative rotator cuff tear. A sum of both values over 103° increases the odds of having a rotator cuff tear by 97-fold. These markers are not correlated with patient demographic or environmental factors, suggesting that the variability of the native acromion and greater tuberosity morphology may be individual risk factors for rotator cuff tear. LEVEL OF EVIDENCE II; diagnostic study.
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Affiliation(s)
- Gregory Cunningham
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, Geneva, Switzerland; Shoulder Center, Hirslanden Clinique la Colline, Geneva, Switzerland.
| | - Cristina Cocor
- Division of Orthopaedics and Trauma Surgery, Lausanne University Hospital, Geneva, Switzerland
| | | | - Allan A Young
- Sydney Shoulder Research Institute, Sydney, Australia
| | - Benjamin Cass
- Sydney Shoulder Research Institute, Sydney, Australia
| | - Beat K Moor
- Division of Orthopaedics and Trauma Surgery, Hôpital du Valais, Martigny, Switzerland
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Hardy V, Rony L, Bächler J, Favard L, Hubert L. Does isolated arthroscopic anterior acromioplasty modify critical shoulder angle? Orthop Traumatol Surg Res 2022; 108:103040. [PMID: 34389495 DOI: 10.1016/j.otsr.2021.103040] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/08/2021] [Accepted: 02/10/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Critical shoulder angle (CSA)>35° correlates significantly with primary rotator cuff tear and re-tear after repair. Acromial axial orientation varies between individuals. The present study aimed to assess the impact of strictly anterior acromioplasty on CSA. HYPOTHESIS CSA is reduced by arthroscopic anterior acromioplasty. MATERIAL AND METHODS A single-center retrospective study included patients receiving isolated arthroscopic acromioplasty between January 2016 and December 2017. Exclusion criteria comprised history of surgery and fracture or dislocation of the shoulder. Pre- and post-operative AP shoulder radiographs were taken. The angle subtended by a line between the inferior and superior edges of the glenoid and a line between the inferior edge of the glenoid and the most lateral point on the acromion was measured. RESULTS One hundred and two patients were included: mean age, 50.5±10.1 years (range, 23-82 years). Mean CSA was 34.7±4.4° (range, 26-48°) preoperatively and 31.7±3.7° (range, 23-40°) postoperatively (p<0.001). In the group with CSA >35°, the decrease was significant: 34.4±3.2° (range, 28-40°) versus 38.9±2.8° (range, 36-48°) (p<0.001), with 64% CSA <35° after isolated anterior acromioplasty. DISCUSSION CSA was decreased by arthroscopic acromioplasty. However, in 36% of cases with preoperative CSA >35°, CSA was not normalized. CONCLUSION Anterior arthroscopic acromioplasty significantly reduced CSA in the overall population, and especially in case of high CSA. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Vincent Hardy
- Centre Hospitalier Régional Universitaire de Tours, Hôpital Trousseau, Avenue de la République, 37170 Chambray-lès-Tours, France.
| | - Louis Rony
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4 Rue Larrey, 49100 Angers, France
| | - Julien Bächler
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4 Rue Larrey, 49100 Angers, France
| | - Luc Favard
- Centre Hospitalier Régional Universitaire de Tours, Hôpital Trousseau, Avenue de la République, 37170 Chambray-lès-Tours, France; Faculté de Médecine de Tours, 10 Boulevard Tonnelé, 37032 Tours cedex 1, France
| | - Laurent Hubert
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4 Rue Larrey, 49100 Angers, France
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30
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Ernat JJ, Rakowski DR, Casp AJ, Horan MP, Millett PJ. Results of arthroscopic rotator cuff repair for calcific tendonitis: a comparative analysis. J Shoulder Elbow Surg 2022; 31:616-622. [PMID: 34481052 DOI: 10.1016/j.jse.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Outcomes following arthroscopic excision of calcific tendonitis and arthroscopic rotator cuff repair (CT-ARCR) are relatively limited without comparison analysis to standard arthroscopic rotator cuff repair (ARCR). The purpose of this study was to evaluate patient-reported outcomes (PROs) after CT-ARCR compared against a matched cohort who received standard ARCR. METHODS An institutional review board-approved retrospective review was performed for patients aged 18-80 years receiving CT-ARCR by a single surgeon from 2006-2018. These were matched 1:3 with patients receiving ARCR. Patients with concurrent labral repair, subscapularis repair, or glenohumeral joint arthritis procedures; refusal to participate; deceased; inadequate contact information; or those with inadequate records were excluded. PROs included Short Form-12 Physical Component Summary (SF-12 PCS) score; American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES); Single Assessment Numeric Evaluation (SANE); Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH); patient satisfaction; activity level/symptoms; and sport participation scores. RESULTS 21 CT-ARCR patients (mean age 50 years, range 36-62) and 54 ARCR patients (mean age 52 years, range 19-77) were included. Minimum 2-year follow-up was obtained in 18 of 21 (86%) CT-ARCR (mean 5.9 years) and 45 of 54 (83%) ARCR patients (mean 5.6 years). CT-ARCR patients improved pre- to postoperation in mean SF-12 PCS (41.1 to 50.0), ASES (54.2 to 94.0), and QuickDASH (54.2 to 94.0). SANE score improvements (57.6 to 82.8) were not significant. ARCR controls improved pre- to postoperation in mean SF-12 PCS (41.4 to 49.0), ASES (59.4 to 88.0), QuickDASH (35.1 to 13.8), and SANE scores (52.6 to 80.8). Pre- to postoperative pain during recreation and sport participation similarly improved in both groups. The only postoperative difference observed between CT-ARCR and ARCR was better patient satisfaction with CT-ARCR (9.7 vs. 8.3). CONCLUSION CT-ARCR results in excellent PROs, activity symptoms, and sports participation at final follow-up. CT-ARCR results were comparable to patients who received conventional ARCR for similar-sized rotator cuff tears that did not have calcific tendonitis.
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Affiliation(s)
- Justin J Ernat
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA
| | | | - Aaron J Casp
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA
| | | | - Peter J Millett
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA.
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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.
