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Garzón-Alfaro A, Botella M, Rus Carlborg G, Prados Olleta N, González-Ramírez AR, Hernández-Cortés P. Anthropometric study of the scapula in a contemporary population from granada. Sex estimation and glenohumeral osteoarthritis prevalence. PLoS One 2024; 19:e0305410. [PMID: 38985776 PMCID: PMC11236152 DOI: 10.1371/journal.pone.0305410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/29/2024] [Indexed: 07/12/2024] Open
Abstract
Anthropometric studies of the scapula have been rare in Spanish populations, nevertheless they are of current interest in forensic anthropology for estimation of sex. Although the estimation of sex is usually carried out on the pelvis and skull, other measurements related to the scapula can be helpful when the skeletal remains are incomplete. Glenohumeral osteoarthritis development is influenced, among others, by the morphology of the scapula, which is one of the less studied aspects. We carried out a descriptive study of anthropometric parameters in a series of 157 scapulae (82 individuals) on bone remains dated to the 20th century from a population of Granada (Southern Spain). Seventy seven (49%) were right-side and 80 (51%) left-side; 72 (45.9%) were from males and 85 (54.1%) from females, and the mean age at death was 70.76±11.7 years. The objective was to develop a discrimination function for sex estimation based on anthropometric parameters of the scapula other than those considered to date, and to analyze the prevalence of glenohumeral osteoarthritis in relation to selected anthropometric parameters. A logistic regression model based on parameters of the upper-external segment of the scapula was done. The obtained formula: 1/1+e^ (- (-57.911 + 0.350*B + 0283*C + 0.249*b + 0.166*a +-0.100*β) classifies male sex with 98.3% accuracy and female sex with 92.1%. Glenohumeral osteoarthritis was detected in 16.6% of individuals and was related to age (p<0.05), scapular length (p<0.05), glenoid width (p<0.05), glenopolar angle (p<0.05), and α angle (p<0.05) in bivariate analyses but showed no significant associations in multivariate analyses. This approach can be useful for anthropological-forensic identification when scapula remains are incomplete. Glenohumeral osteoarthritis is significantly associated with a smaller α angle.
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Affiliation(s)
- Adoración Garzón-Alfaro
- Orthopedic Surgery Department, Upper Limb Surgery Unit, "San Cecilio" University Hospital of Granada, Madrid, Spain
| | - Miguel Botella
- Department of Anthropology, School of Medicine of Granada, Madrid, Spain
| | - Guillermo Rus Carlborg
- Department of Structural Mechanics, Ultrasonics Group (TEP-959), University of Granada, Granada, Spain
- Excellence Research Unit "ModelingNature" MNat UCE.PP2017.03, University of Granada, Granada, Spain
- Biosanitary Research Institute of Granada (IBS), Granada, Spain
| | - Nicolás Prados Olleta
- Orthopedic Surgery Department, Foot and Ankle Surgery Unit, "Virgen de las Nieves", University Hospital of Granada, Madrid, Spain
- Surgery Department, School of Medicine. Granada University, Granada, Spain
| | - Amanda Rocío González-Ramírez
- Biosanitary Research Institute of Granada (IBS), Granada, Spain
- Bio- Health Research Foundation of Eastern Andalusia- Alejandro Otero (FIBAO), Granada, Spain
| | - Pedro Hernández-Cortés
- Orthopedic Surgery Department, Upper Limb Surgery Unit, "San Cecilio" University Hospital of Granada, Madrid, Spain
- Biosanitary Research Institute of Granada (IBS), Granada, Spain
- Surgery Department, School of Medicine. Granada University, Granada, Spain
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Crane C, Wagner C, Wong S, Hall B, Hull J, Irwin K, Williams K, Brooks A. Glenohumeral Osteoarthritis: A Biological Advantage or a Missed Diagnosis? J Clin Med 2024; 13:2341. [PMID: 38673614 PMCID: PMC11051042 DOI: 10.3390/jcm13082341] [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: 02/07/2024] [Revised: 03/29/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Osteoarthritis is a degenerative joint disease that is commonly diagnosed in the aging population. Interestingly, the lower extremity joints have a higher published incidence of osteoarthritis than the upper extremity joints. Although much is known about the disease process, it remains unclear why some joints are more affected than others. (2) Methods: A comprehensive literature review was conducted utilizing the search engines PubMed, Google Scholar, and Elsevier from 2014 to 2024, directing our search to osteoarthritis of various joints, with the focus being on glenohumeral osteoarthritis. (3) Results and Discussion: The literature review revealed a publication difference, which may be explained by the inconsistency in classification systems utilized in the diagnosis of shoulder osteoarthritis. For instance, there are six classification systems employed in the diagnosis of glenohumeral osteoarthritis, making the true incidence and, therefore, the prevalence unobtainable. Furthermore, susceptibility to osteoarthritis in various joints is complicated by factors such as joint anatomy, weight-bearing status, and prior injuries to the joint. (4) Conclusions: This review reveals the lack of understanding of shoulder osteoarthritis's true incidence and prevalence while considering the anatomy and biomechanics of the glenohumeral joint. In addition, this is the first paper to suggest a single criterion for the diagnosis of glenohumeral osteoarthritis.
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Affiliation(s)
- Camille Crane
- Colorado Campus, Rocky Vista University College of Osteopathic Medicine, 8401 South Chambers Road, Greenwood Village, CO 80112, USA; (B.H.); (K.I.)
| | - Caleb Wagner
- Utah Campus, Rocky Vista University College of Osteopathic Medicine, 855 East Center Street, Ivins, UT 84738, USA; (C.W.); (S.W.); (J.H.); (A.B.)
| | - Stephen Wong
- Utah Campus, Rocky Vista University College of Osteopathic Medicine, 855 East Center Street, Ivins, UT 84738, USA; (C.W.); (S.W.); (J.H.); (A.B.)
| | - Bryce Hall
- Colorado Campus, Rocky Vista University College of Osteopathic Medicine, 8401 South Chambers Road, Greenwood Village, CO 80112, USA; (B.H.); (K.I.)
| | - Jillian Hull
- Utah Campus, Rocky Vista University College of Osteopathic Medicine, 855 East Center Street, Ivins, UT 84738, USA; (C.W.); (S.W.); (J.H.); (A.B.)
| | - Katharine Irwin
- Colorado Campus, Rocky Vista University College of Osteopathic Medicine, 8401 South Chambers Road, Greenwood Village, CO 80112, USA; (B.H.); (K.I.)
| | - Kaitlin Williams
- Colorado Campus, Rocky Vista University College of Osteopathic Medicine, 8401 South Chambers Road, Greenwood Village, CO 80112, USA; (B.H.); (K.I.)
| | - Amanda Brooks
- Utah Campus, Rocky Vista University College of Osteopathic Medicine, 855 East Center Street, Ivins, UT 84738, USA; (C.W.); (S.W.); (J.H.); (A.B.)
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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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Cerciello S, Mocini F, Proietti L, Candura D, Corona K. Critical Shoulder Angle in Patients With Cuff Tears. Sports Med Arthrosc Rev 2024; 32:38-45. [PMID: 38695502 DOI: 10.1097/jsa.0000000000000397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
OBJECTIVE The pathogenesis of rotator cuff tears (RCTs) is multifactorial. Critical shoulder angle (CSA), which represents the lateral extension of the acromion over the cuff, has been proposed as an extrinsic risk factor. The aim of the present systematic review and meta-analysis was to analyze the available literature regarding the correlation between RCT and CSA. METHODS A review was carried out in accordance with the "Preferred Reporting Items for Systematic reviews and Meta-Analyses" guidelines on July 17, 2023, using the following databases: PubMed, Ovid, and Cochrane Reviews. The following keywords were used: "critical shoulder angle," "rotator cuff tears," and "rotator cuff lesions." The methodological quality of the studies was assessed with the MINORS SCORE. RESULTS Twenty-eight studies were included. The average CSA among the 2110 patients with full-thickness RCT was 36.7 degrees, whereas the same value among the 2972 controls was 33.1 degrees. The average CSA in the 348 patients with partial-thickness RCT was 34.6 degrees, whereas it was 38.1 degrees in the 132 patients with massive RCT. The average MINORS score was 15.6. CONCLUSIONS CSA values were significantly higher in patients with RCT compared with the asymptomatic population. In addition, it appears that CSA values increase with the severity of rotator cuff involvement.
