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Nazzal EM, Mattar LT, Winkler PW, Popchak AJ, Irrgang JJ, Lin A, Musahl V, Debski RE. Scapular morphology does not predict supraspinatus tendon tear propagation following an individualised exercise therapy programme. J Exp Orthop 2024; 11:e12072. [PMID: 38966184 PMCID: PMC11222707 DOI: 10.1002/jeo2.12072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 05/20/2024] [Indexed: 07/06/2024] Open
Abstract
Purpose To determine whether scapular morphology could predict isolated supraspinatus tendon tear propagation after exercise therapy. We hypothesised that a larger critical shoulder angle (CSA) and type III acromial morphology predict a positive change in tear size. Methods Fifty-nine individuals aged 40-70 years with isolated symptomatic high-grade partial or full-thickness supraspinatus tendon tears were included. Individuals participated in a structured, individualised 12-week exercise therapy programme and underwent ultrasound to measure tear size at baseline and 12 months following therapy. Computed tomography images were segmented to create three-dimensional subject-specific bone models and reviewed by three trained clinicians to measure CSA and to determine acromion morphology based on the Bigliani classification. A binary logistic regression was performed to determine the predictive value of CSA and acromion morphology on tear propagation. Results The CSA was 30.0 ± 5.4°. Thirty-one individuals (52.5%) had type II acromial morphology, followed by type III and type I morphologies (25.4% and 22.0%, respectively); 81.4% experienced no change in tear size, four (6.8%) individuals experienced tear propagation and seven (11.9%) individuals had a negative change in tear size. No significant difference in tear propagation rates based on CSA or acromion morphology (not significant [NS]) was observed. The model predicted tear size status in 81.4% of cases but only predicted tear propagation 8.3% of the time. Overall, CSA and acromion morphology only predicted 24.3% (R 2 = 0.243) of variance in tear propagation (NS). Conclusions CSA and acromion morphology were NS predictors of tear propagation of the supraspinatus tendon 12 months following an individualised exercise therapy programme. Level of Evidence II.
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Affiliation(s)
- Ehab M. Nazzal
- Orthopaedic Robotics LaboratoryPittsburghPennsylvaniaUSA
- Department of Orthopaedic SurgeryUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Luke T. Mattar
- Orthopaedic Robotics LaboratoryPittsburghPennsylvaniaUSA
- Department of Bioengineering, Swanson School of EngineeringUniversity of PittsburghPittsburghPennsylvaniaUSA
| | | | - Adam J. Popchak
- Department of Orthopaedic SurgeryUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
- Department of Physical TherapyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Orthopaedic SurgeryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - James J. Irrgang
- Department of Orthopaedic SurgeryUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
- Department of Physical TherapyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Orthopaedic SurgeryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Albert Lin
- Orthopaedic Robotics LaboratoryPittsburghPennsylvaniaUSA
- Department of Orthopaedic SurgeryUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Volker Musahl
- Orthopaedic Robotics LaboratoryPittsburghPennsylvaniaUSA
- Department of Orthopaedic SurgeryUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Richard E. Debski
- Orthopaedic Robotics LaboratoryPittsburghPennsylvaniaUSA
- Department of Bioengineering, Swanson School of EngineeringUniversity of PittsburghPittsburghPennsylvaniaUSA
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Yang S, Pang L, Zhang C, Wang J, Yao L, Li Y, Huang Y, Tang X. Lower Reoperation Rate and Superior Patient-Reported Outcome Following Arthroscopic Rotator Cuff Repair With Concomitant Acromioplasty: An Updated Systematic Review of Randomized Controlled Trials. Arthroscopy 2024:S0749-8063(24)00408-0. [PMID: 38876445 DOI: 10.1016/j.arthro.2024.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/13/2024] [Accepted: 05/18/2024] [Indexed: 06/16/2024]
Abstract
PURPOSE To systematically assess the postoperative outcomes in patients undergoing arthroscopic rotator cuff repairs with or without concomitant acromioplasty through a rigorous systematic review of randomized controlled trials (RCTs). METHODS This systematic review, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, aimed to identify RCTs comparing clinical outcomes of patients with full-thickness rotator cuff tears undergoing arthroscopic rotator cuff repair with acromioplasty versus those without at a minimum 12-month follow-up. Databases searched included PubMed, Web of Science, Embase, and the Cochrane Library. The risk of bias in the included studies was assessed using the revised Cochrane Risk of Bias 2. Meta-analysis was conducted for outcomes with at least 3 studies reporting, with pooled effect estimates calculated using either fixed-effect or random-effects models based on heterogeneity levels. Results were presented as the weighted mean difference or odds ratio with 95% confidence intervals (CIs). For outcomes with fewer than 3 studies reporting, a Fisher exact test was conducted, with continuity correction applied if necessary. Primary outcomes included rates of retear and reoperation, whereas secondary outcomes included improvement in American Shoulder and Elbow Surgeons (ASES) score, range of motion (ROM), and complication rate. RESULTS Five high-quality RCTs, with low bias risk, involving 409 patients, revealed demographics of 58.4% males, mean age of 58.4 years, and the following acromion types: 12.2% type I, 70.7% type II, and 17.1% type III. Mean follow-up was 52.2 months. Retear (12.5% vs 16.1%, P = .536) and complication rates (odds ratio, 3.11; 95% CI, 0.31-30.73; P = .33) were comparable between the 2 groups. However, reoperation rate (5.3% vs 15.9%, P < .001) and improvement in ASES score (weighted mean difference, 3.99; 95% CI, 1.00-6.99; P = .009) favored the acromioplasty group. Both groups showed significant improvements in ROM, but insufficient data prevented a comparison. CONCLUSIONS Compared with arthroscopic rotator cuff repair alone, arthroscopic rotator cuff repair with acromioplasty demonstrated similar rates of retear and complications but had a significantly lower reoperation rate and superior improvement in ASES score. The available data were insufficient to draw a definitive conclusion regarding ROM. This conclusion is fragile due to a limited sample size. LEVEL OF EVIDENCE Level II, systematic review of Level I and II studies.
