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Karakus O, Oztermeli A. The relationship between the shape of rotator cuff tears and shoulder anatomical parameters. BMC Musculoskelet Disord 2024; 25:696. [PMID: 39223580 PMCID: PMC11367749 DOI: 10.1186/s12891-024-07829-9] [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: 07/14/2024] [Accepted: 08/28/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND The aim of this study is to investigate the potential relationship between shoulder anatomical parameters and the shape of rotator cuff tears (L-shaped, U-shaped, and crescent-shaped). MATERIALS AND METHODS The study included 160 (n:160) patients. Patients were divided into four groups: crescent type, u type and L type tears and control group. There were 40 cases in each group. The operated patients were divided into three groups based on the shape of the tears in arthroscopic images. Measurements of Critical Shoulder Angle (CSA), Greater Tuberosity Angle (GTA), Acromion Index (AI), Lateral Acromion Angle (LAA), and Humerus Footprint width (coronal width and sagittal width) were taken in each group and compared. RESULTS Patients were divided into four different groups: Crescent type group (n:40), L type group (n:40), U type group (n:40) and control group (n:40). Upon assessing the coronal and sagittal width measurements, The mean coranal width measurement of the L-type tear group was 12.62 ± 0.29 mm, which was significantly higher than all other groups (p < 0.05). The mean sagittal width of the L-type tear group was 34.95 ± 0.29 mm, which was significantly higher than all other groups (p < 0.05). When the groups were evaluated based on GTA, CSA, and AI data, the mean GTA measurement of the L-type tear group was 73.03 ± 0.95 degrees, which was significantly higher than all other groups (p < 0.05). The mean CSA measurement of the L-type tear group was 34.77 ± 0.66 degrees, which was significantly higher than all other groups (p < 0.05). The mean AI measurement of the L-type tear group was 0.77 ± 0.02, which was significantly higher than all other groups (p < 0.05). When the groups were evaluated based on LAA data, the mean LAA measurement of the L-type tear group was 76.98 ± 1.04 degrees, which was significantly lower than all other groups (p < 0.05). CONCLUSION In our study, especially in L-shaped tears, measurements of GTA, CSA, AI, LAA, coronal and sagittal width were found to be different compared to the control group. These results suggest that shoulder anatomy affects the mechanisms of rotator cuff tear formation and that these parameters play a more significant role in L-shaped tears.
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Affiliation(s)
- Ozgun Karakus
- University of Health Sciences Turkey, Balıkesir Ataturk City Hospital, Balikesir, Turkey.
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Zhao J, Huang H, Zeng L, Pan J, Liu J, Luo M. Acromioplasty combined with arthroscopic rotator cuff repair can reduce the risk of reoperation: a systematic review and meta-analysis. Postgrad Med 2024:1-12. [PMID: 38975648 DOI: 10.1080/00325481.2024.2377533] [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: 03/28/2024] [Accepted: 07/01/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Whether to perform acromioplasty in arthroscopic rotator cuff repair (ARCR) is controversial, and the optimal surgical approach for rotator cuff tear repair is unknown. The purpose of this study was to compare the reoperation rate, retear rate and patient-reported outcomes (PROs) of ARCR with those of ARCR combined with acromioplasty (ARCR-A). METHODS PubMed, Embase and Cochrane Library were searched for relevant literature dated between database inception and 4 December 2023. The primary outcomes of this study were the reoperation rate and the retear rate. The secondary outcomes were PROs, including the visual analogue scale (VAS) pain score, the American Shoulder and Elbow Surgeons (ASES) score, the University of California-Los Angeles (UCLA) score, the Constant score and the Western Ontario Rotator Cuff (WORC) score. The quality of the included studies was evaluated by using the risk of bias assessment tool. RevMan 5.3 software was used for meta-analysis. Fixed (I2 <50%) or random (I2 ≥50%) effects models were applied to calculate the effect size. RESULTS Meta-analysis revealed that ARCR-A had a lower reoperation rate (OR = 0.35, 95%CI: 0.15-0.85, p = 0.02), but the difference in the retear rate between ARCR-A and ARCR was not significant (p = 0.25). In type 2 acromion patients, the reoperation rate was not significantly different between ARCR and ARCR-A (p = 0.12), but, for type 3 acromion patients, the retear rate was lower for ARCR-A than for ARCR (OR = 0.12, 95%CI: 0.01-0.94, p = 0.04). There were statistically significant differences in the 6-month postoperative Constant scores (p < 0.001), VAS pain scores (p = 0.003) 12-month postoperative ASES scores (p = 0.02) and 24-month postoperative WORC scores (p = 0.04), but these differences were not clinically significant. CONCLUSIONS Combining ARCR with acromioplasty can reduce the rate of reoperation, especially in patients with type 3 acromion, but it provides no clinically important change in the retear rate and postoperative PRO compared with ARCR.