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Affiliation(s)
- Simone Cerciello
- Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Sacred Heart Catholic University, Rome
| | | | | | | | - Korona Corona
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
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Hong G, Kong X, Zhang L, Zheng Y, Fan N, Zang L. Changes in the Lateral Acromion Angle in Rotator Cuff Tear Patients with Acromioplasty. Orthop Surg 2024; 16:471-480. [PMID: 38112436 PMCID: PMC10834229 DOI: 10.1111/os.13965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Arthroscopic surgery has been established as an efficacious intervention for the treatment of rotator cuff tears. The primary aim of this study was to analyze the modifications in the lateral acromial angle (LAA) subsequent to rotator cuff repair surgery using single-row rivet fixation and double-row rivet fixation techniques. Furthermore, we sought to investigate the influence of LAA on the prognosis of rotator cuff repair surgery. METHOD This observational study retrospectively enrolled 105 patients diagnosed with degenerative rotator cuff tears who underwent arthroscopic rotator cuff repair between 2016 and 2019. Following the exclusion of two patients with subscapularis or superior labrum anterior and posterior (SLAP) tears, as well as three patients who were lost to follow-up, a cohort of 100 patients was included for clinical and imaging evaluation. Among these individuals, 50 were assigned to the double-row repair group, whereas the remaining 50 comprised the single-row repair group. Bilateral shoulder magnetic resonance imaging (MRI) scans were conducted no less than 24 months post-surgery. Experienced arthroscopic surgeons, blinded to the LAA measurements, assessed the rotator interval (RI) using a control MRI. Functional assessment was performed using the University of California, Los Angeles (UCLA) quick disability of the shoulder and arm, shoulder and hand (qDASH) score. The Wilcoxon signed-rank test for dependent samples was employed to compare data between the pre- and post-intervention groups. Pearson correlation coefficients were calculated to evaluate the relationship between different parameters. RESULTS The study population consisted of 73 female patients and 27 male patients, with a mean age of 58.32 ± 5.29 years and a mean follow-up duration of 25.88 ± 8.11 months. Preoperatively, the mean LAA was 75.81° ± 11.28°, RI was 4.78 ± 0.62, UCLA score was 17.54 ± 2.44, and qDASH score was 2.45 ± 0.25. The average tear size was 8.95 ± 2.11 mm. A statistically significant difference in LAA was observed between the preoperative and postoperative measurements, with the double-row repair group exhibiting a greater LAA than the single-row repair group. Finally, a significant correlation was identified between LAA, RI, and qDASH scores after a 24-month follow-up period. CONCLUSION According to our findings, the utilization of double-row rivet fixation has a greater LAA angle than single-row rivet fixation. Moreover, this preservation of LAA is significantly associated with the functional recovery of the shoulder joint.
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Affiliation(s)
- Gang Hong
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiaochuan Kong
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Le Zhang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yingfeng Zheng
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Ankar P, Harjpal P. Comparative Analysis of Various Rotator Cuff Stretching Techniques: Efficacy and Recommendations for Gym Enthusiasts. Cureus 2024; 16:e51785. [PMID: 38322067 PMCID: PMC10844772 DOI: 10.7759/cureus.51785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/06/2024] [Indexed: 02/08/2024] Open
Abstract
Shoulder pain is a common complaint among gym-going individuals, particularly those engaged in upper limb workouts. The rotator cuff, comprising four muscles, plays a crucial role in stabilizing the shoulder joint during movements and supporting its mobility. Imbalances or weaknesses in these muscles can lead to shoulder injuries, affecting performance and overall well-being. The main aim of this review is to explore the benefit of one of the approaches in preventing shoulder pain and improving performance among gym-going individuals. Specific rotator cuff stretching exercises target the entire shoulder complex to enhance the mobility, control, and stabilization of the joint. The dynamic warm-up routine will actively engage the relevant muscles in various planes of motion, promoting the increased range of motion and reduced inflammation. Ultimately, the results from this review can serve as important knowledge for gym-going individuals, trainers, and fitness enthusiasts, guiding them in incorporating evidence-based warm-up strategies to optimize their workouts. Empowering individuals to take proactive measures in caring for their shoulder health can lead to improved overall performance and a better training experience in the gym.
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Affiliation(s)
- Prajyot Ankar
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pallavi Harjpal
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Çağlar C, Akçaalan S, Akkaya M, Doğan M. Does Morphology of the Shoulder Joint Play a Role in the Etiology of Rotator Cuff Tear? Curr Med Imaging 2024; 20:e260423216209. [PMID: 37170976 DOI: 10.2174/1573405620666230426141113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/03/2023] [Accepted: 03/10/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND The etiology of rotator cuff tears (RCTs) have been investigated for years and many underlying causes have been identified. Shoulder joint morphology is one of the extrinsic causes of RCTs. AIM Morphometric measurements on MRI sections determined which parameters are an important indicator of RCT in patients with shoulder pain. The aim of this study was to determine the risk factors in the etiology of RCTs by evaluating the shoulder joint morphology with the help of previously defined radiological parameters. METHOD Between January 2019-December 2020, 408 patients (40-70 years old) who underwent shoulder MRI and met the criteria were included in the study. There were 202 patients in the RCT group and 206 patients in the control group. Acromion type, acromial index (AI), critical shoulder angle (CSA), acromiohumeral distance (AHD), lateral acromial angle (LAA), acromial angulation (AA), acromion-greater tuberosity impingement index (ATI), and glenoid version angle (GVA) were measured from the MRI images of the patients. RESULTS AI (0.64 vs. 0.60, p = 0.003) CSA (35.3° vs. 32.4°, p = 0.004), ATI (0.91 vs. 0.83, P < 0.001), and AA (13.6° vs. 11.9°, p = 0.011) values were higher in the RCT group than in the control group and the difference was significant. AHD (8.1 mm vs. 9.9 mm, P < 0.001), LAA (77.2° vs. 80.9°, p = 0.004) and GVA (-3.9° vs. -2.5°, P < 0.001) values were lower in the RCT group than in the control group, and again the difference was significant. According to the receiver operating characteristic curve analysis, the cutoff values were 0.623 for AI and 0.860 for ATI. CONCLUSION Acromion type, AI, CSA, AHD, LAA, AA, ATI, and GVA are suitable radiological parameters to evaluate shoulder joint morphology. High AI, CSA, AA, ATI, GVA and low AHD and LAA are risk factors for RCT.
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Affiliation(s)
- Ceyhun Çağlar
- Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey
| | - Serhat Akçaalan
- Department of Orthopedics and Traumatology, Kırıkkale Training and Research Hospital, Kırıkkale, Turkey
| | - Mustafa Akkaya
- Department of Orthopedics and Traumatology, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Metin Doğan
- Department of Orthopedics and Traumatology, Ankara Yıldırım Beyazıt University, Ankara, Turkey
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Watanabe A, Machida T, Takashima K, Hirooka T. Discovering the Forgotten Trauma Behind Chronic Shoulder Pain: The Critical Role of a Thorough Medical Interview. Cureus 2023; 15:e49173. [PMID: 38130510 PMCID: PMC10734337 DOI: 10.7759/cureus.49173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
We report a rare case of a patient experiencing pain and dysfunction attributable to bone fragments from a trauma sustained over two decades prior. A 43-year-old Japanese woman presented with persistent left shoulder pain. Initial radiographs revealed glenohumeral joint osteoarthritis, an unusual finding for her age. Her medical history included a previously overlooked traumatic dislocation of the left acromioclavicular joint over 20 years ago. Computed tomography scans later uncovered bone fragments below the coracoid process without signs of scapular or tuberosity fractures. The fragments were arthroscopically removed, resulting in significant pain relief. The patient's Shoulder Pain and Disability Index score improved from 60 to 9 at the six-month postoperative follow-up. This case underscores the importance of considering historical trauma in patients presenting with atypical shoulder pain and highlights the potential diagnostic value of revisiting a patient's medical history when unusual lesions are discovered.
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Scanaliato JP, Dunn JC, Polmear MM, Czajkowski H, Green CK, Tomaino MM, Parnes N. Acromial Morphology Does Not Correlate with Age at Time of Rotator Cuff Tear: A Cross-Sectional Study. Shoulder Elbow 2023; 15:40-45. [PMID: 37974607 PMCID: PMC10649486 DOI: 10.1177/17585732221077944] [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: 09/25/2021] [Revised: 12/21/2021] [Accepted: 12/27/2021] [Indexed: 11/19/2023]
Abstract
Background The purpose of this study was to determine if scapular anatomy differs between younger and older patients with atraumatic full-thickness supraspinatus tears. Methods The critical shoulder angle, acromial index and lateral acromial angle were measured on standardized radiographs of two groups of patients who underwent arthroscopic repair of full-thickness degenerative supraspinatus tears. Group 1 included 61 patients under the age of 50 years while Group 2 included 45 patients over the age of 70 years. The mean critical shoulder angle, acromial index, and lateral acromial angle were then compared. Results There was no significant difference between groups for the critical shoulder angle (p = .433), acromial index (p = .881) or lateral acromial angle (p = .263). Interobserver reliability for critical shoulder angle, acromial index, and lateral acromial angle was nearly perfect (interclass correlation coefficient 0.996, 0.996, 0.998, respectively). No significant correlation existed between age and critical shoulder angle (p = .309), acromial index (p = .484) or lateral acromial angle (p = .685). Discussion While the critical shoulder angle and acromial index were found to be high and in the typical range for patients with rotator cuff tears in both groups, there were no significant differences in acromial morphology between Groups 1 and 2.