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Zhang M, Yang Z, Zhang B, Liu T, Jiang J, Yun X. Does the critical shoulder angle decrease after acromioplasty? A systematic review and meta-analysis. J Orthop Surg Res 2022; 17:28. [PMID: 35033137 PMCID: PMC8760732 DOI: 10.1186/s13018-022-02927-7] [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: 10/20/2021] [Accepted: 01/06/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Rotator cuff tears are one of the most common shoulder injuries in the older population. This study aimed to determine whether acromioplasty reliably decreases the critical shoulder angle (CSA) and describe any associated complications. METHODS A systematic literature review was performed according to PRISMA guidelines using PubMed, EMBASE, Web of Science, and Cochrane Library Database. Two reviewers independently screened the titles and abstracts using prespecified criteria. Studies where the acromioplasty was performed as a surgical procedure were included. Patient characteristics and degree of CSA reduction were collected from each individual study. All statistical analyses were performed using Review Manager (RevMan) 5.4.1 software. A random-effects model was used for meta-analysis. RESULTS A total of 9 studies involving 1236 patients were included in the meta-analysis. The age of patients ranged from 23 to 82 years. The follow-up period ranged from 12 to 30 months. Of the 9 studies, 8 (88.9%) were retrospective, 1 (11.1%) was prospective, 5 were comparative, and 4 were case series. The mean CSA was significantly reduced from 36.1° ± 4.6° to 33.7° ± 4.2 (p < 0.05). The meta-analysis showed an overall best estimate of the mean difference in pre- and postoperative CSA equal to 2.63° (95% confidence interval: 2.15, 3.11] (p < 0.00001). CONCLUSIONS Acromioplasty can significantly reduce CSA, notably in cases of high preoperative CSA. In addition, the effect of lateral acromioplasty on the CSA was more significant compared to anterolateral acromioplasty. Acromioplasty was not associated with complications during the short-term follow-up.
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Affiliation(s)
- Mingtao Zhang
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, Gansu, China
| | - Zhitao Yang
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, Gansu, China
| | - Borong Zhang
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, Gansu, China
| | - Tao Liu
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, Gansu, China
| | - Jin Jiang
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, Gansu, China.
| | - Xiangdong Yun
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, Gansu, China.
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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.
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Zaid MB, Young NM, Pedoia V, Feeley BT, Ma CB, Lansdown DA. Radiographic shoulder parameters and their relationship to outcomes following rotator cuff repair: a systematic review. Shoulder Elbow 2021; 13:371-379. [PMID: 34394734 PMCID: PMC8355656 DOI: 10.1177/1758573219895987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/06/2019] [Accepted: 11/09/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Anatomic parameters, such as the critical shoulder angle and acromion index, have emerged as methods to quantify scapular anatomy and may contribute to rotator cuff pathology. The purpose of this paper is to investigate the published literature on influences of scapular morphology on the development of re-tears and patient-reported outcomes following rotator cuff repair. METHODS A systematic review of the Embase and PubMed databases was performed to identify published studies on the potential influence of scapular bony morphology and re-tear rates and patient-reported outcomes after rotator cuff repair. Studies were reviewed by two authors. RESULTS A total of 615 unique titles and 49 potentially relevant abstracts were reviewed, with eight published manuscripts identified for inclusion. Two of three papers reported no relationship between these acromion index and rotator cuff re-tear rate, while one paper found an increased re-tear rate. All three studies on critical shoulder angle found a significant association between critical shoulder angle and cuff re-tear rate. There was no clear relationship between any bony morphologic measurement and patient-reported outcomes after rotator cuff repair. CONCLUSIONS Rotator cuff re-tear rate appears to be significantly associated with the critical shoulder angle and glenoid inclination, while not clearly associated with acromial morphologic measurements.
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Affiliation(s)
- Musa B Zaid
- Musa B Zaid, 500 Parnassus Ave, MU-320 W,
San Francisco, CA 94143, USA.
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Yoğun Y, Armangil M, Basat HÇ. The Effect of Acromial Morphology on the Functional Outcomes of Degenerative Rotator Cuff Tear Surgery. Indian J Orthop 2021; 56:237-243. [PMID: 35140853 PMCID: PMC8789986 DOI: 10.1007/s43465-021-00468-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 07/25/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to investigate how the critical shoulder angle (CSA) and acromion index (AI) affect the outcome of arthroscopic rotator cuff tear (RCT) repair. METHODS A total of 287 patients, who underwent arthroscopic surgery due to degenerative rotator cuff tear, were evaluated. The Constant Shoulder Score (CSS), Oxford Shoulder Score (OSS) and Visual Analogue Scale (VAS) were evaluated preoperatively and postoperatively. The AI and CSA were measured on true anteroposterior shoulder radiographs. The patients were separated into two groups according to their CSA and AI values (control group ≤ 38°, increased CSA > 38°, and control group ≤ 0.7, increased AI > 0.7). The relationship between CSS, OSS and VAS was examined in all the groups. RESULT The evaluation was made of a total of 287 patients with a mean age of 60.29 ± 8.55 years. The mean duration of follow-up of the patients was 34.00 ± 18.97 months (range 12-80 months). There was a statistically significant difference between the preoperative and postoperative clinical scores of the patients (p < 0.05). No relationship was determined between CSA, AI and CSS, OSS or VAS during follow-up (p > 0.05). The interobserver ICC for CSA and AI were determined to be 0.962 and 0.967, respectively (95% CI) indicating a high correlation (p < 0.001). CONCLUSION CSA and AI do not affect functional outcomes in the postoperative period, so they are not significant at the time of degenerative arthroscopic rotator cuff repair decisions.