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Affiliation(s)
- Jinlong Zhao
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Hetao Huang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Lingfeng Zeng
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
| | - Jianke Pan
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
| | - Jun Liu
- The Research Team on Bone and Joint Degeneration and Injury of Guangdong Provincial Academy of Chinese Medical Sciences, Guangzhou, China
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Second Chinese Medicine Hospital (Guangdong Province Engineering Technology Research Institute of Traditional Chinese Medicine), Guangzhou, China
| | - Minghui Luo
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China
- Guangdong Provincial Hospital of Chinese Medicine, Zhuhai, China
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Yaka H, Erdem TE, Özer M, Kanatli U. Can the presence of SLAP-5 lesions be predicted by using the critical shoulder angle in traumatic anterior shoulder instability? Skeletal Radiol 2024:10.1007/s00256-024-04708-1. [PMID: 38758391 DOI: 10.1007/s00256-024-04708-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/03/2024] [Accepted: 05/12/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE Although SLAP-5 lesions are associated with recurrent dislocations, their causes and pathomechanisms have not been fully elucidated. This study aimed to investigate the association between SLAP-5 lesions and scapular morphology in traumatic anterior shoulder instability (ASI). We hypothesized that there may be a relationship between SLAP-5 lesions and scapular morphology in traumatic ASI patients. MATERIALS AND METHODS The study included 74 patients with isolated Bankart lesions and 69 with SLAP-5 lesions who underwent arthroscopic labral repair for ASI. Critical shoulder angle (CSA) was measured on the roentgenograms, while glenoid inclination (GI) and glenoid version (GV) were measured on magnetic resonance imaging (MRI) by two observers in two separate sessions blinded to each other. Both groups were compared in terms of CSA, GI, and GV. RESULTS The mean ages of Bankart and SLAP-5 patients were 28.4±9.1 and 27.9±7.7 (P=0.89), respectively; their mean CSA values were 33.1°±2.6° and 28.2°±2.4°, respectively (P<0.001). The ROC analysis's cut-off value was 30.5°, with 75.0% sensitivity and 76.7% specificity (AUC = 0.830). SLAP-5 lesions were more common on the dominant side than isolated Bankart lesions (P=0.021), but no difference was found between the groups in terms of GI and GV (P=0.334, P=0.081, respectively). CONCLUSIONS In ASI, low CSA values appeared to be related to SLAP-5 lesions, and the cut-off value of CSA for SLAP lesion formation was 30.5° with 75.0% sensitivity and 76.7% specificity. Scapula morphology may be related to the SLAP-5 lesions, and CSA can be used as an additional parameter in provocative diagnostic tests and medical imaging techniques for the detection of SLAP lesions accompanying Bankart lesions. LEVEL OF EVIDENCE III retrospective case-control study.
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Affiliation(s)
- Haluk Yaka
- Department of Orthopaedics & Traumatology, School of Medicine, Necmettin Erbakan University, Konya, Turkey.