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Affiliation(s)
| | - John C Dunn
- William Beaumont Army Medical Center, El Paso, TX
| | | | | | - Clare K Green
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Matthew M Tomaino
- Tomaino Orthopaedic Care for Shoulder, Hand and Elbow, Rochester, NY
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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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Yang J, Xiang M, Li Y, Zhang Q, Dai F. The Correlation between Various Shoulder Anatomical Indices on X-Ray and Subacromial Impingement and Morphology of Rotator Cuff Tears. Orthop Surg 2023; 15:1997-2006. [PMID: 36573272 PMCID: PMC10432442 DOI: 10.1111/os.13610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/22/2022] [Accepted: 11/03/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Rotator cuff injury caused by subacromial impingement presents different morphologies. This study aims to investigate the correlation between various shoulder anatomical indexes on X-ray with subacromial impingement and morphology of rotator cuff tears to facilitate surgical management. METHOD This retrospective study was carried out between January 2020 and May 2022. Patients who were diagnosed as sub-acromial impingement associated with rotator cuff tears (without tendon retraction) and received arthroscopic surgery were enrolled in this study. The radiographic indexes of acromial slope (AS), acromial tilt (AT), lateral acromial angle (LAA), acromial Index (AI), and sub-acromial distance (SAD) were measured on preoperative true AP view and outlet view. The location of rotator cuff tear (anterior, middle, posterior, medial, and lateral) and morphology of tear (horizontal, longitudinal, L-shaped, and irregular shaped) were evaluated by arthroscopy. Groups were set up due to different tear location and tear morphologies, by comparing the various radiographic indices between each group (one-way analysis of variance and t-test), the correlation between radiographic indices and tear characteristics was investigated. RESULTS We analyzed 92 shoulders from 92 patients with a mean age of 57.23 ± 8.45 years. The AS in anterior tear group (29.32 ± 6.91°) was significantly larger than that in middle tear group (18.41 ± 6.13°) (p = 0.000) and posterior tear group (24.01 ± 7.69°) (p = 0.041). The AS in posterior tear group (24.01 ± 7.69°) was significantly larger than that in middle tear group (18.41 ± 6.13°) (p = 0.029). The LAA in middle tear group (67.41 ± 6.54°) was significantly smaller than that in posterior group (72.74 ± 8.78°) (p = 0.046). The AS in longitudinal tear group (26.86 ± 8.41°) was significantly larger than that in horizontal tear group (22.05 ± 9.47°) (p = 0.035) and L-shaped group (21.56 ± 6.62°) (p = 0.032). The LAA in horizontal group (70.60 ± 6.50°) was significantly larger than that in L-shaped group (66.39 ± 7.31°) (p = 0.033). The AI in L-shaped tear group (0.832 ± 0.074) was significantly larger than that in horizontal tear group (0.780 ± 0.084) (p = 0.019) and irregular tear group (0.781 ± 0.068) (p = 0.047). CONCLUSION Acromion with a larger AS and a smaller LAA tend to cause anterior or posterior rotator cuff tears rather than middle tears in sub-acromial impingement. Meanwhile acromion with a larger AS tends to cause a longitudinal tear, a larger LAA tends to cause horizontal tears and a larger AI tends to cause L-shaped tears.
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Affiliation(s)
- Jinsong Yang
- Sichuan Provincial Orthopedic Hospital Upper Arm DepartmentChengduChina
| | - Ming Xiang
- Sichuan Provincial Orthopedic Hospital Upper Arm DepartmentChengduChina
| | - Yiping Li
- Sichuan Provincial Orthopedic Hospital Upper Arm DepartmentChengduChina
| | - Qing Zhang
- Sichuan Provincial Orthopedic Hospital Upper Arm DepartmentChengduChina
| | - Fei Dai
- Sichuan Provincial Orthopedic Hospital Upper Arm DepartmentChengduChina
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Zhou T, Han C, Weng X. Present situation and development prospects of the diagnosis and treatment of rotator cuff tears. Front Surg 2023; 10:857821. [PMID: 37440927 PMCID: PMC10333593 DOI: 10.3389/fsurg.2023.857821] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/24/2023] [Indexed: 07/15/2023] Open
Abstract
Rotator cuff tears are an important cause of shoulder pain and are caused by degeneration or trauma of the shoulder tendon at the anatomical neck of the humeral head. The understanding and research of rotator cuff tears have a history of hundreds of years, and their etiology, diagnosis, and treatment have a complete system, but some detailed rules of diagnosis and treatment still have room for development. This research paper briefly introduces the diagnosis and treatment of rotator cuff tears. The current situation and its valuable research direction are described.
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Affiliation(s)
- Tianjun Zhou
- Department of Orthopedic, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Chang Han
- Department of Orthopedic, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Xisheng Weng
- Department of Orthopedic, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
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Liu J, Dai S, Deng H, Qiu D, Liu L, Li M, Chen Z, Kang J, Tao J. Evaluation of the prognostic value of the anatomical characteristics of the bony structures in the shoulder in bursal-sided partial-thickness rotator cuff tears. Front Public Health 2023; 11:1189003. [PMID: 37304102 PMCID: PMC10250604 DOI: 10.3389/fpubh.2023.1189003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 05/15/2023] [Indexed: 06/13/2023] Open
Abstract
Background In recent studies, individual scapular anatomy has been found to be related to degenerative full-thickness rotator cuff tears. However, research on the relationship between the anatomical characteristics of shoulder radiographs and bursal-sided partial-thickness rotator cuff tears (PTRCTs) is limited, and the risk factors for this pathology still need to be determined. Methods The bursal-sided PTRCTs group included 102 patients without a history of shoulder trauma who underwent arthroscopy between January 2021 and October 2022. A total of 102 demographically matched outpatients with intact rotator cuffs were selected as the control group. Radiographs were used to measure the lateral acromial angle (LAA), critical shoulder angle (CSA), greater tuberosity angle (GTA), β-angle, acromion index (AI), acromiohumeral distance (AHD), acromial tilt (AT), acromial slope (AS), acromial type, and acromial spur by two independent observers. Multivariate analyses of these data were used to identify potential risk factors for bursal-sided PTRCTs. Receiver operating characteristic (ROC) analysis was performed to assess the sensitivity and specificity of CSA, GTA, and AI for this type of pathology. Result The β-angle, AHD, AS and acromion type showed no difference between bursal-sided PTRCTs and controls (p = 0.009, 0.200, 0.747 and 0.078, respectively). CSA, GTA and AI were significantly higher in bursal-sided PTRCTs (p < 0.001). LAA, β-angle and AT were significantly lower in bursal-sided PTRCTs. Multivariate logistic regression analysis demonstrated significant correlations between the acromial spur (p = 0.024), GTA (p = 0.004), CSA (p = 0.003) and AI (p = 0.048) and bursal-sided PTRCTs. The areas under the ROC curves for AI, CSA, and GTA were 0.655 (95% CI 0.580-0.729), 0.714 (95% CI 0.644-0.784), and 0.695 (95% CI 0.622-0.767), respectively. Conclusion Acromial spur, GTA, CSA, and AI were independent risk factors for bursal-sided PTRCTs. Furthermore, CSA was the most powerful predictor of bursal-sided PTRCTs compared to GTA and AI.
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Affiliation(s)
- Jun Liu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Simin Dai
- Department of Emergency, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Hui Deng
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Dewei Qiu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Li Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Mingzhang Li
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhijun Chen
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jiawei Kang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jun Tao
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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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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15
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Fieseler G, Schwesig R, Sendler J, Cornelius J, Schulze S, Lehmann W, Hermassi S, Delank KS, Laudner K. IRO/Shift Test Is Comparable to the Jobe Test for Detection of Supraspinatus Lesions. J Pers Med 2022; 12:jpm12091422. [PMID: 36143208 PMCID: PMC9506539 DOI: 10.3390/jpm12091422] [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: 08/11/2022] [Revised: 08/26/2022] [Accepted: 08/27/2022] [Indexed: 11/16/2022] Open
Abstract
To determine how the internal rotation and shift (IRO/shift) test compares to the gold standard of clinical tests (Jobe test) for diagnosing supraspinatus lesions and to confirm these clinical results with surgical findings, 100 symptomatic patients were clinically examined between October 2018 and November 2019. All 100 patients were evaluated using both the IRO/shift test and Jobe test. A total of 48 of these patients received surgical intervention. Based on these data, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for both the IRO/shift test and Jobe test were calculated. The IRO/shift test had a sensitivity of 96% (95% CI: 82–100%), specificity of 50% (95% CI: 27–73%), PPV of 73% (95% CI: 56–86%), NPV of 91% (95% CI: 59–100%), and an accuracy of 77% (95% CI: 63–88%). The Jobe test had a sensitivity of 89% (95% CI: 72–98%), specificity of 60% (95% CI: 36–81%), PPV of 76% (95% CI: 58–89%), NPV of 80% (95% CI: 52–96%), and an accuracy of 77% (95% CI: 54–81%). These results suggest that the IRO/shift test is comparable to the Jobe test, which is often viewed as the gold standard clinical examination for assessing supraspinatus lesions. This study was approved by the Ethics Commission of the Martin Luther University Halle-Wittenberg (reference number: 2018-05).