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Affiliation(s)
- Songyun Yang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Department of Orthopedics, People's Hospital of Santai County, Santai, People's Republic of China
| | - Long Pang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Chunsen Zhang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jiapeng Wang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Lei Yao
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yinghao Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yizhou Huang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Xin Tang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China; Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
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Prietzel A, Languth T, Bülow R, Ittermann T, Laqua R, Haralambiev L, Wassilew GI, Ekkernkamp A, Bakir MS. Establishing Normative Values for Acromion Anatomy: A Comprehensive MRI-Based Study in a Healthy Population of 996 Participants. Diagnostics (Basel) 2024; 14:107. [PMID: 38201416 PMCID: PMC10795676 DOI: 10.3390/diagnostics14010107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/20/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024] Open
Abstract
Shoulder pain is a common issue often linked to conditions such as subacromial impingement or rotator cuff lesions. The role of the acromion in these symptoms remains a subject of debate. This study aims to establish standardized values for commonly used acromion dimensions based on whole-body MRI scans of a large and healthy population and to investigate potential correlations between acromion shape and influencing factors such as sex, age, BMI, dominant hand, and shoulder pain. The study used whole-body MRI scans from the Study of Health in Pomerania, a German population-based study. Acromion index, acromion tilt, and acromion slope were measured. Interrater variability was tested with two independent, trained viewers on 100 MRI sequences before actual measurements started. Descriptive statistics and logistic regression were used to evaluate the results. We could define reference values based on a shoulder-healthy population for each acromion parameter within the 2.5 to 97.5 percentile. No significant differences were found in acromion slope, tilt, and index between male and female participants. No significant correlations were observed between acromion morphology and anthropometric parameters such as height, weight, or BMI. No significant differences were observed in acromion parameters between dominant and non-dominant hands or stated pain intensity. This study provides valuable reference values for acromion-related parameters, offering insight into the anatomy of a healthy shoulder. The findings indicate no significant differences in acromion morphology based on sex, weight, BMI, or dominant hand. Further research is necessary to ascertain the clinical implications of these reference values. The establishment of standardized reference values opens new possibilities for enhancing clinical decision making regarding surgical interventions, such as acromioplasty.
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Affiliation(s)
- Anne Prietzel
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany; (A.P.)
| | - Theo Languth
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany; (A.P.)
| | - Robin Bülow
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
| | - René Laqua
- Institute of Diagnostic Radiology, Städtisches Krankenhaus Kiel, Chemnitzstraße 33, 24116 Kiel, Germany
| | - Lyubomir Haralambiev
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany; (A.P.)
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683 Berlin, Germany
| | - Georgi Iwan Wassilew
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany; (A.P.)
| | - Axel Ekkernkamp
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany; (A.P.)
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683 Berlin, Germany
| | - Mustafa Sinan Bakir
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany; (A.P.)
- Department of Trauma Surgery and Orthopedics, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Straße 7, 12683 Berlin, Germany
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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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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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Livesey MG, Bedrin MD, Baird MD, Tran A, Weir TB, Hasan SA, Gilotra MN, Kilcoyne KG, Dickens JF. Acromion morphology is associated with glenoid bone loss in posterior glenohumeral instability. J Shoulder Elbow Surg 2023; 32:1850-1856. [PMID: 37003427 DOI: 10.1016/j.jse.2023.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 02/22/2023] [Accepted: 03/01/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND The acromion morphology in a shoulder with posterior instability differs from that of a shoulder without glenohumeral instability. Specifically, the acromion with a flatter sagittal tilt, greater posterior acromial height, and less posterior coverage is associated with posterior instability. However, the association between acromion morphology and glenoid bone loss (GBL) in the setting of posterior glenohumeral instability has not previously been investigated. The purpose of this study was to determine whether acromial morphology influences the extent or pattern of posterior GBL in a cohort of patients with posterior glenohumeral instability. METHODS This multicenter retrospective study identified 89 shoulders with unidirectional posterior glenohumeral instability. Total area GBL was measured using the best-fit circle method on magnetic resonance imaging (MRI). Shoulders were divided into 3 groups: (1) no GBL (n = 30), (2) GBL 0%-13.5% (n = 45), or (3) GBL ≥13.5% (n = 14). Acromion measurements were performed on MRI and included acromial tilt, posterior acromial height, anterior acromial coverage, and posterior acromial coverage. RESULTS Patients without GBL had a steeper acromial tilt (58.5° ± 1.4°) compared with those with 0%-13.5% GBL (64.3° ± 1.5°) or GBL ≥13.5% (67.7° ± 1.8°) (P = .004). Patients without GBL also had greater posterior coverage (65.4° ± 1.7°) compared with those with GBL (60.3° ± 1.4°) (P = .015). Posterior acromion height was not significantly different among groups. CONCLUSION The results demonstrate that an acromion with a flatter sagittal tilt and less posterior coverage is associated with GBL in the setting of posterior glenohumeral instability. This is important to consider as posterior GBL has been identified as a risk factor for failure of posterior soft tissue-stabilizing procedures.