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Affiliation(s)
- Yener Yoğun
- Orthopedics and Traumatology Department, Etimesgut Şehit Sait Ertürk State Hospital, Etimesgut, Ankara, Turkey
| | - Mehmet Armangil
- Faculty of Medicine, Orthopedics and Traumatology Department, Ankara University, Hand Surgery Unit, Ankara, Turkey
| | - Hakkı Çağdaş Basat
- Faculty of Medicine, Orthopedics and Traumatology Department, Ahi Evran University, Kirsehir, Turkey
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Lin CL, Lin LF, Hsu TH, Lin LC, Lin CH, Huang SW. Acromioplasty reduces critical shoulder angle in patients with rotator cuff tear. PLoS One 2021; 16:e0253282. [PMID: 34191814 PMCID: PMC8245121 DOI: 10.1371/journal.pone.0253282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/28/2021] [Indexed: 11/18/2022] Open
Abstract
Critical shoulder angle (CSA) is the angle between the superior and inferior bone margins of the glenoid and the most lateral border of the acromion and is potentially affected during a rotator cuff tear (RCT). Acromioplasty is generally performed to rectify the anatomy of the acromion during RCT repair surgery. However, limited information is available regarding the changes in the CSA after anterolateral acromioplasty. We hypothesized that CSA can be decreased after anterolateral acromioplasty. Data were retrospectively collected from 712 patients with RCTs and underwent arthroscopic rotator cuff repair between January 2012 and December 2018, of which 337 patients were included in the study. The presurgical and postsurgical CSA were then determined and compared using a paired samples t test. Because previous study mentioned CSA more than 38 degrees were at risk of rotator cuff re-tear, patients were segregated into two groups: CSA < 38° and CSA ≥ 38°; these groups were compared using an independent-samples t test. These 337 participants (160 male and 177 female) presented a CSA of 38.4° ± 6.0° before anterolateral acromioplasty, which significantly decreased to 35.8° ± 5.9° after surgery (P < .05). Before surgery, 172 patients were present in the CSA ≥ 38° group and 57 were preset in the CSA < 38° group after surgery. The CSA decreased significantly in the CSA ≥ 38° group rather than in the CSA < 38° group (P < .05). In conclusion, the CSA can be effectively decreased through anterolateral acromioplasty, and this reduction in the CSA is more significant among individuals with CSA ≥ 38° than among those with CSA < 38°, indicating that acromioplasty is recommended along with RCT repair especially among individuals with a wide presurgical CSA.
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Affiliation(s)
- Che-Li Lin
- Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li-Fong Lin
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Tzu-Herng Hsu
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Lien-Chieh Lin
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chueh-Ho Lin
- Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan, R.O.C
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, R.O.C
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- * E-mail:
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Hardy V, Rony L, Bächler J, Favard L, Hubert L. WITHDRAWN: Does anterior arthroscopic acromioplasty modify critical shoulder angle? Orthop Traumatol Surg Res 2021; 107:102936. [PMID: 33872821 DOI: 10.1016/j.otsr.2021.102936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 03/16/2020] [Indexed: 02/04/2023]
Abstract
This article has been withdrawn because we accidentally published the same article twice due to an error by the Managing editor/Elsevier. The correct version of the article has been published later in Orthop Traumatol Surg Res, 108 (2022) 103040, https://doi.org/10.1016/j.otsr.2021.103040. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal
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Affiliation(s)
- Vincent Hardy
- Centre Hospitalier Régional Universitaire de Tours, Hôpital Trousseau, avenue de la République, 37170 Chambray-lès-Tours, France.
| | - Louis Rony
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4, rue Larrey, 49100 Angers, France
| | - Julien Bächler
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4, rue Larrey, 49100 Angers, France
| | - Luc Favard
- Centre Hospitalier Régional Universitaire de Tours, Hôpital Trousseau, avenue de la République, 37170 Chambray-lès-Tours, France; Faculté de Médecine de Tours, 10, boulevard Tonnelé, 37032 Tours cedex 1, France
| | - Laurent Hubert
- Centre Hospitalier Universitaire d'Angers, Département de Chirurgie Osseuse, 4, rue Larrey, 49100 Angers, France
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de Almeida Filho IA, Coelho DA. Rotator Cuff Healing. Rev Bras Ortop 2021; 56:291-298. [PMID: 34239192 PMCID: PMC8249069 DOI: 10.1055/s-0040-1713764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/15/2020] [Indexed: 11/05/2022] Open
Abstract
The present article broadly addresses the aspects that interfere with the healing process of the rotator cuff. Life habits, such as smoking and alcoholism, are considered, systemic factors such as diabetes mellitus, hypertension, and obesity, as well as local factors, among which are those related to the pre, peri, and postoperative periods. From an extensive literature review, with the citation of 60 scientific articles from both Western and Eastern literature, the authors intend to deepen the theme by bringing to medical practice conducts based on new established concepts.
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Affiliation(s)
- Ildeu Afonso de Almeida Filho
- Departamento de Ortopedia, Hospital Felício Rocho, Belo Horizonte, MG, Brasil
- Hospital Vera Cruz, Belo Horizonte, MG, Brasil
| | - Daniel Andrade Coelho
- Hospital Vera Cruz, Belo Horizonte, MG, Brasil
- Hospital Semper, Belo Horizonte, MG, Brasil
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Mandaleson A. Re-tears after rotator cuff repair: Current concepts review. J Clin Orthop Trauma 2021; 19:168-174. [PMID: 34123722 PMCID: PMC8170498 DOI: 10.1016/j.jcot.2021.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022] Open
Abstract
Re-tear following rotator cuff repair is common and has been reported to range from between 13 and 94% despite satisfactory clinical outcomes following rotator cuff surgery. Various risk factors have been associated with an increased tear rate, including patient factors, tear and shoulder morphology, repair technique, and rehabilitation regimes. Different modes of rotator cuff failure have been described. The management of re-tear in patients following rotator cuff repair is challenging and depends on the age, functional status and requirements of the patient, and re-tear size and residual tendon length. This article aims to review the factors associated with rotator cuff re-tear. It describes which of these are associated with poor clinical outcomes, and discusses the long-term outcomes of re-tear and treatment options.