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Affiliation(s)
- George Fieseler
- Clinic for Orthopedic and Trauma Surgery, Sports Medicine, Clinic Hannoversch Münden, 34346 Hannoversch Münden, Germany
| | - René Schwesig
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, 06120 Halle, Germany
| | - Julia Sendler
- Clinic for Orthopedic and Trauma Surgery, Sports Medicine, Clinic Hannoversch Münden, 34346 Hannoversch Münden, Germany
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, 06120 Halle, Germany
| | - Jakob Cornelius
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, 06120 Halle, Germany
| | - Stephan Schulze
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, 06120 Halle, Germany
| | - Wolfgang Lehmann
- Clinic for Orthopedic, Trauma and Reconstructive Surgery, Georg August University Göttingen, 37075 Göttingen, Germany
| | - Souhail Hermassi
- Physical Education Department, College of Education, Qatar University, Doha 2713, Qatar
| | - Karl-Stefan Delank
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, 06120 Halle, Germany
| | - Kevin Laudner
- Department of Health Sciences, University of Colorado Colorado Springs, Colorado Springs, CO 80918, USA
- Correspondence:
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Rojas Lievano J, Bautista M, Woodcock S, Fierro G, González JC. Controversy on the Association of the Critical Shoulder Angle and the Development of Degenerative Rotator Cuff Tears: Is There a True Association? A Meta-analytical Approach. Am J Sports Med 2022; 50:2552-2560. [PMID: 34432551 DOI: 10.1177/03635465211027305] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The role of the critical shoulder angle (CSA) as a risk factor for rotator cuff tear (RCT) remains controversial. Studies on the association between the CSA and RCT show considerable differences in design, and this could be responsible for the variation in study results. PURPOSE To (1) describe the reliability of CSA measurement and (2) evaluate the results of the studies reporting the association between the CSA and RCT using meta-analytical techniques to explore potential sources of variation of study results. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS MEDLINE, EMBASE, and CINAHL electronic databases were searched through June 30, 2019. Case-control and cross-sectional studies reporting the association of the CSA and RCT were selected. The weighted mean difference in the CSA was estimated using a random-effects model. Prediction interval was computed to better express uncertainties in the effect estimate. Metaregression and subgroup analyses were performed to explore potential sources of heterogeneity. RESULTS A total of 14 studies, including 1154 cases and 1271 controls, were identified. Of these studies, 79% (11/14) assessed the reliability of the CSA measurement, demonstrating an excellent intraobserver (range, 0.91-0.99) and interobserver (range, 0.87-0.99) reliability. Compared with controls, cases with RCT showed larger measurements of the CSA (3.3° [95% CI, 2.3°- 4.4°]). However, there was a high heterogeneity (I2 = 93%), and the 95% prediction interval (-0.4° to 7.1°) included no difference in the CSA. Results of the metaregression analysis showed a significant association of several methodological aspects with the heterogeneity. The difference in the CSA tended to be larger when only full-thickness tears were included, when no specific defined criterion for assessing radiographic viewing perspective was used, in studies with smaller sample sizes, and in studies at higher risk of bias. CONCLUSION While the CSA can be reliably measured, the difference in the CSA between cases and controls varied from very large to modest or almost no difference. Several determinants of heterogeneity were determined. Owing to this heterogeneity, it is difficult to gain an insight into the strength and exact nature of the association between the CSA and RCT with the current evidence.
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Affiliation(s)
- Jorge Rojas Lievano
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia.,Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria Bautista
- Department of Orthopedics and Traumatology, Fundación Valle del Lili, Cali, Colombia
| | - Santiago Woodcock
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Guido Fierro
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia.,Facultad de Medicina, Universidad de Los Andes, Bogotá, Colombia
| | - Juan Carlos González
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia.,Facultad de Medicina, Universidad de Los Andes, Bogotá, Colombia
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Vocelle AR, Weidig G, Bush TR. Shoulder structure and function: The impact of osteoarthritis and rehabilitation strategies. J Hand Ther 2022; 35:377-387. [PMID: 35918274 DOI: 10.1016/j.jht.2022.06.008] [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: 01/30/2022] [Revised: 05/31/2022] [Accepted: 06/20/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Invited review. BACKGROUND Shoulder osteoarthritis can result in significant functional deficits. To improve diagnosis and treatment, we must better understand the impact of osteoarthritis on shoulder biomechanics and the known mechanical benefits of currently available treatments. PURPOSE The purpose of this paper is to present up-to-date data on the effects of osteoarthritis and rehabilitation on the biomechanical parameters contributing to shoulder function. With this goal, we also reviewed the anatomy and the ranges of motion of the shoulder. METHODS A search of electronic databases was conducted. All study designs were included to inform this qualitative, narrative literature review. RESULTS This review describes the biomechanics of the shoulder, the impact of osteoarthritis on shoulder function, and the treatment of shoulder osteoarthritis with an emphasis on rehabilitation. CONCLUSIONS The shoulder is important for the completion of activities of daily living, and osteoarthritis of the shoulder can significantly reduce shoulder motion and arm function. Although shoulder rehabilitation is an integral treatment modality to improve pain and function in shoulder osteoarthritis, few high-quality studies have investigated the effects and benefits of shoulder physical and occupational therapies. To advance the fields of therapy and rehabilitation, future studies investigating the effects of therapy intensity, therapy duration, and the relative benefits of therapy subtypes on shoulder biomechanics and function are necessary.
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Affiliation(s)
- Amber R Vocelle
- Physical Medicine and Rehabilitation Department, E.W. Sparrow Hospital, Lansing, MI, USA; Physical Medicine and Rehabilitation Department, Michigan State University, East Lansing, MI, USA
| | - Garrett Weidig
- Mechanical Engineering Department, Michigan State University, East Lansing, MI, USA
| | - Tamara R Bush
- Mechanical Engineering Department, Michigan State University, East Lansing, MI, USA.
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Wang C, Ma XY, Lu LT, Guo Z, Dai GF. A finite element model of the shoulder: application to the changes of biomechanical environment induced by postoperative malrotation of humeral shaft fracture. BMC Musculoskelet Disord 2022; 23:525. [PMID: 35655295 PMCID: PMC9161483 DOI: 10.1186/s12891-022-05479-3] [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: 09/18/2021] [Accepted: 05/19/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Objectives
The humerus fracture is one of the most commonly occurring fractures. In this research, we attempted to evaluate and compare the extent of malrotation and biomechanical environment after surgical treatment of humeral shaft fractures.
Methods
A finite element (FE) model of the shoulder was built based on Computed Tomography (CT) data of a patient with a humeral shaft fracture. The muscle group around the shoulder joint was simulated by spring elements. The changes of shoulder stresses under rotation were analyzed. The biomechanics of the normal shoulder and postoperative malrotation of the humeral shaft was analyzed and compared.
Results
During rotations, the maximum stress was centered in the posterosuperior part of the glenoid for the normal shoulder. The von Mises shear stresses were 4.40 MPa and 4.89 MPa at 40° of internal and external rotations, respectively. For internal rotation deformity, the shear contact forces were 7–9 times higher for the shoulder internally rotated 40° than for the normal one. For external rotation deformity, the shear contact forces were about 3–5 times higher for the shoulder with 40° external rotation than the normal one.
Conclusion
Postoperative malrotation of humeral shaft fracture induced the changes of the biomechanical environment of the shoulders. The peak degree of malrotation was correlated with increased stresses of shoulders, which could be paid attention to in humeral shaft fracture treatment. We hoped to provide information about the biomechanical environment of humeral malrotation.
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Haidamous G, Merimee S, Simon P, Denard PJ, Lädermann A, Mighell MA, Gorman RA, Frankle MA. Acromial fractures following reverse shoulder arthroplasty: the role of the acromial morphology and a comparison of clinical outcomes. J Shoulder Elbow Surg 2022; 31:S34-S43. [PMID: 35183742 DOI: 10.1016/j.jse.2022.01.132] [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: 11/12/2021] [Revised: 01/10/2022] [Accepted: 01/16/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose was to evaluate the relationship between acromial morphology and the location of acromial fractures following reverse shoulder arthroplasty and determine whether fracture location and displacement impact clinical outcomes. METHODS We performed a multicenter retrospective review of reverse shoulder arthroplasties complicated by acromial fractures. Radiographs were compared to determine the differences in acromial morphology, as well as fracture orientation and pattern, between patients with Levy type I (n = 17) and Levy type II (n = 25) fractures. Patients with a minimum of 2 years' follow-up were selected to examine the association between clinical outcomes and fracture location and displacement. Twenty-two patients were stratified based on whether they achieved the minimal clinically important difference (MCID) in the American Shoulder and Elbow Surgeons score (20 points). The groups were then compared regarding fracture location and displacement using measurements such as the acromiohumeral distance. RESULTS The Levy type I group had a higher acromial slope than the Levy type II group (127° vs. 117°, P < .001). Levy type I fractures had a transverse pattern occurring in the coronal plane, whereas Levy type II fractures had an oblique pattern occurring in the sagittal plane (P < .001). At final follow-up, 12 of 22 patients (55%) achieved the MCID. Those who did not achieve the MCID had more displaced fractures including a lower acromiohumeral distance (8 mm vs. 20 mm, P = .007). There was no difference in the distribution of Levy type I and type II fractures based on the MCID cutoff (P = .093). CONCLUSION An increased acromial slope is associated with transverse fractures in the Levy I region, whereas a lower acromial slope is associated with oblique fractures in the Levy II region. Overall, 55% of patients achieved the MCID at mid-term follow-up. The outcomes of those who did not achieve the MCID became worse postoperatively, and this was associated with increased fracture displacement.