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Affiliation(s)
| | - Michael D Bedrin
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Michael D Baird
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Andrew Tran
- University of Maryland Medical Center, Baltimore, MD, USA
| | - Tristan B Weir
- University of Maryland Medical Center, Baltimore, MD, USA
| | - S Ashfaq Hasan
- University of Maryland Medical Center, Baltimore, MD, USA
| | | | - Kelly G Kilcoyne
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Jonathan F Dickens
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center Uniformed Services University of Health Sciences, Bethesda, MD, USA; Department of Orthopaedics, Duke University, Durham, NC, USA; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
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Ye Z, Qiao Y, Wu C, Chen C, Su W, Xu C, Dong S, Xu J, Zhao J. Effect of Anterior Acromial Coverage on Functional and Radiological Outcomes After Arthroscopic Repair of Anteroposterior Massive Rotator Cuff Tears. Am J Sports Med 2023; 51:2831-2841. [PMID: 37593843 DOI: 10.1177/03635465231187900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
BACKGROUND Rotator cuff tear size, fatty infiltration, and scapular morphology are correlated with tendon healing and functional outcomes after arthroscopic repair; however, the association between anteroposterior acromial coverage and the clinical outcomes of anteroposterior massive rotator cuff tears (AP-MRCTs; involving all 3 tendons) remains unclear. PURPOSE To identify the association between AP acromial coverage and functional and radiological outcomes after arthroscopic repair of AP-MRCTs. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 98 patients who underwent arthroscopic repair of AP-MRCTs between January 2015 and December 2020 were included in the study and classified according to whether anterior acromial coverage (AAC) was anterior (46 patients; positive AAC group) or posterior (52 patients; negative AAC group) to the scapular line on true lateral shoulder radiographs. Demographic characteristics, surgical details, and functional outcomes were prospectively collected. Acromial morphological features, global tear extension (GTE), the global fatty infiltration index (GFII), tendon integrity after repair, proximal humeral migration, and glenohumeral abduction were measured and calculated on radiographs or magnetic resonance imaging scans preoperatively and at 2 years postoperatively. Multivariate logistic regression was performed to identify the independent risk factors of a rotator cuff retear. RESULTS The positive AAC group showed larger AAC, posterior acromial tilt, and anterior acromial slope as well as smaller posterior acromial coverage compared with the negative AAC group. Postoperatively, the American Shoulder and Elbow Surgeons score (82.5 ± 8.3 vs 77.2 ± 11.5, respectively; P = .013), active abduction (157.8°± 27.1° vs 142.7°± 39.6°, respectively; P = .048), and glenohumeral abduction (45.6°± 10.4° vs 39.7°± 14.9°, respectively; P = .041) in the positive AAC group were significantly higher than those in the negative AAC group, while the retear rate (23.9% vs 44.2%, respectively; P = .035) and proximal humeral migration (1.7 ± 1.0 vs 2.3 ± 1.2 mm, respectively; P = .006) were significantly lower in the positive AAC group than in the negative AAC group. Smaller AAC (odds ratio [OR], 0.93 [95% CI, 0.87-1.00]; P = .040), larger GTE (OR, 1.03 [95% CI, 1.01-1.06]; P = .017), and a higher GFII (OR, 3.49 [95% CI, 1.09-11.19]; P = .036) were associated with an increased risk of a rotator cuff retear. CONCLUSION Increased AAC was associated with a lower retear rate and better functional outcomes after arthroscopic repair of AP-MRCTs. A preliminary risk evaluation integrating GTE, the GFII, and AAC is recommended to consider the necessity of additional procedures for patients in need of arthroscopic rotator cuff repair.
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Affiliation(s)
- Zipeng Ye
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Qiao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenliang Wu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chang'an Chen
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Su
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Caiqi Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shikui Dong
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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8
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Fallahpour N, Jamalipour Soufi G, Jamalipour Soufi K, Hekmatnia A. Evaluation of the acromion variants in MRI and their association with rotator cuff injuries in non-traumatic patients. J Orthop 2023; 42:17-23. [PMID: 37449026 PMCID: PMC10336402 DOI: 10.1016/j.jor.2023.06.012] [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: 05/18/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose Understanding demographic and MRI parameters with determinant role in rotator cuff tearing (RCT) is required to predict outcomes and select more appropriate treatment in patients with non-traumatic shoulder pain. This study aimed to survey the association of rotator cuff tears with these factors. Methods We performed this cross-sectional study on patients referred to Kashani Hospital with non-traumatic shoulder pain suspected of rotator cuff injuries from April 2020 to February 2021. We obtained their demographic data and MRI from electronic hospital records. After that, two radiologists reviewed MRI and recorded data. We employed the SPSS 23 software to organize the obtained results and statistical evaluations. Results 371 subjects, with the age of 48.61 ± 14.89 years, were included in our study, and 50% of them were male. The flat and down-sloping acromion and partial tearing of the supra and infraspinatus tendons were more frequent than the others. Gender could not consider as a determinant factor for the severity of tendon injuries, acromion types and variants. The relation of age to acromion morphology and the tendinopathy severity was significant. Remarkably, down-sloping acromion was higher at all the acromion shapes; however, it makes no difference in the level of supra and infraspinatus involvement. Moreover, we found that partial tearing was higher in all acromion types, except concave. This distribution was significant only for supraspinatus tears. Conclusion The clinical decision is the most important step in patients with RCT and MRI prognostic factors, which are helpful to improve the management of the cases. RCT in older patients and down-slope acromion was more severe than the others. According to the previous studies, acromion morphology (as an important determinant factor) in RCT could be influenced by age, as well.