| | - Turgut Emre Erdem
- Department of Orthopaedics & Traumatology, Pazarcık State Hospital, Kahraman Maraş, Turkey
| | - Mustafa Özer
- Department of Orthopaedics & Traumatology, School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ulunay Kanatli
- Department of Orthopaedics & Traumatology, Gazi University School of Medicine, Ankara, Turkey
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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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Salentiny Y, Lassandro N, Karanassos M, Boudard G, Bataille JF, Guignand D, Le Rue O, Moreel P, Navez G, George T, Sarran O, Tournier C, Grenier C, Lafosse T. Clinical and radiological outcome after arthroscopic rotator cuff repair using PEEK-CF anchors. Orthop Traumatol Surg Res 2024; 110:103714. [PMID: 37865235 DOI: 10.1016/j.otsr.2023.103714] [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: 01/27/2022] [Revised: 08/07/2023] [Accepted: 09/05/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE The goal of this study was to evaluate the clinical and radiological outcome after arthroscopic rotator cuff repair using new carbonfiber reinforced polyetheretherketone (CF-PEEK) suture anchors. METHODS One hundred (n=100) patients with rotator cuff tears were enrolled at seven French hospitals between July 2019 and June 2020. Pain levels, Constant score and Subjective Shoulder Value (SSV) were taken preoperatively and 6months postoperatively. Ultrasonography (US) was performed at 6months postoperatively to evaluate tendon healing using the Sugaya classification. Statistical analysis was done with the Student t-test with 95% confidence intervals. RESULTS One hundred patients of the 100 patients were followed at 6months. The mean SSV and Constant score improved from 40.1% preoperatively to 78% at 6months (p<0.0001) and from 43 points preoperatively to 65 points at 6months (p<0.0001), respectively. The mean level of pain, as measured with the visual analogue scale, decreased from 5.9 to 1.6 (p<0.001). There were no postoperative complications that resulted in revision surgery. CONCLUSION The study showed good results at 6months follow-up using carbonfiber reinforced PEEK anchors with improved Constant and SSV scores as well as a high ultrasonographic tendon healing rate, making PEEK-CF anchors safe to use, comparable to commonly used anchors. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Yves Salentiny
- Alps Surgery Institute, Clinique Générale, Annecy, France.
| | - Nunzio Lassandro
- Department of Orthopedics and Trauma, University of Verona, Verona, Italy
| | - Marinos Karanassos
- Orthopaedics and Trauma Surgery, Military General Hospital, Thessaloniki, Greece
| | | | | | | | - Olivier Le Rue
- Cabinet médical de Marcq-en-Baroeul, Marcq-en-Baroeul, France
| | - Philippe Moreel
- Institut de Chirurgie Orthopédique de Provence, Aix-en-Provence, France
| | | | | | | | | | | | - Thibault Lafosse
- Alps Surgery Institute, Hand, Upper Limb, Brachial Plexus, and Microsurgery Unit (PBMA), Clinique Générale, Annecy, France
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Can FI, Gültaç E, Yilmaz S, Kilinç RM, Kilinç CY. The Association between SLAP Lesions and Critical Shoulder Angle and Glenoid Depth. ACTA CHIRURGIAE ORTHOPAEDICAE ET TRAUMATOLOGIAE CECHOSLOVACA 2024; 91:57-61. [PMID: 38447566 DOI: 10.55095/achot2024/007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
PURPOSE OF THE STUDY The critical shoulder angle (CSA) is formed by the combination of glenoid inclination and acromial index and has been shown related to rotator cuff tears and glenohumeral osteoarthritis. SLAP lesions today have an important place among bicipitolabral pathologies that cause intensive shoulder pain. We aimed to investigate the relationship between CSA and glenoid depth and SLAP lesions. MATERIAL AND METHODS Between March 2017 and January 2022, 279 consecutive shoulder arthroscopy patients' MRI images were retrospectively examined. After the exclusion criteria, 191 patients were eligible. Patients with SLAP lesions (n=37) were assembled as the study group (Group 1), and patients with intact superior labrum (n=154) were named as the control group (Group 2). Critical shoulder angle (CSA) and glenoid depth measurements were performed using the preoperative MRI images. RESULTS A total of 191 patients, of whom 84 were male (44%) were included. The mean age was 49.9±14.96 (range 18-79). There was a statistically signifi cant difference between the SLAP group (Group 1) and the control group (Group 2) in terms of CSA (p=0.032). The mean CSA was 31.66°±3.51° in Group 1 and 33.57° ±5.01° in Group 2. The cut-off value for CSA in patients with SLAP lesions was calculated as 32.85° and the area under the curve was 0.61, therefore a satisfactory association was observed between the groups. The mean glenoid depth was 4.32 ±1.25 mm in Group 1, and 4.39 ±0.32 mm in Group 2. There was no statistically signifi cant difference between the groups in terms of glenoid depth (p=0.136) and also no association between the glenoid depth and SLAP lesions was observed (cut-off=4.45 mm, AUC=0.32). CONCLUSIONS Low CSA is associated with SLAP lesions, just as in glenohumeral osteoarthritis. Further prospective clinical studies are needed to enlighten the predisposing effect of CSA to SLAP lesions and the success of superior labral repairs. LEVEL OF EVIDENCE Retrospective comparative study, Level III.