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Hou J, Li F, Zhang X, Zhang Y, Yang Y, Tang Y, Yang R. The Ratio of the Transverse to Longitudinal Diameter of the Glenoid Projection Is of Good Predictive Value for Defining the Reliability of Critical Shoulder Angle in Nonstandard Anteroposterior Radiographs. Arthroscopy 2021; 37:438-446. [PMID: 33129967 DOI: 10.1016/j.arthro.2020.08.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate (1) whether measurement of the critical shoulder angle (CSA) is still reliable in some nonstandard anteroposterior radiographs; and (2) whether the ratio of the transverse to longitudinal diameter of the glenoid projection (RTL) could be used to determine the reliability of the CSA in nonstandard anteroposterior radiographs. METHODS The authors analyzed radiology records from 2017 to 2019 for patients with computed tomography (CT) scans of the shoulder. According to the Suter-Henninger classification system, each CT scan underwent 3-dimensional (3D) reconstructions to obtain 8 digitally reconstructed radiographs (DRRs), including 1 type A1 film and 7 type D1 films with different rotation angles. CSA and RTL were measured on all films, and 2 blinded reviewers evaluated DRRs. The relationship between RTL and CSA was determined by Pearson correlation test. The threshold value was determined by receiver operating characteristic (ROC) analyses using RTL as predictors and defined reliable CSA as criterion in the logistic regression. Intra- and inter-rater reliability were assessed by the intraclass correlation coefficient (ICC). Discriminative capacity was calculated with ROC analyses and area under the curve (AUC). An optimal measurement cutoff with resultant sensitivity and specificity was calculated. RESULTS A total of 86 patients were included, mean age 40.70 ± 18.25 years, 19 of whom had rotator cuff tears (RCTs) and 67 without RCTs. Spearman's correlation test revealed that the deviation of CSA was positively correlated with RTL, correlation coefficient 0.544 (P < .001) in all patients and 0.686 (P < .001) only in patients with RCTs. ROC analysis of all patients showed that the AUC of the RTL was 0.90, and the optimal cutoff point was 0.25 (sensitivity 88%, specificity 87%). ROC analysis only of patients with RCTs showed that the AUC of the RTL was 0.95, and the optimal cutoff point was 0.22 (sensitivity 95%, specificity 92%). CONCLUSION The ratio of the transverse to longitudinal diameter of the glenoid projection (RTL) is of good predictive value in defining the reliability of the CSA in malposition films. Based on the results, the CSA can be considered reliable if its RTL is <0.25. LEVEL OF EVIDENCE III, retrospective cohort study investigating a diagnostic test.
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Affiliation(s)
- Jingyi Hou
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Fangqi Li
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Xiang Zhang
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Yuanhao Zhang
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Yaping Yang
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Yiyong Tang
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Rui Yang
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China.
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Harada N, Gotoh M, Ishitani E, Kakuma T, Yano Y, Tatara D, Kawakami J, Imai T, Karasuyama M, Kudoh Y, Shiba N. Combination of risk factors affecting retear after arthroscopic rotator cuff repair: a decision tree analysis. J Shoulder Elbow Surg 2021; 30:9-15. [PMID: 32838953 DOI: 10.1016/j.jse.2020.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Several risk factors for postoperative retear after arthroscopic rotator cuff repair (ARCR) have been cited in a large number of reports; various combinations of these seem to be present in the clinical setting. PURPOSE Using a combination model for decision tree analysis, we aimed to investigate the combination of risk factors that affect postoperative retear the most. METHODS A total of 286 patients who underwent magnetic resonance (MR) imaging at 6 months after surgery were included in this study. Based on the structural integrity of the MR images taken 6 months after surgery, the patients were divided into a healed group (intact tendon, 254 patients) and a retear group (ruptured tendon, 32 patients). Using univariate and decision tree analyses, we selected a combination of 11 risk factors that drastically affected postoperative retear. RESULTS The mean age was 64.9 ± 7.1 years, and the mean symptom duration was 9.7 ± 11.6 months. The tear was small/medium in 177 patients and large/massive in 109 patients. The technique for surgical repair was single row in 42 patients, double row in 60 patients, and suture bridging in 216 patients. On univariate analysis, both groups had significant differences in the anteroposterior (AP) tear size (P < .0001), mediolateral tear size (P < .0001), hyperlipidemia (P = .0178), global fatty degeneration index (P < .0001), supraspinatus fatty degeneration stage (P < .0001), and critical shoulder angle (CSA) (P = .0015). All of these 5 risk factors, except for mediolateral tear size, were selected as candidates for the decision tree analysis. Eight combination patterns were determined to have prediction probabilities that ranged from 4.3% to 86.1%. In particular, the combination of an AP tear size of ≥40 mm, hyperlipidemia, and a CSA of ≥37° affected retear after ARCR the most. CONCLUSIONS Decision tree analysis lead to the extraction of different retear factor combinations, which were divided into 5 retear groups. The worst combination was of AP tear size ≥40 mm, hyperlipidemia, and CSA ≥37°, and the prediction probability of this combination was 86.2%. Therefore, our data may offer a new index for the prediction of retear after ARCR.
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Affiliation(s)
- Nobuya Harada
- Department of Rehabilitation, Fukuoka Shion Hospital, Fukuoka, Japan; Kurume University School of Medicine Graduate School, Fukuoka, Japan
| | - Masafumi Gotoh
- Department of Orthopedic Surgery, Kurume University Medical Center, Fukuoka, Japan.