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Affiliation(s)
| | - Stephanie Merimee
- Department of Orthopaedics and Sports Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Peter Simon
- Translational Research, Foundation for Orthopaedic Research and Education (FORE), Tampa, FL, USA; Department of Medical Engineering, University of South Florida College of Engineering and Morsani College of Medicine, Tampa, FL, USA
| | - Patrick J Denard
- Southern Oregon Orthopedics, Oregon Shoulder Institute, Medford, OR, USA
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Mark A Mighell
- Shoulder Service, Florida Orthopaedic Institute, Tampa, FL, USA
| | - R Allen Gorman
- Translational Research, Foundation for Orthopaedic Research and Education (FORE), Tampa, FL, USA
| | - Mark A Frankle
- Shoulder Service, Florida Orthopaedic Institute, Tampa, FL, USA; Department of Orthopaedics and Sports Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
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Editorial Commentary: Current Indications for Lateral Acromioplasty Include Patients With Elevated Critical Shoulder Angle Plus Subacromial Impingement With Rotator Cuff Pathology or Previous Rotator Cuff Repair. Arthroscopy 2022; 38:716-718. [PMID: 35248226 DOI: 10.1016/j.arthro.2021.11.002] [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: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 02/02/2023]
Abstract
The critical shoulder angle (CSA) reflects the lateral extent of the acromion and the inclination of the glenoid. In 2013, CSA was first introduced and its association with rotator cuff (RC) tears and glenohumeral osteoarthritis (GHOA) was shown. It was speculated that with a high CSA, there was an increased superior force vector from the deltoid and that this superior force led to RC tears. Conversely, when the CSA was low, there was a greater compressive force from the deltoid and that this compressive force led to GHOA. CSA serves as a further development of 2 previously reported measurements (glenoid inclination and acromial index). A key potential therapeutic aspect of the CSA is the ability to modify it surgically, which theoretically could protect RC repairs or prevent progression. In our current clinical practice, we perform lateral acromioplasty (LA) in patients undergoing treatment of subacromial impingement with an "at-risk" rotator cuff (partial rotator cuff tear and severe tendinopathy on magnetic resonance imaging) with a CSA > 38° or all patients with a CSA >35° after an RC repair to protect the RC repair construct. The relationships of high and low CSA, the anatomic safe zone, and thus clinical applicability of LA are well established and performed in our daily surgical practice. However, we do not yet have widespread clear clinical evidence on potential benefits regarding the clinical outcome after LA. Finally, at this time, the downsides seem minimal, so we continue to use LA as an adjunct in patients with RC tears and RC tendons that are at risk.
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Hsu TH, Lin CL, Wu CW, Chen YW, Vitoonpong T, Lin LC, Huang SW. Accuracy of Critical Shoulder Angle and Acromial Index for Predicting Supraspinatus Tendinopathy. Diagnostics (Basel) 2022; 12:diagnostics12020283. [PMID: 35204373 PMCID: PMC8871498 DOI: 10.3390/diagnostics12020283] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 11/16/2022] Open
Abstract
Critical shoulder angle (CSA) is the angle between the superior and inferior bony margins of the glenoid and the most lateral border of the acromion. The acromial index (AI) is the distance from the glenoid plane to the acromial lateral border and is divided by the distance from the glenoid plane to the lateral aspect of the humeral head. Although both are used for predicting shoulder diseases, research on their accuracy in predicting supraspinatus tendinopathy in patients with shoulder pain is limited. Data were retrospectively collected from 308 patients with supraspinatus tendinopathy between January 2018 and December 2019. Simultaneously, we gathered the data of 300 patients with shoulder pain without supraspinatus tendinopathy, confirmed through ultrasound examination. Baseline demographic data, CSA, and AI were compared using the independent Student’s t test and Mann–Whitney U test. Categorical variables were analyzed using the chi-square test. A receiver operating characteristic curve (ROC) analysis was performed to investigate the accuracy of CSA and AI for predicting supraspinatus tendinopathy, and the optimal cut-off point was determined using the Youden index. No statistical differences were observed for age, sex, body mass index, evaluated side (dominant), diabetes mellitus, and hyperlipidemia between the groups. The supraspinatus tendinopathy group showed higher CSAs (p < 0.001) than did the non-supraspinatus tendinopathy group. For predicting supraspinatus tendinopathy, the area under the curve (AUC) of ROC curve of the CSA was 76.8%, revealing acceptable discrimination. The AUC of AI was 46.9%, revealing no discrimination. Moreover, when patients with shoulder pain had a CSA > 38.11°, the specificity and sensitivity of CSA in predicting supraspinatus tendinopathy were 71.0% and 71.8%, respectively. CSA could be considered an objective assessment tool to predict supraspinatus tendinopathy in patients with shoulder pain. AI revealed no discrimination in predicting supraspinatus tendinopathy in patients with shoulder pain.
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Affiliation(s)
- Tzu-Herng Hsu
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (T.-H.H.); (C.-W.W.); (Y.-W.C.); (L.-C.L.)
| | - Che-Li Lin
- Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan;
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Chin-Wen Wu
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (T.-H.H.); (C.-W.W.); (Y.-W.C.); (L.-C.L.)
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Yi-Wen Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (T.-H.H.); (C.-W.W.); (Y.-W.C.); (L.-C.L.)
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Timporn Vitoonpong
- Rehabilitation Department, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand;
| | - Lien-Chieh Lin
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (T.-H.H.); (C.-W.W.); (Y.-W.C.); (L.-C.L.)
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan; (T.-H.H.); (C.-W.W.); (Y.-W.C.); (L.-C.L.)
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Correspondence: ; Tel.: +886-222-490-088 (ext. 1602)
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Bodendorfer BM. CORR Insights®: What Factors Are Associated with Symptomatic Rotator Cuff Tears: A Meta-analysis. Clin Orthop Relat Res 2022; 480:106-108. [PMID: 34695043 PMCID: PMC8673989 DOI: 10.1097/corr.0000000000002020] [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: 09/01/2021] [Accepted: 09/30/2021] [Indexed: 01/31/2023]
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McCready E, Easley JT, Risch M, Troyer KL, Johnson JW, Gadomski BC, McGilvray KC, Kisiday JD, Nelson BB. Biomechanical, Morphological, and Biochemical Characteristics of Articular Cartilage of the Ovine Humeral Head. Cartilage 2022; 13:19476035221081465. [PMID: 35225009 PMCID: PMC9137309 DOI: 10.1177/19476035221081465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/10/2022] [Accepted: 01/23/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Shoulder pain is commonly attributed to rotator cuff injury or osteoarthritis. Ovine translational models are used to investigate novel treatments aimed at remedying these conditions to prevent articular cartilage degeneration and subsequent joint degradation. However, topographical properties of articular cartilage in the ovine shoulder are undefined. This study investigates the biomechanical, morphological, and biochemical attributes of healthy ovine humeral head articular cartilage and characterizes topographical variations between surface locations. DESIGN Ten humeral heads were collected from healthy skeletally mature sheep and each was segregated into 4 quadrants using 16 regions of interest (ROIs) across the articular surface. Articular cartilage of each ROI was analyzed for creep indentation, thickness, and sulfated glycosaminoglycan (sGAG) and collagen quantity. Comparisons of each variable were made between quadrants and between ROIs within each quadrant. RESULTS Percent creep, thickness, and sGAG content, but not collagen content, were significantly different between humeral head quadrants. Subregion analysis of the ROIs within each surface quadrant revealed differences in all measured variables within at least one quadrant. Percent creep was correlated with sGAG (r = -0.32, P = 0.0001). Collagen content was correlated with percent creep (r = 0.32, P = 0.0009), sGAG (r = -0.19, P = 0.049), and thickness (r = -0.19, P = 0.04). CONCLUSIONS Topographical variations exist in mechanical, morphologic, and biochemical properties across the articular surface of the ovine humeral head. Recognizing this variability in ovine humeral head cartilage will provide researchers and clinicians with accurate information that could impact study outcomes.