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Affiliation(s)
- F I Can
- Muğla Research and Training Hospital, Orthopedics and Traumatology Clinic, Mugla, Turkey
| | - E Gültaç
- Department of Orthopedics and Traumatology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - S Yilmaz
- Muğla Research and Training Hospital, Orthopedics and Traumatology Clinic, Mugla, Turkey
| | - R M Kilinç
- Department of Radiology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - C Y Kilinç
- Department of Orthopedics and Traumatology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
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Brandariz R, Charbonnier C, Culebras Almeida A, Lädermann A, Cunningham G. The role of bone morphology of the greater tuberosity and lateral acromion on subacromial space during scaption: a three-dimensional dynamic simulation analysis. BMC Musculoskelet Disord 2023; 24:888. [PMID: 37968608 PMCID: PMC10647087 DOI: 10.1186/s12891-023-06957-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 10/12/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND The bone morphology of the greater tuberosity and lateral acromion plays a central role in subacromial impingement syndrome. The critical shoulder angle (CSA) and greater tuberosity angle (GTA) are two-dimensional measurement parameters that have been validated to evaluate it radiologically. These markers are, however, static and don't consider the dynamic effect of glenohumeral motion. OBJECTIVES This study aimed to better understand the biomechanics in subacromial impingement with a dynamic simulation based on a validated 3D biomechanical model coupling joint kinematics and 3D reconstructed computed tomography. STUDY DESIGN & METHODS Sixty-one patients were included in this study: a case group of 44 patients with degenerative rotator cuff tears involving only the supraspinatus, and a control group of 17 without a rotator cuff tear. Patients with previous surgeries, traumatic cuff tears, and cuff tear arthropathy were excluded. CSA, GTA, and impingement-free range of motion (IF-ROM) of the glenohumeral joint in scaption were calculated. Correlation tests were used to determine the relationship between ROM and CSA, GTA, and combined CSA and GTA values. RESULTS CSA and GTA were significantly higher in the rotator cuff tear group (p = 0.001 and < 0.001), while IF-ROM was significantly higher in the control group (p = 0.001). There was no overall correlation between CSA and GTA (R = 0.02, p = 0.8). Individual correlation between both angles with IF-ROM was negatively weak for CSA (R = -0.4, p < 0.001) and negatively moderate for GTA and IF-ROM (R = -0.5, p < 0.001). However, combining both angles resulted in a negatively high correlation with IF-ROM (R = -0.7, p < 0.001). CONCLUSION Subacromial space narrowing during scaption is highly correlated to the cumulative values of GTA and CSA. These findings suggest that the combined bony morphology of the lateral acromion and greater tuberosity plays an important role in subacromial impingement. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Caecilia Charbonnier
- Medical Research Department, Artanim Foundation, Meyrin, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Alejandro Culebras Almeida
- Shoulder and Elbow Center La Colline, Geneva, Switzerland
- Department of Orthopaedics and Traumatology, Réseau Hospitalier Neuchâtelois, Neuchâtel, Switzerland
| | - Alexandre Lädermann
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Gregory Cunningham
- Shoulder and Elbow Center La Colline, Geneva, Switzerland.
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
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Chen H. Application progress of artificial intelligence and augmented reality in orthopaedic arthroscopy surgery. J Orthop Surg Res 2023; 18:775. [PMID: 37838695 PMCID: PMC10576364 DOI: 10.1186/s13018-023-04280-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/11/2023] [Indexed: 10/16/2023] Open
Abstract
In today's rapidly developing technological era, the technological revolution triggered by the rapid iteration of artificial intelligence and augmented reality has provided brand-new digital intelligent empowerment for orthopaedic clinical operation. Although traditional arthroscopy has been widely promoted globally due to its advantages such as minimally invasive, safety and early functional exercise, it still has deficiencies in precision and personalization. The assistance of artificial intelligence and augmented reality enables precise positioning and navigation in arthroscopic surgery, as well as personalized operations based on patient conditions, which lifts the objective limitations of traditional sports medicine surgery. The integration of artificial intelligence and augmented reality with orthopaedic arthroscopy surgery is still in infancy, even though there are still some insufficient to be solved, but its prospect is bright.