| | - Eiichi Ishitani
- Department of Orthopedic Surgery, Fukuoka Shion Hospital, Fukuoka, Japan
| | - Tatsuyuki Kakuma
- Department of Biostatistics, Kurume University School of Medicine, Fukuoka, Japan
| | - Yuka Yano
- Department of Rehabilitation, Fukuoka Shion Hospital, Fukuoka, Japan
| | - Daisuke Tatara
- Department of Rehabilitation, Fukuoka Shion Hospital, Fukuoka, Japan
| | - Junichi Kawakami
- Department of Physical Therapy, Kyushu Nutrition Welfare University, Fukuoka, Japan
| | - Takaki Imai
- Department of Rehabilitation, Keishinkai Hopital, Saga, Japan
| | - Masaki Karasuyama
- Department of Physical Therapy, Kyushu Nutrition Welfare University, Fukuoka, Japan
| | - Yu Kudoh
- Kurume University School of Medicine Graduate School, Fukuoka, Japan
| | - Naoto Shiba
- Department of Orthopedic Surgery, Kurume University, Fukuoka, Japan
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Olmos MI, Boutsiadis A, Swan J, Brossard P, Barthelemy R, Delsol P, Barth J. Lateral acromioplasty cannot sufficiently reduce the critical shoulder angle if preoperatively measured over 40°. Knee Surg Sports Traumatol Arthrosc 2021; 29:240-249. [PMID: 32248274 DOI: 10.1007/s00167-020-05951-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/23/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate whether arthroscopic lateral acromion resection can sufficiently reduce the critical shoulder angle (CSA) without damaging deltoid muscle insertion. METHODS Ninety patients who underwent arthroscopic rotator cuff (RC) repair were retrospectively analysed. According to the preoperative CSA, patients were categorized as Group I (CSA < 35°) and Group II (CSA ≥ 35°). Additional arthroscopic lateral acromion resection was performed in Group II. The CSA was measured 1 week postoperatively, while RC integrity and the deltoid attachment were assessed at 3, 6 and 12 months via ultrasound. Deltoid function was evaluated using the Akimbo test, in which patients place their hands on the iliac crest with abduction in the coronal plane and internal rotation of the shoulder joint while simultaneously flexing the elbow joint and pronating the forearm. RESULTS Large and massive RC tears were more prevalent in Group II (p = 0.017). In both groups, the CSA reduction was statistically significant (Group I = 1°: range 0°-3°, Group II = 3.7°: range 1°-8°; p < 0.001). When the preoperative CSA was > 40°, the respective postoperative CSA remained > 35° in 83.3% of cases (p < 0.001). Final shoulder strength was correlated with the amount of CSA reduction (rho = 0.41, p = 0.002). The postoperative CSA was higher, but not significantly different (n.s.), in patients with re-torn (36°, range 32°-40°) than with healed RC (33°, range 26°-38°). No clinical detachment or hypotrophy of the deltoid was observed with the Akimbo test and ultrasound evaluation. CONCLUSIONS Arthroscopic lateral acromion resection is a safe procedure without affecting deltoid muscle origin or function, and it is effective in significantly reducing the CSA. However, the CSA cannot always be reduced to < 35°, especially in patients with preoperative CSA values > 40°. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Manuel Ignacio Olmos
- Department of Orthopaedic Surgery, Centre Osteoarticulaire Des Cèdres, Parc Sud Galaxie, 5 Rue Des Tropiques, Echirolles, 38130, Grenoble, France
| | - Achilleas Boutsiadis
- Department of Orthopedic Surgery, 401 Military Hospital of Athens, Athens, Greece
| | - John Swan
- Department of Orthopaedic Surgery, Centre Osteoarticulaire Des Cèdres, Parc Sud Galaxie, 5 Rue Des Tropiques, Echirolles, 38130, Grenoble, France
| | - Paul Brossard
- Department of Orthopedic Surgery, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | | | - Philippe Delsol
- Department of Orthopaedic Surgery, Centre Osteoarticulaire Des Cèdres, Parc Sud Galaxie, 5 Rue Des Tropiques, Echirolles, 38130, Grenoble, France
| | - Johannes Barth
- Department of Orthopaedic Surgery, Centre Osteoarticulaire Des Cèdres, Parc Sud Galaxie, 5 Rue Des Tropiques, Echirolles, 38130, Grenoble, France.
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Liu HX, Xu XX, Xu DL, Hu YZ, Pan XY, Yu Z, Xu YJ. The acromion-greater tuberosity impingement index: A new radiographic measurement and its association with rotator cuff pathology. J Orthop Surg (Hong Kong) 2020; 28:2309499020913348. [PMID: 32212965 DOI: 10.1177/2309499020913348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Several radiographic parameters describe humeral head coverage by the acromion. We describe a new radiographic measurement, the acromion-greater tuberosity impingement index (ATI), and its ability to predict rotator cuff pathology. METHODS The ATI was measured with magnetic resonance imaging (MRI) and X-ray analysis in 83 patients with rotator cuff pathology and 76 patients with acute rotator cuff tears. The lateral acromial angle (LAA), acromion type, the acromion index (AI) and the critical shoulder angle (CSA) were measured to assess their correlations with the ATI. Receiver operating characteristic (ROC) curves were used to predict degenerative rotator cuff pathology. The change in the ATI after acromion surgery was evaluated in both groups. RESULTS According to the ROC curves, the ATI is a good predictor of degenerative rotator cuff pathology on both X-ray (cut-off, 0.865) and MRI (cut-off, 0.965). Patients with degenerative rotator cuff pathology had a significantly higher average ATI compared to the trauma group (p = 0.001 for X-ray and MRI). The degenerative group had a significantly lower LAA (p = 0.001) and a higher ratio of type III acromion (p = 0.035) than the trauma group. The ATI on X-ray was negatively related to the LAA and positively related to the AI, the CSA and acromion type (each p < 0.05). The ATI on MRI was negatively related to the LAA and positively related to the AI and acromion type (each p <0.05). More patients in the degenerative group than the trauma group needed acromioplasty or acromion decompression (p < 0.05). The ATI on MRI was significantly lower after acromion surgery compared to before surgery in both groups (p < 0.05). CONCLUSION The ATI is a good predictor of degenerative supraspinatus tendon tears or subacromial impingement syndrome. The ATI on MRI is more accurate and can precisely guide acromion surgery.