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Affiliation(s)
- Erin McCready
- Preclinical Surgical Research Laboratory, C. Wayne McIlwraith Translational Medicine Institute, Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Jeremiah T. Easley
- Preclinical Surgical Research Laboratory, C. Wayne McIlwraith Translational Medicine Institute, Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Makayla Risch
- Preclinical Surgical Research Laboratory, C. Wayne McIlwraith Translational Medicine Institute, Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Kevin L. Troyer
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - James W. Johnson
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Benjamin C. Gadomski
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Kirk C. McGilvray
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - John D. Kisiday
- Orthopaedic Research Center, C. Wayne McIlwraith Translational Medicine Institute, Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Brad B. Nelson
- Preclinical Surgical Research Laboratory, C. Wayne McIlwraith Translational Medicine Institute, Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
- Orthopaedic Research Center, C. Wayne McIlwraith Translational Medicine Institute, Department of Clinical Sciences, Colorado State University, Fort Collins, CO, USA
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24
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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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25
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Yilmazturk K, Birinci M, Kuyucu E, Bulbul AM. Is shoulder geometry important for rotator cuff tears? Int J Clin Pract 2021; 75:e15005. [PMID: 34739181 DOI: 10.1111/ijcp.15005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 09/23/2021] [Accepted: 10/27/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This study is aiming to evaluate some specific anatomic shoulder parameters such as the lateral acromial angle (LAA), acromial index (AI), coracohumeral distance (CHD) and critical shoulder angle (CSA) in rotator cuff tears. METHODS A total of 100 cases consisting of 50 patients with rotator cuff tears and 50 patients without rotator cuff tears, who underwent shoulder MRI (mangnetic resonance imaging) examination in Istanbul Medipol University Orthopedics and Traumatology Department, participated in this study. In this retrospective study, CCA, LAA, AI and CSA were evaluated in MRI in order to shed light on the theories of rotator cuff tears. RESULTS There was no significant difference (P ˃ .05) in acromial index and coracohumeral distance in the patient group. Lateral acromial angle and critical shoulder angle were significantly different in the patient group compared to the control group (P < .05). There was a weak negative correlation between CSA and CHD. CONCLUSION In our study, we found that patients with smaller LAA and higher CSA values in MRI images are prone to have rotator cuff tears. Further studies are needed in order to evaluate whether this association has predictive value.
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Affiliation(s)
- Kerem Yilmazturk
- Department of Anatomy, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
- Clinical Anatomy PhD Program, Graduate School of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Murat Birinci
- Department of Orthopaedics & Traumatology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Ersin Kuyucu
- Medical Park Bahcelievler Hospital, Department of Orthopaedics and Traumatology, Altinbas Universitesi, Istanbul, Turkey
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26
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Serrano N, Kissling M, Krafft H, Link K, Ullrich O, Buck FM, Mathews S, Serowy S, Gascho D, Grüninger P, Fornaciari P, Bouaicha S, Müller-Gerbl M, Rühli FJ, Eppler E. CT-based and morphological comparison of glenoid inclination and version angles and mineralisation distribution in human body donors. BMC Musculoskelet Disord 2021; 22:849. [PMID: 34610804 PMCID: PMC8493698 DOI: 10.1186/s12891-021-04660-4] [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: 02/13/2021] [Accepted: 08/25/2021] [Indexed: 11/11/2022] Open
Abstract
Background For optimal prosthetic anchoring in omarthritis surgery, a differentiated knowledge on the mineralisation distribution of the glenoid is important. However, database on the mineralisation of diseased joints and potential relations with glenoid angles is limited. Methods Shoulder specimens from ten female and nine male body donors with an average age of 81.5 years were investigated. Using 3D-CT-multiplanar reconstruction, glenoid inclination and retroversion angles were measured, and osteoarthritis signs graded. Computed Tomography-Osteoabsorptiometry (CT-OAM) is an established method to determine the subchondral bone plate mineralisation, which has been demonstrated to serve as marker for the long-term loading history of joints. Based on mineralisation distribution mappings of healthy shoulder specimens, physiological and different CT-OAM patterns were compared with glenoid angles. Results Osteoarthritis grades were 0-I in 52.6% of the 3D-CT-scans, grades II-III in 34.3%, and grade IV in 13.2%, with in females twice as frequently (45%) higher grades (III, IV) than in males (22%, III). The average inclination angle was 8.4°. In glenoids with inclination ≤10°, mineralisation was predominantly centrally distributed and tended to shift more cranially when the inclination raised to > 10°. The average retroversion angle was − 5.2°. A dorsally enhanced mineralisation distribution was found in glenoids with versions from − 15.9° to + 1.7°. A predominantly centrally distributed mineralisation was accompanied by a narrower range of retroversion angles between − 10° to − 0.4°. Conclusions This study is one of the first to combine CT-based analyses of glenoid angles and mineralisation distribution in an elderly population. The data set is limited to 19 individuals, however, indicates that superior inclination between 0° and 10°-15°, and dorsal version ranging between − 9° to − 3° may be predominantly associated with anterior and central mineralisation patterns previously classified as physiological for the shoulder joint. The current basic research findings may serve as basic data set for future studies addressing the glenoid geometry for treatment planning in omarthritis. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04660-4.
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Affiliation(s)
- Nabil Serrano
- Institute of Evolutionary Medicine (IEM), University of Zurich, Zurich, Switzerland
| | - Marc Kissling
- Institute of Anatomy, University of Bern, Bern, Switzerland
| | - Hannah Krafft
- Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Karl Link
- Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland.,Anatomy, University of Fribourg, Fribourg, Switzerland
| | - Oliver Ullrich
- Division of Gross Anatomy, Institute of Anatomy, University of Zurich, Zurich, Switzerland
| | - Florian M Buck
- Medical Radiology Institute, Schulthess Clinic, Zurich, Switzerland
| | - Sandra Mathews
- Institute of Evolutionary Medicine (IEM), University of Zurich, Zurich, Switzerland
| | - Steffen Serowy
- Clinic of Neuroradiology, University Hospital of Magdeburg, Magdeburg, Germany
| | - Dominic Gascho
- Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | | | - Paolo Fornaciari
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland.,Department of Orthopaedic Surgery and Traumatology, University Hospital Fribourg, Fribourg, Switzerland
| | - Samy Bouaicha
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Magdalena Müller-Gerbl
- Musculoskeletal Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Frank-Jakobus Rühli
- Institute of Evolutionary Medicine (IEM), University of Zurich, Zurich, Switzerland.
| | - Elisabeth Eppler
- Musculoskeletal Research, Department of Biomedicine, University of Basel, Basel, Switzerland. .,Clinic of Neuroradiology, University Hospital of Magdeburg, Magdeburg, Germany. .,Institute of Anatomy, University of Bern, Bern, Switzerland.
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Postoperative malrotation of humerus shaft fracture causes degeneration of rotator cuff and cartilage. Sci Rep 2021; 11:18596. [PMID: 34545141 PMCID: PMC8452695 DOI: 10.1038/s41598-021-98040-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/01/2021] [Indexed: 12/28/2022] Open
Abstract
We hypothesized that postoperative malrotation of humeral shaft fractures can alter the bio-mechanical environment of the shoulder; thus, rotator cuff and cartilage degeneration could be induced. Therefore, we designed an animal experiment to evaluate the impact of malrotation deformities after minimally invasive surgery for humeral fractures on the rotator cuff and cartilage, which has rarely been described in previous studies. Twenty-four New Zealand white rabbits were randomly divided into the sham control group (A), negative control group (B) and malrotated group (C). A sham operation with surgical exposure alone was performed in group A. Humeral shaft osteotomy was performed in Group B and C. In Group B, the fractures were fixed in situ with plate -screw system. While in Group C, iatrogenic rotational deformity was created after the proximal end of the fracture being internally rotated by 20 degrees and then subsequently fixed. The animals with bone healing were sacrificed for pathological and biochemical examination. In group C, the modified Mankin scale for cartilage pathology evaluation and the modified Movin scale for tendon both showed highest score among groups with statistical significance (P < 0.05); Disordered alignment and proportion of collagen I/III of rotator cuff were confirmed with picrosirius red staining; Transmission electron microscopy also showed ultrastructural tendon damage. Immunohistochemistry showed that both MMP-1 and MMP-13 expression were significantly higher in group C than groups A and B(P < 0.05). Minimally invasive techniques for humerus shaft fracture might be cosmetically advantageous, but the consequent postoperative malrotation could increase the risk of rotator cuff and cartilage degeneration. This conclusion is supported here by primary evidence from animal experiments.