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Affiliation(s)
| | | | | | - Ali Hekmatnia
- Radiology Department, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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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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10
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Gould HP. CORR Insights®: High Acromial Slope and Low Acromiohumeral Distance Increase the Risk of Retear of the Supraspinatus Tendon After Repair. Clin Orthop Relat Res 2023; 481:1171-1173. [PMID: 36812065 PMCID: PMC10194537 DOI: 10.1097/corr.0000000000002600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/27/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Heath P Gould
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
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11
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Caffard T, Kralewski D, Ludwig M, Dornacher D, Fuchs M, Kappe T, Reichel H, Sgroi M. High Acromial Slope and Low Acromiohumeral Distance Increase the Risk of Retear of the Supraspinatus Tendon After Repair. Clin Orthop Relat Res 2023; 481:1158-1170. [PMID: 36623210 PMCID: PMC10194550 DOI: 10.1097/corr.0000000000002520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/15/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Retearing of the supraspinatus (SSP) tendon after repair is relatively common, but its cause is rarely clear. Although the role of acromion morphology and glenoid orientation in the pathogenesis of primary SSP tendon tears have frequently been analyzed, their association with the risk of rerupture of a repaired SSP tendon is poorly understood. QUESTIONS/PURPOSES (1) Is acromial morphology associated with the risk of retear after SSP tendon repair? (2) Is there an association between inclination and version of the glenoid and the odds for retear of the SSP tendon after repair? (3) Are there differences in outcome scores between patients who had intact cuff repairs and those who had retears? METHODS Between August 2012 and December 2015, we treated 92 patients for SSP tendon tears; all of these patients were considered for inclusion in the present study. We considered patients with complete tear of the SSP that was reconstructed with a double-row repair and a minimum follow-up of 2 years as potentially eligible. Based on these criteria, 28% (26 of 92) were excluded because they had a partial rupture and did not receive a double-row reconstruction. A further 9% (eight of 92) were excluded because of missing planes or slices (such as sagittal, axial, or frontal) on MRI, and another 3% (three of 92) were lost before the minimum study follow-up interval or had incomplete datasets, leaving 60% (55 of 92) for inclusion in the present analysis. All included patients had a minimum follow-up of 2 years; follow-up with MRI occurred at a mean duration of 2.3 ± 0.4 years postoperatively. All patients were asked to complete the Western Ontario Rotator Cuff Index and Oxford Shoulder Scores, and they underwent MRI of the operated-on shoulder. Preoperative true AP radiographs and MR images of the affected shoulders were retrospectively assessed by measuring the acromiohumeral interval, critical shoulder angle, acromial slope, acromial tilt, acromial index, lateral acromial angle, and glenoid version and inclination. The patients also underwent acromioplasty, in which the underface of the acromion was flattened. To rule out any change in the above parameters because of acromioplasty, these parameters were compared using preoperative and postoperative MR images and showed no difference. In addition, the tendon integrity and quality on postoperative MRI were analyzed independently of one another by the same two observers using the Sugaya and Castricini classifications, accounting for atrophy and fatty degeneration of the SSP muscle. To assess interobserver reliability, the two observers took measurements independently from each other. They were orthopaedic residents who completed a training session before taking the measurements. All measurements had excellent intrarater (Cronbach alpha 0.996 [95% confidence interval (CI) 0.99 to 1.00; p > 0.01) and interrater (interrater correlation coefficient 0.975 [95% CI 0.97 to 0.98]; p > 0.01) reliabilities. To answer the study's first question, SSP integrity on postoperative MRI was compared with acromial morphologic parameters measured on preoperative AP radiographs and MR images. To answer the second question, the postoperative integrity and quality of the SSP tendon were correlated with glenoid inclination and glenoid version. To answer our third question, we compared outcome scores between patients with intact SSP tendons and those with reruptured SSP tendons. To investigate any correlation among the acromial morphology, glenoid orientation, and postoperative outcomes, a binomial logarithmic regression analysis was performed. Receiver operating characteristic curves were used to determine cutoff points for the radiologic parameters that showed a correlation in the binomial regression analysis. RESULTS After controlling for potentially confounding variables such as acromioplasty or preoperative fatty infiltration as well as muscle atrophy, the only morphological parameters associated with a higher risk (adjusted odds ratio) of SSP tendon rerupture were the acromiohumeral interval (adjusted OR 0.9 [95% CI 0.9 to 0.99]; p < 0.01) and acromial slope (adjusted OR 1.4 [95% CI 1.1 to 1.8]; p < 0.01). The critical shoulder angle, acromial tilt, acromial index, and lateral acromial angle were not associated with the risk of rerupture. The cutoff values for acromial slope and acromiohumeral interval were 24.5° and 7.4 mm, respectively. Patients with an acromiohumeral interval smaller than 7.4 mm or an acromial slope greater than 24.5° had higher odds (acromiohumeral interval: OR 11 [95% CI 2 to 46]; p = 0.01 and acromial slope: OR 9 [95% CI 2 to 46]; p = 0.04) for rerupture of the SSP. No difference was found between patients with intact SSP tendons and those with reruptured SSP tendons in terms of glenoid inclination (6° ± 4° versus 6° ± 3°, mean difference 0.8° [-1° to 3°]; p < 0.48) and glenoid version (-2° ± 3° versus -3° ± 3°, mean difference 1° [-1° to 3°]; p < 0.30). No difference was found between the intact and reruptured SSP groups regarding clinical outcomes (Western Ontario Rotator Cuff Index: 98 ± 2 versus 97 ± 3, mean