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Affiliation(s)
- Hai-Xiao Liu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China.,Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xin Xian Xu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dao Liang Xu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yue Zheng Hu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China.,Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiao-Yun Pan
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhang Yu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - You-Jia Xu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Long Y, Hou J, Tang Y, Li F, Yu M, Zhang C, Yang R. Effect of arthroscopic acromioplasty on reducing critical shoulder angle: a protocol for a prospective randomized clinical trial. BMC Musculoskelet Disord 2020; 21:819. [PMID: 33287773 PMCID: PMC7722311 DOI: 10.1186/s12891-020-03818-w] [Citation(s) in RCA: 2] [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: 06/02/2020] [Accepted: 11/22/2020] [Indexed: 02/07/2023] Open
Abstract
Background The critical shoulder angle (CSA), which helps to predict patients who are at risk of rotator cuff tears (RCTs) with large degree and who are susceptible to osteoarthritis with low angle, has been identified as one of the most vital acromial parameters; anterolateral and lateral acromioplasties have been proven to be valid ways to reduce CSA. However, no study has compared the effect of different acromioplasties on the reduction of the large CSA (≥33°) clinically. Additionally, either anterolateral or lateral acromioplasty could not precisely correct large CSAs to a favorable range (30–33°) in each patient. Thus, we will propose a novel precise acromioplasty technique for the purpose of reducing CSA accurately and effectively, and compare the effectiveness of different acromioplasties on the reduction of the CSA. Methods A total of 60 RCT patients who have indications for arthroscopic rotator cuff repair and with pre-operative CSA ≥33° will be recruited in outpatient center of Sun Yat-sen Memorial Hospital. Eligible participants will be randomly allocated to Group A (anterolateral acromioplasty), Group B (lateral acromioplasty) or Group C (precise acromioplasty) via a random, computer-generated number system. Three surgical plans will be made for each participant respectively by one professional surgeon according to the results of randomization allocation. The post-operative CSA will be measured 2 days post-operation. Follow-up will be maintained at 3, 6, and 12 months after surgery including the visual analog scale score, the University of California at Los Angeles score, the Constant Shoulder Score and the American Shoulder and Elbow Surgeon Shoulder Assessment Form. Finally, all outcomes will be assessed by two researchers who are blinded to the recruitment and allocation. Discussion This is the first clinical trial to evaluate the impact of different acromioplasties on the reduction of the CSA. Additionally, this study will provide a new precise acromioplasty technique, which is a novel precision and individualized treatment to prevent degenerative RCTs by reducing the CSA. Trial registration ChiCTR2000032343. Registered on April 26th, 2020.
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Affiliation(s)
- Yi Long
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang Road West, Guangzhou, 510120, Guangdong, China
| | - Jingyi Hou
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang Road West, Guangzhou, 510120, Guangdong, China
| | - Yiyong Tang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang Road West, Guangzhou, 510120, Guangdong, China
| | - Fangqi Li
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang Road West, Guangzhou, 510120, Guangdong, China
| | - Menglei Yu
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang Road West, Guangzhou, 510120, Guangdong, China
| | - Congda Zhang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang Road West, Guangzhou, 510120, Guangdong, China
| | - Rui Yang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang Road West, Guangzhou, 510120, Guangdong, China.
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Franceschetti E, Giovannetti de Sanctis E, Palumbo A, Ranieri R, Casti P, Mencattini A, Maffulli N, Franceschi F. Lateral Acromioplasty has a Positive Impact on Rotator Cuff Repair in Patients with a Critical Shoulder Angle Greater than 35 Degrees. J Clin Med 2020; 9:jcm9123950. [PMID: 33291482 PMCID: PMC7762128 DOI: 10.3390/jcm9123950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND A Critical Shoulder Angle (CSA), evaluated on plain radiographs, greater than 35° is considered predictive of rotator cuff tears. The present prospective comparative study aimed, firstly, to develop a formula to calculate the amount of acromion that should be resected performing a lateral acromioplasty and, secondly, verify whether lateral acromioplasty to reduce the CSA associated with arthroscopic cuff repair decreased the rate of recurrence of the tears, and impacted favorably on clinical postoperative outcomes. METHODS Patients undergoing arthroscopic rotator cuff repair (RCR) for rotator cuff tears with a CSA greater than 35° were included in this study and divided into two groups, based on whether the CSA had been reduced by arthroscopic resection of the lateral portion of the acromion. A new mathematical formula was developed in order to quantify the amount of bone to be resected while performing the lateral acromioplasty. Patients with traumatic tears, previous surgery, osteoarthritis or plain radiographs, not classified as A1 according to Suter-Henninger, were excluded. Clinical and radiographic outcomes were assessed at a minimum of 2 years of follow-up considering the tear size. RESULTS 289 patients were included in this study. Thirty-seven were lost to follow-up. Group A (Lateral acromioplasty) patients included: 38 small tears, 30 medium tears, 28 large tears and 22 massive tears; Group B (control group) was composed of 40 small tears, 30 medium tears, 30 large tears and 23 massive tears. The Constants Score value and retear Rate were, respectively, significant higher (p = 0.007 and p = 0.004) and lower (p = 0.029 and p = 0.028) in Group A, both in the Small-and Medium-size subgroups. No complications were outlined. The mediolateral width of the acromion was reduced, according to the preoperatively calculated measure. CONCLUSION Arthroscopic lateral acromioplasty decreased the CSA within the favorable range (30°-35°) in all patients treated, resecting the amount of bone predicted by the mathematical formula. Lateral acromioplasty is a safe and reproducible technique which may prevent recurrence of rotator cuff tears in patients with small and medium lesions. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Edoardo Franceschetti
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (A.P.)
| | - Edoardo Giovannetti de Sanctis
- Department of Orthopaedics and Traumatology, Catholic University, Agostino Gemelli Hospital, 00168 Rome, Italy
- Correspondence:
| | - Alessio Palumbo
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy; (E.F.); (A.P.)
| | - Riccardo Ranieri
- Department of Orthopaedic and Trauma Surgery, Humanitas Clinical and Research Center, Rozzano, 20089 Milan, Italy;
| | - Paola Casti
- Department of Electronics Engineering, University of Rome Tor Vergata, Via del Politecnico 1, 00133 Rome, Italy; (P.C.); (A.M.)
| | - Arianna Mencattini
- Department of Electronics Engineering, University of Rome Tor Vergata, Via del Politecnico 1, 00133 Rome, Italy; (P.C.); (A.M.)