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Verhaegen F, Meynen A, Debeer P, Scheys L. Determination of predisposing scapular anatomy with a statistical shape model-Part II: shoulder osteoarthritis. J Shoulder Elbow Surg 2021; 30:e558-e571. [PMID: 33600897 DOI: 10.1016/j.jse.2021.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/22/2020] [Accepted: 01/10/2021] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS AND BACKGROUND Shoulder osteoarthritis can be divided into different glenoid types (A, B, C, and D) and subtypes. The aim of this study was to investigate if there is an association between the prearthropathy scapular anatomy, shoulder osteoarthritis, and different glenoid types and subtypes. METHODS Using principal components analysis, a statistical shape model (SSM) of the scapula was constructed from a data set of 110 computed tomographic (CT) scans. These subjects formed the control group. Next, CT scan images of 117 patients with osteoarthritis were classified according to the modified Walch classification. A complete 3-dimensional (3D) scapular bone model was created for every patient, and using the SSM, a reconstruction of their prearthropathy scapular anatomy was performed. Automated 3D measurements were performed in both the patient and control group to obtain glenoid version and inclination, critical shoulder angle (CSA), posterior acromial slope (PAS), lateral acromion angle, scapular offset, and the rotational alignment of the coracoacromial complex. These parameters were compared between controls, patients with osteoarthritis, and glenoid types and subtypes. RESULTS Mean version and inclination for the control group was 6° retroversion and 8° superior inclination (both SD 4°). The mean CSA, PAS, coracoid-posterior acromion angle, posterior acromion-scapular plane angle, and fulcrum axis ratio were 30° (SD 4°), 64° (SD 8°), 116° (SD 9°), 55° (SD 7°), and 46% (SD 4%), respectively. Patients with osteoarthritis had a significant lower CSA, posterior acromion-scapular plane angle, coracoid-posterior acromion angle, and fulcrum axis ratio (27°, 50°, 111°, and 44%, all P < .001). We found a significant difference between the control group and the respective glenoid types for the following parameters: mean CSA and coracoid-posterior acromion angle for A glenoids (27°, P = .001, and 111°, P = .007); mean version, CSA, PAS, coracoid-posterior acromion angle, posterior acromion-scapular plane angle, and fulcrum axis ratio for B glenoids (11°, 27°, 71°, 111°, 49°, and 43%, all P < .001); and mean version, CSA, and posterior acromion-scapular plane angle for D glenoids (2°, P = .002, 26°, P = .003, and 48°, P = .007). DISCUSSION There seems to be an association between prearthropathy scapular anatomy and shoulder osteoarthritis. A small lateral extension and less posterior rotation of the acromion is associated with shoulder osteoarthritis and is present in almost all types and subtypes of glenoid morphology. Furthermore, B and D glenoids are associated with, respectively, a more and less pronounced prearthropathy glenoid retroversion.
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Affiliation(s)
- Filip Verhaegen
- Department of Development and Regeneration, KU Leuven, Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium.
| | - Alexander Meynen
- Department of Development and Regeneration, KU Leuven, Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Philippe Debeer
- Department of Development and Regeneration, KU Leuven, Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Lennart Scheys
- Department of Development and Regeneration, KU Leuven, Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
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The critical shoulder angle, the acromial index, the glenoid version angle and the acromial angulation are associated with rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 2021; 29:2257-2263. [PMID: 32671437 DOI: 10.1007/s00167-020-06145-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the critical shoulder angle (CSA), acromion index (AI), acromion angulation (AA) and glenoid version angle (GVA) between patients with full-thickness rotator cuff tears (RCTs) and patients with intact rotator cuffs. METHODS Between 2014 and 2018, the CSA, AI, AA and GVA were measured in consecutively included patients aged > 40 years who underwent shoulder arthroscopy for full-thickness RCTs. A total of 437 patients with RCTs and a mean age of 51.2 years (± 5.8) were included, 35.7% of whom were male. In the control group, there were n = 433 patients (36.3% male) with an intact rotator cuff, and the mean age was 50.7 years (± 5.3). RESULTS The mean AI for the RCT group was 0.7 ± 0.1, which was significantly higher than the mean AI for the control group (0.6 ± 0.1, p < 0.001). The mean CSA for the RCT group was 33.6° ± 3.9°, which was significantly higher than the mean CSA for the control group (31.5° ± 4°, p < 0.001). The mean AA for the RCT group was 13.9° ± 9°, which was significantly higher than the mean AA for the control group (12.4 ± 8.6, p = 0.012). The mean GVA for the RCT group was - 3.5° ± 4.6° and significantly retroverted compared with the mean GVA for the control group (- 2.2° ± 4.6°, p < 0.001). The cutoff values determined by the ROC curve analyses were as follows: 0.6 for AI, 31.4° for CSA, 9.6° for AA and - 2.6° for GVA. CONCLUSION The CSA, AI, GVA and AA values measured by MRI were determined to be significantly related to full-thickness rotator cuff ruptures. The AI, CSA, AA and GVA may be considered risk factors for degenerative rotator cuff tears. Assessing the CSA, AI, GVA and AA can be helpful for diagnostic evaluation of patients with full-thickness RCTs. LEVEL OF EVIDENCE III.
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30
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Schmalzl J, Jessen M, Gilbert F, Gerhardt C, Lehmann LJ. Proximal humeral fracture morphology in patients with advanced osteoarthritis: An observational study in a surgically treated cohort. J Orthop Surg (Hong Kong) 2021; 28:2309499020944114. [PMID: 32996369 DOI: 10.1177/2309499020944114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Several factors affect proximal humeral fracture (PHF) morphology. In the presence of glenohumeral osteoarthritis (GOA), the joint kinematics is alternated which might influence fracture configuration. The purpose of this study was to identify fracture patterns in patients with advanced osteoarthritis to facilitate recognition and treatment. METHODS In this retrospective analysis, and computed tomography (CT) scans of all patients undergoing surgical treatment for a PHF during a 5-year period were analyzed. Fracture pattern according to the AO Foundation/Orthopaedic Trauma Association (AO-OTA) classification and the presence of GOA were evaluated. In addition, critical shoulder angle (CSA), glenoid configuration, and glenoid inclination (GI) were measured. RESULTS Of the 713 patients, 574 met the inclusion criteria. A total of 166 patients showed radiological signs of GOA (28.9%). Advanced GOA (stage 2 or 3) was identified in 23 patients (4.0%). In this group, the mean age was 77 ± 10 years, mean CSA was 28.8 ± 4.2°, and the mean GI was 19.0 ± 7.8°. All fractures were extra-articular metaphyseal fractures (5 A2, 11 A3, 7 B1.1). Patients with advanced GOA had more than threefold risk (risk ratio 3.2; confidence interval 95% 2.80-3.74; p < 0.0001) for sustaining a metaphyseal fracture. In patients with GOA grade 1 compared to patients with no radiographic signs of GOA, this could not be observed. CONCLUSION Patients experiencing PHF with radiological signs of advanced GOA have a higher risk of sustaining a metaphyseal fracture compared to individuals with the absence of or mild GOA. To date, no classification system for PHFs takes preexisting osteoarthritis into account, although it might indicate a different treatment and therefore the recognition is crucial.
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Affiliation(s)
- Jonas Schmalzl
- Department of Traumatology and Hand Surgery, Teaching Hospital Albert-Ludwigs-University, Freiburg, Germany
| | - Malik Jessen
- Department of Traumatology and Hand Surgery, Teaching Hospital Albert-Ludwigs-University, Freiburg, Germany.,Orthopaedic and Trauma Surgery Centre (OUZ), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Fabian Gilbert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University of Wuerzburg, Wuerzburg, Germany
| | - Christian Gerhardt
- Department of Traumatology and Hand Surgery, Teaching Hospital Albert-Ludwigs-University, Freiburg, Germany
| | - Lars-Johannes Lehmann
- Department of Traumatology and Hand Surgery, Teaching Hospital Albert-Ludwigs-University, Freiburg, Germany.,Orthopaedic and Trauma Surgery Centre (OUZ), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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31
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Chalmers PN, Miller M, Wheelwright JC, Kawakami J, Henninger HB, Tashjian RZ. Acromial and glenoid morphology in glenohumeral osteoarthritis: a three-dimensional analysis. JSES Int 2021; 5:398-405. [PMID: 34136846 PMCID: PMC8178618 DOI: 10.1016/j.jseint.2021.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background The purpose of this study was to determine the association between glenohumeral osteoarthritis (GHOA) and three-dimensional acromial and glenoid morphology. Methods In this retrospective study, we compared computed tomographic studies of three groups of scapulae: normal healthy, mild GHOA (Samilson-Prieto grade 1), and severe GHOA (Samilson-Prieto grade 3). All scans were segmented to create three-dimensional reconstructions. From these models, critical shoulder angle and acromial offset were measured, as normalized to scapular height. The coronal plane inclination of the glenoid was measured using a glenoid sphere-fit method. Reliability was confirmed via intraclass correlation coefficients > 0.75. Results Eighty scapulae were included: 30 normal, 20 mild GHOA, and 30 severe GHOA. There were no differences in acromial offset between the normal group and either the mild-GHOA group or the severe-GHOA group. The severe-GHOA group had a smaller critical shoulder angle than either the normal (30 ± 5° vs. 34 ± 4°, P = .003) or mild-GHOA groups (34 ± 4°, P = .020), but the normal and mild-GHOA groups did not differ (P = .965). The severe-GHOA group had more inferiorly inclined glenoids than either the normal (7 ± 6° vs. 12 ± 5°, P = .002) or mild-GHOA groups (14 ± 5°, P ≤ .001), but the normal and mild-GHOA groups did not differ (P = .281). Conclusion Normal and severe-GHOA shoulders differ in critical shoulder angle and glenoid inclination but not acromial offset. The lack of a difference in critical shoulder angle or inferior inclination between mild-GHOA and normal groups calls into question whether inclination and critical shoulder angle differences predate severe GHOA.