difference 0.73 [95% CI -0.30 to 0.31]; p = 0.96; Oxford Shoulder Score: 26 ± 13 versus 23 ± 10, mean difference 2.80 [95% CI -4.12 to 9.72]; p = 0.41). CONCLUSION The preoperative acromiohumeral interval and acromial slope are associated with SSP tendon rerupture after repair. Conversely, the critical shoulder angle, acromial tilt, lateral acromial angle, and acromial index had no association with the postoperative outcome. Additionally, glenoid inclination and version were not associated with the rerupture rate after SSP tendon repair. A detailed analysis of the acromiohumeral interval and acromial slope is recommended in clinical practice in patients undergoing SSP tendon repair. Surgeons should consider measuring the acromiohumeral interval and acromial slope preoperatively when performing SSP repair, especially in the context of planned acromioplasties. Future studies should investigate the role of acromioplasty during SSP repair in patients with a pathologic acromial slope and acromiohumeral interval. In this context, it should be determined whether a more-radical acromioplasty could reduce the risk of rerupture of the SSP in these patients. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Thomas Caffard
- Department of Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
| | | | - Marius Ludwig
- Department of Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
| | - Daniel Dornacher
- Department of Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
| | - Michael Fuchs
- Department of Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
| | - Thomas Kappe
- Department of Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
| | - Heiko Reichel
- Department of Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
| | - Mirco Sgroi
- Department of Orthopaedic Surgery, RKU, University of Ulm, Ulm, Germany
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Fu S, Lan Y, Wang G, Bao D, Qin B, Zheng Q, Liu H, Wong VKW. External stimulation: A potential therapeutic strategy for tendon-bone healing. Front Bioeng Biotechnol 2023; 11:1150290. [PMID: 37064229 PMCID: PMC10102526 DOI: 10.3389/fbioe.2023.1150290] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/23/2023] [Indexed: 04/03/2023] Open
Abstract
Injuries at the tendon-bone interface are very common in the field of sports medicine, and healing at the tendon-bone interface is complex. Injuries to the tendon-bone interface can seriously affect a patient’s quality of life, so it is essential to restore stability and promote healing of the tendon-bone interface. In addition to surgical treatment, the healing of tendons and bones can also be properly combined with extracorporeal stimulation therapy during the recovery process. In this review, we discuss the effects of extracorporeal shock waves (ESWs), low-intensity pulsed ultrasound (LIPUS), and mechanical stress on tendon-bone healing, focusing on the possible mechanisms of action of mechanical stress on tendon-bone healing in terms of transcription factors and biomolecules. The aim is to provide possible therapeutic approaches for subsequent clinical treatment.
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Affiliation(s)
- Shijie Fu
- Faculty of Chinese Medicine, Macau University of Science and Technology, Taipa, Macao SAR, China
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Dr. Neher’s Biophysics Laboratory for Innovative Drug Discovery, State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao SAR, China
| | - Yujian Lan
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Guoyou Wang
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Dingsu Bao
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Bo Qin
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Qiu Zheng
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Huan Liu
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China
- *Correspondence: Huan Liu, ; Vincent Kam Wai Wong,
| | - Vincent Kam Wai Wong
- Dr. Neher’s Biophysics Laboratory for Innovative Drug Discovery, State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, Macao SAR, China
- *Correspondence: Huan Liu, ; Vincent Kam Wai Wong,
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13
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Acute, Traumatic Rotator Cuff Tears Have Smaller Critical Shoulder Angles Than Degenerative Tears. Arthroscopy 2023; 39:225-231. [PMID: 36208709 DOI: 10.1016/j.arthro.2022.08.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 08/22/2022] [Accepted: 08/29/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To determine whether the critical shoulder angle (CSA) in acute, traumatic rotator cuff tears (RCTs) is consistent with the previously described CSA in chronic degenerative RCTs. METHODS We performed a multicenter retrospective analysis of 134 patients presenting to 5 surgeons fellowship trained in shoulder and elbow or sports. Preoperative imaging was used to measure the CSA and tear characteristics. Patients were included if they had acute, traumatic full-thickness RCTs documented on advanced imaging and had preoperative Grashey radiographs. Patients were excluded if they had any history of shoulder pain, injury, surgery, or treatment prior to the current episode; were overhead athletes; or had fatty infiltration greater than Goutallier grade 1 on imaging. RESULTS The mean CSA was 33.5° (standard deviation, 4.1°), and 60% of tears had a CSA of less than 35°, much below the mean of 38.0° and the threshold of greater than 35° in degenerative RCTs. The mean age was 58 years, and 70% of patients were men. Overall, 60% of tears involved the subscapularis, 49% of tears occurred in patients aged 60 years or older, and 18% of patients sustained a dislocation. Older age (β = 0.316, P = .003) and male sex (β = 5.532, P = .025) were predictive of tear size, and older age (β = 0.229, P = .011) and biceps avulsion (β = 8.822, P = .012) were predictive of tear retraction. CONCLUSIONS Acute, traumatic RCTs have CSAs that are 5° smaller than those of degenerative tears, and the majority (60%) have CSAs that are below the threshold consistent with degenerative RCTs. The majority of traumatic tears (60%) involve the subscapularis. CLINICAL RELEVANCE The study findings suggest that a traumatic tear is not simply the acute failure of a degenerative tendon and that it represents a distinct pathologic entity. These findings support current practice of treating traumatic RCTs differently than degenerative RCTs.