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Via Salvador Allende, 43, 84081 Baronissi, Italy;
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, UK
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent ST4, UK
| | - Francesco Franceschi
- Department of Orthopaedic and Trauma Surgery, San Pietro Fatebenefratelli Hospital, Via Cassia 600, 00123 Rome, Italy;
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Opsomer GJ, Verstuyft L, Muermans S. Long-term follow-up of patients with a high critical shoulder angle and acromion index: is there an increased retear risk after arthroscopic supraspinatus tendon repair? JSES Int 2020; 4:882-887. [PMID: 33345229 PMCID: PMC7738603 DOI: 10.1016/j.jseint.2020.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The effect of the acromion index (AI) and critical shoulder angle (CSA) on the short-term healing rate after arthroscopic repair of the supraspinatus tendons is already known. Long-term effects have not been published yet. PURPOSE Long-term evaluation of the effect of the AI and CSA on the postoperative healing rate and clinical results after arthroscopic repair of the supraspinatus tendon. METHODS Patients with a symptomatic, single-tendon, full-thickness supraspinatus tear in whom nonoperative management had failed were treated with an arthroscopic repair. Preoperative radiographs were used to measure CSA and AI. Eight years postoperatively, magnetic resonance imaging (MRI) studies were performed and evaluated on repair integrity. Patient-reported outcome measurements were collected pre- and postoperatively. RESULTS Thirty-one patients were evaluated 8 years postoperatively. The mean age at the time of surgery was 61 ± 9 years. MRI evaluation showed that 20 patients (65%) had an intact repair and 11 (35%) had a full-thickness retear. No significant differences were found between the intact and retear groups regarding age (P = .605), initial tear size (P = .485), retraction grade (P = .439), and all PROMs. The mean CSA for the intact group (33° ± 1°) was significantly lower than the CSA in the retear group (38° ± 1°; P = .004). Eighteen patients (58%) had a CSA ≥35°, and 9 (50%) among them had a retear and 9 (50%) had an intact repair.The mean AI for the intact group (0.72 ± 0.11) was significantly lower than the AI in the retear group (0.81 ± 0.08 ; P = .021). Seventeen patients (55%) had an AI ≥0.75, and 9 (53%) among them had a retear and 8 had an intact repair. If the AI was ≥0.75, the odds ratio of having a retear was 6.19 (P = .045). No progressive worsening of PROMs and clinical results could be demonstrated related to a higher CSA or AI during the entire follow-up. CONCLUSION At long-term follow-up, a higher CSA has the tendency to have an increased rate of retear after arthroscopic supraspinatus tendon repair, but this was not significant. A higher AI significantly increased the retear risk. A higher CSA and AI did not impair the clinical results over time. An AI ≥0.75 was associated with a 6-fold increase in risk of retear after arthroscopic supraspinatus tendon repair.
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Affiliation(s)
- Gert-Jan Opsomer
- Department of Orthopedic Surgery, Shoulder Care Institute, AZ Delta Hospital, Roeselare, Belgium
| | - Lotte Verstuyft
- Department of Orthopedic Surgery, Shoulder Care Institute, AZ Delta Hospital, Roeselare, Belgium
| | - Stijn Muermans
- Department of Orthopedic Surgery, Shoulder Care Institute, AZ Delta Hospital, Roeselare, Belgium
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MacLean IS, Gowd AK, Waterman BR, Dempsey IJ, Bach BR, Cole BJ, Romeo AA, Verma NN. The Effect of Acromioplasty on the Critical Shoulder Angle and Acromial Index. Arthrosc Sports Med Rehabil 2020; 2:e623-e628. [PMID: 33135003 PMCID: PMC7588649 DOI: 10.1016/j.asmr.2020.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 07/16/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose To evaluate the effect of acromioplasty using a cutting block technique on bony coverage as measured by the critical shoulder angle (CSA) and acromial index (AI). Methods This study is a retrospective radiographic review using data from a previous prospective randomized clinical trial that offered enrollment to patients aged 18 years or older with a full-thickness tear of the superior rotator cuff between October 2007 and January 2011. Each patient was allocated to repair with either acromioplasty using a cutting block technique or non-acromioplasty treatment arms in a blinded fashion. Medical and demographic information was recorded for each patient. Between January 2017 and December 2017, patients were contacted for repeat follow-up clinical evaluation and radiographs. Measurements of acromial index and critical shoulder angle were performed on pre- and postoperative radiographs by a single reviewer. Results Seventy-one (75%) patients were available for follow up. The 2 groups were similar in terms of baseline demographics and acromial type. When compared with preoperative measures, acromioplasty did not result in significant reductions in mean CSA (34.5° vs 35.5°; P = .293) or AI (0.68 vs 0.66; P = .283). Furthermore, postoperative CSA (34.5° vs 36.2°, P = .052) and AI (0.66 vs 0.67, P = .535) demonstrated no statistically significant differences between patients with and without acromioplasty, respectively. Conclusions There was no statistically significant change in either the CSA or AI following acromioplasty, nor was there a significant postoperative difference in CSA or AI between the group that underwent acromioplasty and the group that did not. Clinical Relevance Some studies suggest a greater postoperative CSA may result in greater risk of retear after arthroscopic rotator cuff repair. The CSA and AI may not be modifiable with acromioplasty.