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Affiliation(s)
- Peter N. Chalmers
- Assistant Professor, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
- Corresponding author: Peter N. Chalmers, MD, Department of Orthopaedic Surgery, 590 Wakara Way, Salt Lake City, UT 84108, USA.
| | - Matt Miller
- Research Associate, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - John C. Wheelwright
- Research Associate, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jun Kawakami
- Research Associate, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Heath B. Henninger
- Associate Professor, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Robert Z. Tashjian
- Professor, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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Vaswani R, Como C, Fourman M, Wilmot A, Borrero C, Vyas D, Lin A. Glenoid Radius of Curvature and Humeral Head Volume Are Associated With Postoperative Dislocation After Arthroscopic Bankart Repair. Arthrosc Sports Med Rehabil 2021; 3:e565-e571. [PMID: 34027470 PMCID: PMC8129454 DOI: 10.1016/j.asmr.2020.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 12/29/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose To measure bony morphologic parameters and identify their association with arthroscopic Bankart repair failure. Methods This was a retrospective comparative study. The inclusion criteria were primary arthroscopic Bankart repair, no prior shoulder surgery, traumatic cause, and had a Bankart (soft tissue and bony) lesion evident on magnetic resonance imaging (MRI). The exclusion criteria were posterior labral pathology, multidirectional instability, connective tissue disorder, rotator cuff pathology, and those who underwent concomitant shoulder procedures. Patients who had a postoperative redislocation (unstable group) were compared with matched patients who did not (stable group). Data were obtained by chart review and from preoperative MRI. Comparisons were made using the Student t test, Fisher exact test, or χ2 test. Statistical significance was defined as P < .05. Inter-rater reliability was measured between reviewers. Results A total of 45 patients experienced a postoperative dislocation and were matched to 90 patients without a postoperative dislocation. There were no differences in demographic and radiographic variables. The radius of curvature (ROC) of the glenoid was larger (shallower) in the unstable group (23.6 mm vs 22.6 mm, P = .05). The humeral head volume (HHV) trended higher in the unstable group (68.9 mL vs 62.9 mL, P = .06). The glenoid volume was not significantly different. A greater percentage of patients with a glenoid ROC of 24.5 mm or greater (62.1% vs 26.4%, P = .0003) and an HHV of 80 mm3 or greater (60.8% vs 28.9%, P = .003) experienced a redislocation compared with patients without these factors. Patients with a glenoid ROC of 24.5 mm or more and an HHV of 80 mm3 or more had greater than 4 times the odds of redislocation (odds ratio, 4.56; 95% confidence interval, 1.44-14.43; P = .0098). Strong inter-rater reliability was found for the HHV, glenoid volume, glenoid ROC, and humeral head ROC measurements (r = 0.94, r = 0.88, r = 0.89, and r = 0.95, respectively). Conclusions This study shows that large ROC (shallow) glenoids in conjunction with large humeral heads may predispose patients to failure after arthroscopic Bankart repair. Level of Evidence Level III, retrospective comparative trial.
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Affiliation(s)
- Ravi Vaswani
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Christopher Como
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Mitch Fourman
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Andrew Wilmot
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Camilo Borrero
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Dharmesh Vyas
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Albert Lin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
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Neither critical shoulder angle nor acromion index were related with specific pathology 20 years later! Knee Surg Sports Traumatol Arthrosc 2021; 29:2648-2655. [PMID: 34009456 PMCID: PMC8298350 DOI: 10.1007/s00167-021-06602-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/30/2021] [Indexed: 01/23/2023]
Abstract
PURPOSE The critical shoulder angle (CSA) and the acromion index (AI) are measurements of acromial shape reported as predictors of degenerative rotator cuff tears (RCT) and glenohumeral osteoarthritis (GH OA). Whether they are the cause or effect of shoulder pathologies is uncertain since pre-morbid radiographs most often are lacking. The main aim of this study was to investigate if CSA or AI were related to the development of RCT or GH OA after 20 years. A secondary aim was to investigate if the CSA and AI had changed over time. METHODS In the hospital archive, 273 preoperative plain shoulder radiographs were found of patients scheduled for elective surgery other than cuff repair and arthroplasty. Forty-five images fulfilled the strict criteria published by Suter and Henninger (2015) and were used to measure CSA and AI with two independent assessors. No patient had any sign of OA in the index radiographs or any information in the medical records indicating RCT. After a median of 20 (16-22) years, 30 of these patients were radiologically re-examined with bilateral true frontal views and ultrasound of the rotator cuff. There were 19 men (20 study shoulders) and 11 females (12 study shoulders). RESULTS Mean age at follow-up was 56 (32-78) years. There was no correlation between CSA (r = 0.02) (n.s) or AI (r = - 0.13) (n.s) in the primary radiographs and OA at follow-up. Nor was any correlation found between index CSA (r = 0.12) (n.s) or AI (r = - 0.13) (n.s) and RCT at follow-up. Mean difference in CSA was - 1.7 (- 10-3) degrees and mean AI difference was - 0.04 (- 0.13-0.09) between the first and the second radiographs, 20 years later. Bilaterally, mean CSA was 32 and AI 0.61 at follow-up. CONCLUSION In this study, no correlation between the CSA, AI and development of OA or RCT could be found. The mean CSA and AI decreased over a 20-year period but the difference was very small. No difference was found between the study shoulders and the contralaterals. These findings question previously reported etiological associations between scapular anatomy and the development of OA or RCT and thereby the use of these calculations as the basis of treatment. LEVEL OF EVIDENCE III.
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Schmalzl J, Jessen M, Gilbert F, Gerhardt C, Lehmann LJ. Proximal humeral fracture morphology in patients with advanced cuff tear arthropathy: an observational study in a surgically treated cohort. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:517-524. [PMID: 33025159 DOI: 10.1007/s00590-020-02801-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/23/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND In the presence of cuff tear arthropathy (CTA), joint kinematics is alternated and fracture configuration might be different. The purpose of this study was to identify fracture patterns in patients with advanced CTA to facilitate recognition and treatment. METHODS Radiographs and computed tomography scans of all patients undergoing surgical treatment for a proximal humeral fracture (PHF) in our institution during a 5-year period were retrospectively analyzed. Fracture pattern according to the AO-OTA and Resch classification and the presence of CTA were evaluated. Glenoid configuration according to Walch, fatty atrophy of the supraspinatus muscle and the centrum-collum-diaphyseal (CCD) angle were analyzed. RESULTS A total of 574 out of 713 patients were included. Twenty-three patients (4%) with a mean age of 82 ± 8 years showed advanced CTA with acetabularization of the acromion (≥ stage 3 according to Hamada/Fukuda). There were exclusively valgus fractures with a mean CCD angle of 158° ± 18°. Patients with CTA ≥ grade 3 had a nearly twofold greater risk (risk ratio: 1.8; confidence interval (CI): 95% 1.6-1.9; p < 0.0001) of sustaining a valgus fracture compared to patients without or with CTA < grade 3. The risk for a tuberosity fracture was nearly twofold greater in patients without or with mild CTA (risk ratio: 1.68; confidence interval (CI): 95% 1.17-2.40; p = 0.0046) compared to those with advanced CTA. CONCLUSION In advanced CTA, a predominantly valgus fracture pattern can be observed. In addition, fractures of the greater tuberosity were significantly less frequent and were rarely displaced. Up to date, no classification system for PHF has been developed in the setting of CTA although it might indicate a different treatment, and therefore, recognition is crucial. However, when present, this changes the fracture pattern and ability to treat the fracture as the rotator cuff can no longer be utilized as a means of reducing the fragments.
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Affiliation(s)
- Jonas Schmalzl
- Department of Traumatology and Hand Surgery, St. Vincentius Clinic, ViDia Clinics, Suedendstraße 32, 76137, Karlsruhe, Germany. .,Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University of Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany.
| | - Malik Jessen
- Department of Traumatology and Hand Surgery, St. Vincentius Clinic, ViDia Clinics, Suedendstraße 32, 76137, Karlsruhe, Germany.,Orthopaedic and Trauma Surgery Centre (OUZ), Medical Faculty Mannheim, Ruprecht-Karls-University, Heidelberg, Germany
| | - Fabian Gilbert
- Department of Trauma, Hand, Plastic and Reconstructive Surgery, Julius-Maximilians-University of Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany
| | - Christian Gerhardt
- Department of Traumatology and Hand Surgery, St. Vincentius Clinic, ViDia Clinics, Suedendstraße 32, 76137, Karlsruhe, Germany
| | - Lars-Johannes Lehmann
- Department of Traumatology and Hand Surgery, St. Vincentius Clinic, ViDia Clinics, Suedendstraße 32, 76137, Karlsruhe, Germany.,Orthopaedic and Trauma Surgery Centre (OUZ), Medical Faculty Mannheim, Ruprecht-Karls-University, Heidelberg, Germany
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