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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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Thiesemann S, Kirchner F, Fal MF, Albers S, Kircher J. Anterolateral Acromioplasty Does Not Change the Critical Shoulder Angle and Acromion Index in a Clinically Relevant Amount. Arthroscopy 2022; 38:2960-2968. [PMID: 35777676 DOI: 10.1016/j.arthro.2022.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 02/22/2022] [Accepted: 06/08/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Assessment on whether radiographic parameters of the acromion measured in radiographs change significantly after anterolateral acromioplasty. METHODS This retrospective study included patients that underwent an arthroscopic anterolateral acromioplasty between January 2014 and September 2020. n = 435 subjects with high-quality preoperative and postoperative radiographs according to Suter-Henninger criteria were included in the final assessment. All measurements were independently performed by the first and second author in a blinded fashion using dicomPACS software: acromion index (AI), critical shoulder angle (CSA), lateral acromial angle (LAA), beta angle, acromio-humeral distance (AHD), Aoki angle, frontal supraspinatus outlet angle (FSOW), and acromion type, according to Bigliani. SPSS software was used for statistical analysis. RESULTS The beta angle and the CSA did not significantly change after operation (alpha power 0.32 and 0.11, respectively). In a subgroup analysis of patients with a pathological CSA >35° (n = 194), the CSA changed from 38.62 (range: 35.08-47.52, SD 2.83) to 38.04 (range: 29.18-48.12, SD 3.77) postoperatively (P = .028) (Fig 8). All other parameters changed significantly after operation (AI, AHD, FSOW, and Aoki; P = .001, LAA; P = .039) (Fig. 9). The interobserver and intraobserver reliability was good to excellent in the majority of measured values. Mean patient age was 59.2 years (range: 18.1-87.1; SD 11.3), mean height was 1.73 meters (range: 1,50-1.98, SD 0.09), mean weight was 80.2 kg (range: 37.0-133.0, SD 16.68), and mean body mass index was 26.6 (range: 0.0-46.1, SD 4.73). CONCLUSION Anterolateral acromioplasty producing a flat acromion undersurface did not result in a significant change of the CSA in the study population. Pathological preoperative CSA values of >35° were significantly reduced but not to normal values, but only by a small amount that puts the clinical relevance into question. LEVEL OF EVIDENCE IV, diagnostic study, case series.
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Affiliation(s)
- Sophie Thiesemann
- ATOS Klinik Fleetinsel Hamburg, Department of Shoulder and Elbow Surgery, Hamburg, Germany
| | - Florian Kirchner
- ATOS Klinik Fleetinsel Hamburg, Department of Shoulder and Elbow Surgery, Hamburg, Germany.
| | - Milad Farkhondeh Fal
- University Hospital Hamburg Eppendorf, Department of Trauma and Orthopaedic Surgery, Martinistraße 52, 20251 Hamburg, Germany
| | - Sebastian Albers
- ATOS Klinik Fleetinsel Hamburg, Department of Shoulder and Elbow Surgery, Hamburg, Germany
| | - Jörn Kircher
- ATOS Klinik Fleetinsel Hamburg, Department of Shoulder and Elbow Surgery, Hamburg, Germany
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Lavoie-Gagne O, Fury MS, Mehta N, Harkin WE, Bernstein DN, Berlinberg EJ, Parvaresh K, O'Donnell E, Forsythe B. Double-Row Repair With Platelet-Rich Plasma Optimizes Retear Rates After Small to Medium Full-Thickness Rotator Cuff Repair: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials. Arthroscopy 2022; 38:2714-2729. [PMID: 35337958 DOI: 10.1016/j.arthro.2022.03.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the different interventions described in the literature for the surgical treatment of small and medium complete rotator cuff tears. METHODS A systematic review of randomized controlled trials of small-medium, full-thickness rotator cuff tears published since 2000 was performed. Clinical characteristics, re-tear rates, range of motion (ROM), and patient-reported outcomes (PRO) data were collected. Interventions were compared via arm-based Bayesian network meta-analysis in a random-effects model. Interventions were ranked for each domain (re-tear risk, pain, ROM, and PROs) via surface under the cumulative ranking curves. RESULTS A total of 18 studies comprising 2046 shoulders (47% females, mean age 61 ± 3 years, mean follow-up 21 ± 5 months) were included. Interventions that ranked highest for minimizing re-tear risk included arthroscopic single-row repair (A+SR) or double-row repair (A+DR) with or without platelet-rich plasma (PRP). Open repair and A+SR repair with acromioplasty (ACP) ranked highest for pain relief. Interventions that ranked highest for ROM improvement included open repair, PT, and A+DR with or without ACP. Interventions that ranked highest for PROs included arthroscopic footprint microfracture with or without SR, open repair, and A+SR with or without ACP. CONCLUSIONS Based on a network meta-analysis of level 1 studies, arthroscopic rotator cuff repair with a SR or DR construct demonstrates similar retear rates, PROs, and clinical outcomes. The highest-ranking treatment for minimizing retears was arthroscopic repair with DR constructs and PRP augmentation, although open repair and arthroscopic SR remain reliable options with excellent clinical outcomes. Addition of PRP to DR constructs trended toward a 56% decreased risk of retear as compared to DR repair alone. Although no single treatment emerged superior, several interventions offered excellent clinical improvements in pain, ROM, and PROs that exceeded minimal clinically important difference thresholds. LEVEL OF EVIDENCE I, systematic review and meta-analysis of level I studies.