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Affiliation(s)
- Ian S MacLean
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
| | - Brian R Waterman
- Section of Sports Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, U.S.A.,Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, U.S.A
| | - Ian J Dempsey
- Section of Sports Medicine, Rush University Medical Center, Chicago, Illinois, U.S.A.,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Bernard R Bach
- Section of Sports Medicine, Rush University Medical Center, Chicago, Illinois, U.S.A.,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Section of Sports Medicine, Rush University Medical Center, Chicago, Illinois, U.S.A.,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Anthony A Romeo
- Section of Shoulder and Elbow Surgery, Rothman Institute, Philadelphia, Pennsylvania, U.S.A
| | - Nikhil N Verma
- Section of Sports Medicine, Rush University Medical Center, Chicago, Illinois, U.S.A.,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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Acromial morphology is not associated with rotator cuff tearing or repair healing. J Shoulder Elbow Surg 2020; 29:2229-2239. [PMID: 32417045 DOI: 10.1016/j.jse.2019.12.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/23/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purposes of this study were to determine whether acromial morphology (1) could be measured accurately on magnetic resonance images (MRIs) as compared to computed tomographs (CTs) as a gold standard, (2) could be measured reliably on MRIs, (3) differed between patients with rotator cuff tears (RCTs) and those without evidence of RCTs or glenohumeral osteoarthritis, and (4) differed between patients with rotator cuff repairs (RCRs) that healed and those that did not. METHODS This is a retrospective comparative study. We measured coronal, axial, and sagittal acromial tilt; acromial width, acromial anterior and posterior coverage, and glenoid version and inclination on MRI corrected into the plane of the glenoid. We determined accuracy by comparison with CT via intraclass correlation coefficients (ICCs). To determine reliability, these same measurements were made on MRI by 2 observers and ICCs calculated. We compared these measurements between patients with a full-thickness RCT and patients aged >50 years without evidence of an RCT or glenohumeral osteoarthritis. We then compared these measurements between those patients with healed RCRs and those with a retorn rotator cuff on MRI. In this portion, we only included patients with both a preoperative MRI and a postoperative MRI at least 1 year from RCR. Only those patients without tendon defects on postoperative MRIs were considered to be healed. In these patients, we also radiographically measured the critical shoulder angle. RESULTS In a validation cohort of 30 patients with MRI and CT, all ICCs were greater than 0.86. In these patients, the inter-rater ICCs of the MRI measurements were >0.53. In our RCT group of 110 patients, there was greater acromial width [mean difference (95% confidence interval) = 0.1 (0, 0.2) mm, P = .012] and significantly less sagittal acromial tilt [9° (5°-12°), P < .001] than in our comparison group of 107 patients. A total of 110 RCRs were included. Postoperative MRI scans were obtained at a mean follow-up of 24.2 ± 15.8 months, showing 84 patients (76%) had healed RCRs. Aside from acromial width, which was 0.2 mm different and thus did not have clinical significance, there was no association between healing and any of the measured morphologic characteristics. Patients with healed repairs had significantly smaller tears in terms of both width (P < .001) and retraction (P < .001). CONCLUSION Although the acromion is wider in RCTs, the difference of 0.1 mm likely has no clinical significance. The acromion is more steeply sloped from posteroinferior to anterosuperior in those with RCTs. These findings call into question subacromial impingement due to native acromial morphology as a cause of rotator cuff tearing. Acromial morphology, critical shoulder angle, and glenoid inclination were not associated with healing after RCR. This study does not support lateral acromioplasty.
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Where and what damage occurs at the acromial undersurface in patients with rotator cuff tears? J Shoulder Elbow Surg 2020; 29:2065-2071. [PMID: 32414611 DOI: 10.1016/j.jse.2020.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 01/29/2020] [Accepted: 02/02/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The gross pathology of the acromial undersurface in shoulders with rotator cuff tears with subacromial impingement is not completely understood. Many researchers have focused on damage to the anterior one-third area of the acromial undersurface, but few have studied the middle and posterior one-third areas. The purpose of this study was to clarify where and what damage occurs at the acromial undersurface in patients with rotator cuff tears. METHODS We performed arthroscopic shoulder (n = 182, all with rotator cuff tears; mean age, 64.9 ± 8.4 years) and cadaveric shoulder (n = 23, 14 intact cuffs and 9 rotator cuff tears; mean age, 74.8 years) evaluations to observe the extent and degree of damage to the acromial undersurface. We statistically analyzed the association between the severity of the damage to the acromial undersurface (assessed using the Copeland-Levy classification as A0, normal; A1, minor scuffing; A2, major damage; or A3, visualization of bare bone area) and rotator cuff tear size (assessed using the classification of DeOrio and Cofield as partial; small, <1 cm; medium, 1-3 cm; or large or massive, >3 cm). RESULTS The anterior, middle, and posterior one-thirds of the acromial undersurface were somewhat damaged (class A1-A3) in 92.6%, 90.1%, and 78.6% of shoulders with rotator cuff tears, respectively, according to arthroscopic evaluation. Increasing cuff tear size was significantly associated with worsening degree of damage to the acromial undersurface (P < .001). In the 9 cadaveric shoulders with rotator cuff tears, class A1-A3 damage was identified in the anterior one-third area in 100%, in the middle one-third area in 88.9%, and in the posterior one-third area in 33.3%. In the 14 cadaveric shoulders with a normal rotator cuff, class A1-A3 damage was identified in the anterior one-third area in 35.7%, in the middle one-third area in 14.3%, and in the posterior one-third area in 0.71%. CONCLUSION Damage to the acromial undersurface in patients with rotator cuff tears occurred at the middle, posterior, and anterior one-third areas, and the degree of damage was related to cuff tear size. Surgeons should evaluate the entire acromial undersurface to check for subacromial impingement damage at the middle and posterior one-third areas as well as the anterior one-third area of the acromial undersurface; this might aid in the treatment of patients with rotator cuff disease or subacromial impingement syndrome.
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A biomechanical confirmation of the relationship between critical shoulder angle (CSA) and articular joint loading. J Shoulder Elbow Surg 2020; 29:1967-1973. [PMID: 32499200 DOI: 10.1016/j.jse.2020.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/21/2020] [Accepted: 03/01/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The critical shoulder angle (CSA) has been shown to be correlated with shoulder disease states. The biomechanical hypothesis to explain this correlation is that the CSA changes the shear and compressive forces on the shoulder. The objective of this study is to test this hypothesis by use of a validated computational shoulder model. Specifically, this study assesses the impact on glenohumeral biomechanics of modifying the CSA. METHODS An inverse dynamics 3-dimensional musculoskeletal model of the shoulder was used to quantify muscle forces and glenohumeral joint forces. The CSA was changed by altering the attachment point of the middle deltoid into a normal CSA (33°), a reduced CSA of 28°, and an increased CSA of 38°. Subject-specific kinematics of slow and fast speed abduction in the scapular plane and slow and fast forward flexion measured by a 3-dimensional motion capture system were used to quantify joint reaction shear and compressive forces. RESULTS Increasing the CSA results in increased superior-inferior forces (shearing forces; integrated over the range of motion; P < .05). Reducing CSA results in increased lateromedial (compressive) forces for both the maximum and integrated sum of the forces over the whole motion (P < .01). DISCUSSION/CONCLUSION Changes in the CSA modify glenohumeral joint biomechanics with increasing CSA producing higher shear forces that could contribute to rotator cuff overuse, whereas reducing the CSA results in higher compressive forces that contribute to joint wear.
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