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Affiliation(s)
| | - Matthew S Fury
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts, U.S.A
| | - Nabil Mehta
- Rush University Medical Center, Chicago, Illinois, U.S.A
| | | | - David N Bernstein
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts, U.S.A
| | | | | | - Evan O'Donnell
- Massachusetts General Hospital, Boston, Massachusetts, U.S.A
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Gieg SD, Schaefer C, Smith MJ, Ma R, Heil SD, Kim HM. Utility of lateral scapular radiographs in initial evaluation of nontraumatic shoulder conditions. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:149-154. [PMID: 37587963 PMCID: PMC10426687 DOI: 10.1016/j.xrrt.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Lateral scapular radiographs have been routinely included in the initial radiographic examination of both traumatic and nontraumatic shoulder conditions. With the advance of modern imaging modalities, the clinical utility of the lateral scapular view has become questionable. The purpose of the study was to assess the utilization of the lateral scapular view among the members of the American Shoulder and Elbow Surgeons (ASES) and to determine the clinical utility of the lateral scapular view in the initial evaluation of nontraumatic shoulder conditions. Methods The study consisted of two parts. The first part involved an online survey of ASES members, which asked them 3 questions regarding their preference for radiographic evaluation of new patients with nontraumatic shoulder pain. The second part involved a clinical vignette-based survey, where 4 shoulder surgeons at our institution were given 50 clinical vignettes and asked to independently answer 4 questions regarding the most probable diagnosis, abnormal radiographic findings, further imaging studies, and treatment plan for each case. The survey was repeated twice; the first was given without a lateral scapular view, and the second given 4 weeks later with a lateral scapular view included. We obtained diagnostic accuracy and percent agreement of each surgeon over two surveys and intraobserver and interobserver reliability on each variable. Results Of a total of 235 ASES members who responded to the online survey, 193 (82.1%) indicated their routine use of a lateral scapular view. The most common reason for obtaining the view was better characterization of acromion morphology (75.4%). The clinical vignette-based survey showed substantial intrarater reliability (κ > 0.6) of the 4 surgeons between the two surveys for the most probable diagnosis, abnormal x-ray findings, and further imaging studies, while the intrarater reliability for treatment plan was moderate (κ = 0.548). The mean diagnostic accuracy of the 4 surgeons was almost equal (74% vs. 75%) between the surveys. Overall, each surgeon's percent agreement across the 2 surveys was over 70%. None of the 4 surgeons recommended a lateral scapular view for further imaging during the first survey; each wanted either advanced imaging (computed tomography, magnetic resonance imaging) or none. Discussion The addition of a lateral scapular radiograph in the presence of other orthogonal views does not appear to improve surgeons' diagnostic accuracy or affect their decision-making on the treatment plan in nontraumatic shoulder conditions. The clinical utility of the lateral scapular view may need to be reassessed in this setting.
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Affiliation(s)
- Samuel D. Gieg
- Missouri Orthopaedic Institute, University of Missouri, Columbia, MO, USA
| | | | - Matthew J. Smith
- Missouri Orthopaedic Institute, University of Missouri, Columbia, MO, USA
| | - Richard Ma
- Missouri Orthopaedic Institute, University of Missouri, Columbia, MO, USA
| | - Sally D. Heil
- Missouri Orthopaedic Institute, University of Missouri, Columbia, MO, USA
| | - H. Mike Kim
- Missouri Orthopaedic Institute, University of Missouri, Columbia, MO, USA
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Spasojevic M, Mackenzie SP, Young A, Cass B. Subacromial osteochondroma and rotator cuff tear in a young adult with multiple osteochondromas. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:92-95. [PMID: 37588279 PMCID: PMC10426680 DOI: 10.1016/j.xrrt.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
| | | | - Allan Young
- Sydney Shoulder Research Institute, St Leonards, Australia
| | - Benjamin Cass
- Sydney Shoulder Research Institute, St Leonards, Australia
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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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Liu CT, Miao JQ, Wang H, An Ge H, Wang XH, Cheng B. The association between acromial anatomy and articular-sided partial thickness of rotator cuff tears. BMC Musculoskelet Disord 2021; 22:760. [PMID: 34488703 PMCID: PMC8419993 DOI: 10.1186/s12891-021-04639-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/23/2021] [Indexed: 11/21/2022] Open
Abstract
Background Acromial anatomy has been found to be correlated with degenerative full-thickness rotator cuff tears in current studies. However, research on the relationship between acromial anatomy and articular-sided partial thickness of rotator cuff tears (PTRCTs) is still lacking. The purpose of this study was to evaluate whether these imaging graphic parameters exhibit any association between acromial anatomy and degenerative articular-sided PTRCTs. Methods Between January 2016 and December 2018, a total of 91 patients without a history of trauma underwent arthroscopy as an articular-sided PTRCT group. In the control group, with age- and sex-matched patients, we selected 91 consecutive outpatient patients who underwent shoulder magnetic resonance imaging (MRI) because of shoulder pain and an MRI diagnosis of only synovial hyperplasia and effusion. MRI was used to measure the acromial type, acromiohumeral distance (AHD), lateral acromial angle (LAA), acromion index (AI), and critical shoulder angle (CSA) by 2 independent observers. Results The acromion type, AHD and LAA showed no difference between degenerative articular-sided PTRCTs and controls (P = 0.532, 0.277, and 0.108, respectively). AI and CSA were significantly higher in degenerative articular-sided PTRCTs (P = 0.002 and 0.003, respectively). A good correlation was found between AI and CSA to measurement(Pearson correlation coefficient = 0.631). Conclusions Our study revealed that higher AI and CSA were found in degenerative articular-sided PTRCTs. Acromial anatomy with a large acromial extension was associated with the occurrence of degenerative articular-sided PTRCTs.
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Affiliation(s)
- Cen Tao Liu
- Department of Orthopedics, Putuo People's Hospital, Tongji University, No. 1291 Jiangning Road, Putuo District, 200060, Shanghai, China
| | - Jia Qing Miao
- Department of Orthopedics, Putuo People's Hospital, Tongji University, No. 1291 Jiangning Road, Putuo District, 200060, Shanghai, China
| | - Hua Wang
- Department of Orthopedics, Putuo People's Hospital, Tongji University, No. 1291 Jiangning Road, Putuo District, 200060, Shanghai, China
| | - Heng An Ge
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Yanchang Middle Road, Jing'an District, 200072, Shanghai, China
| | - Xian Hui Wang
- Department of Orthopedics, Putuo People's Hospital, Tongji University, No. 1291 Jiangning Road, Putuo District, 200060, Shanghai, China.
| | - Biao Cheng
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Yanchang Middle Road, Jing'an District, 200072, Shanghai, China.
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Quinlan NJ, Hillyard B, Wheelwright JC, Miller M, Kawakami J, Tashjian RZ, Chalmers PN. Footprint size matters: wider coronal greater tuberosity width is associated with increased rates of healing after rotator cuff repair. JSES Int 2021; 5:486-492. [PMID: 34136859 PMCID: PMC8178600 DOI: 10.1016/j.jseint.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background The purpose of this study was to determine whether greater tuberosity morphology (1) could be measured reliably on magnetic resonance imaging (MRI), (2) differed between patients with rotator cuff tears (RCTs) compared with those without tears or glenohumeral osteoarthritis, or (3) differed between patients with rotator cuff repairs (RCR) who healed and those that did not. Methods This is a retrospective comparative study. (1) We measured greater tuberosity width (coronal and sagittal), lateral offset, and angle on MRI corrected into the plane of the humerus. To determine reliability, these measurements were made by two observers and intraclass correlation coefficients were calculated. (2) We compared these measurements between patients with a full-thickness RCT and patients aged >50 years without evidence of a RCT or glenohumeral osteoarthritis. (3) We then compared these measurements between those patients with healed RCRs and those with evidence of retear on MRI. In this portion, we only included patients with both a preoperative and postoperative MRI at least 1 year from RCR. Postoperative MRIs were obtained to assess healing rates, not because of concern for failure. Those without tendon defects were considered healed. Results (1) In a validation cohort of 50 patients with MRI, all inter-rater intraclass correlation coefficients were greater than 0.75. (2) There were no differences between our RCT group of 110 patients and our comparison group of 100 patients in tuberosity coronal width, sagittal width, or lateral offset. The RCT group had a significantly smaller greater tuberosity angle (63 ± 4° vs 65 ± 5°, P = .003). (3) In our group of 110 RCRs, postoperative MRI scans were obtained at a mean follow-up of 23.6 ± 15.7 months showing 84 (76%) patients had healed RCRs. Larger coronal tuberosity width was associated with healing (1.3 ± 0.2 vs 1.2 ± 0.2 cm, P = .032), as was smaller tear width (P < .001), and retraction (P < .001). When coronal width was dichotomized, there was a significantly higher healing rate with a width over 1.2 cm (85 vs 66%, P = .02). No other greater tuberosity morphological characteristics were associated with RCR or postoperative healing. Conclusion RCTs do not appear to be associated with greater tuberosity morphology. Postoperative rotator cuff healing based on MRI is 76%. Higher rates of healing occur with a wider coronal tuberosity width (ie, rotator cuff tendon footprint). Consideration could be given to widening the footprint intraoperatively in an effort to improve healing rates although this remains to be validated.
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Affiliation(s)
- Noah J Quinlan
- Orthopaedic Resident, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Bradley Hillyard
- Research Associate, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - John Cade Wheelwright
- Research Associate, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Matt Miller
- 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
| | - Robert Z Tashjian
- Professor, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Peter N Chalmers
- Assistant Professor, Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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Kajita Y, Iwahori Y, Harada Y, Takahashi R, Deie M. Morphological characteristics of the acromion in Fosbury flop tears and their clinical outcomes after arthroscopic rotator cuff repair. J Orthop 2020; 22:548-552. [PMID: 33214742 DOI: 10.1016/j.jor.2020.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/01/2020] [Indexed: 11/16/2022] Open
Abstract
Background Rotator cuff tears that have flipped upon itself and adhered medially have been recently described as Fosbury flop tears (FFT). However, there are no reports on the cause and clinical outcomes of FFT. We investigated the preoperative anatomical factors and clinical outcomes related to the occurrence of FFT. Methods Among patients with more than two years of follow-up, 33 patients with FFT who underwent arthroscopic rotator cuff repair (ARCR) for a small-to-medium sized tear of the supraspinatus tendon alone (Group F: mean age, 63.4 ± 8.9 years) and 52 patients without FFT who underwent ARCR (Group C: mean age, 62.1 ± 7.0 years) were included. Presence of diabetes mellitus, critical shoulder angle (CSA), lateral acromial angle (LAA), acromiohumeral distance (AHD), sagittal and coronal morphologies of the acromion, JOA score, and rate of rotator cuff re-tear were evaluated. Results There were significantly more males in Group F (P = 0.017). There were no significant differences in age or rate of diabetic complications. The mean CSA, LAA, and AHD in the Groups F and C were respectively as follows: CSA, 33.7 ± 4.0° and 34.5 ± 3.4°; LAA, 82.1 ± 9.9° and 82.1 ± 6.9°; AHD, 10.2 ± 1.4 mm and 9.8 ± 1.4 mm. There were no significant differences between groups. The acromial morphology showed no significant difference in the sagittal plane; however, significantly more double-floor type acromia were found in the coronal plane (P < 0.001). Although the JOA score significantly improved in both groups, there was no significant difference between groups. The re-rupture rate was significantly higher in Group F than Group C (15.2% versus 1.9%; P = 0.02). Conclusions Double-floor type acromia in the coronal plane was common in Group F. The location of osteophytes on the inferior surface of the acromion was believed to be associated with the occurrence of FFT. Furthermore, a high re-tear rate was observed in group F.
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Affiliation(s)
- Yukihiro Kajita
- Department of Orthopaedic Surgery, Aichi Medical University, Japan
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Japan
| | - Yusuke Iwahori
- Department of Orthopaedic Surgery, Asahi Hospital, Japan
| | - Yohei Harada
- Department of Orthopaedic Surgery, Aichi Medical University, Japan
| | | | - Masataka Deie
- Department of Orthopaedic Surgery, Aichi Medical University, Japan
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