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Affiliation(s)
- Haojie Chen
- Department of Orthopaedics, The First People's Hospital of Xiaoshan District, No. 199, Shixin South Road, Chengxiang Street, Xiaoshan District, Hangzhou, China.
- Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China.
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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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Ma Q, Sun C, Gao H, Cai X. The combined utilization of predictors seems more suitable to diagnose and predict rotator cuff tears. BMC Musculoskelet Disord 2022; 23:1013. [PMID: 36434626 PMCID: PMC9701010 DOI: 10.1186/s12891-022-05986-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Morphological markers presenting the lateral extension of acromion and the greater tuberosity of humerus were proposed to diagnose and predict rotator cuff tears (RCTs) in recent years, but few studies have addressed the combined performance when using two predictors together. As a presence of a RCT may be associated with the impingement caused by both acromion and the greater tuberosity, we believe a combined utilization of predictors could result in a better diagnostic and predictive performance than using a single predictor. The aim of this study is to (i) explore whether the combination is more efficient to predict and diagnose RCTs; (ii) find out which combination is the most superior screening approach for RCTs. METHODS This was a retrospective study and patients who visited our hospital and were diagnosed with or without partial-thickness or full-thickness RCTs via magnetic resonance imaging from January 2018 to April 2022 were enrolled and classified into two groups respectively. Four predictors, the critical shoulder angle (CSA), the acromion index (AI), the greater tuberosity angle (GTA) and the double-circle radius ratio (DRR) were picked to participate in the present study. Quantitative variables were compared by independent samples t tests and qualitative variables were compared by chi-square tests. Binary logistic regression analysis was used to construct discriminating combined models to further diagnose and predict RCTs. Receiver operating characteristic (ROC) curves were pictured to determine the overall diagnostic performance of the involved predictors and the combined models. RESULTS One hundred and thirty-nine shoulders with RCTs and 57 shoulders without RCTs were included. The mean values of CSA (35.36 ± 4.57 versus 31.41 ± 4.09°, P < 0.001), AI (0.69 ± 0.08 versus 0.63 ± 0.08, P < 0.001), DRR (1.43 ± 0.10 versus 1.31 ± 0.08, P < 0.001) and GTA (70.15 ± 7.38 versus 64.75 ± 7.91°, P < 0.001) were significantly higher in the RCT group than for controls. Via ROC curves, we found the combined model always showed a better diagnostic performance than either of its contributors. Via logistic regression analysis, we found the values of both predictors over their cutoff values resulted in an increasement (20.169-161.214 folds) in the risk of having a RCT, which is more than that by using a single predictor only (2.815 -11.191 folds). CONCLUSION The combined utilization of predictors is a better approach to diagnose and predict RCTs than using a single predictor, and CSA together with DRR present the strongest detectability for a presence of RCTs.
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Affiliation(s)
- Qi Ma
- grid.12527.330000 0001 0662 3178Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168, Litang Road, Changping District, Beijing, 102218 China ,Beijing MEDERA Medical Group, Beijing, China
| | - Changjiao Sun
- grid.12527.330000 0001 0662 3178Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168, Litang Road, Changping District, Beijing, 102218 China
| | - Hong Gao
- grid.12527.330000 0001 0662 3178Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168, Litang Road, Changping District, Beijing, 102218 China ,Beijing MEDERA Medical Group, Beijing, China
| | - Xu Cai
- grid.12527.330000 0001 0662 3178Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168, Litang Road, Changping District, Beijing, 102218 China ,Beijing MEDERA Medical Group, Beijing, China
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Computer Image-Guided Precise Acromioplasty for Reducing the Critical Shoulder Angle. Arthrosc Tech 2022; 11:e1863-e1869. [PMID: 36457394 PMCID: PMC9705271 DOI: 10.1016/j.eats.2022.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/27/2022] [Indexed: 11/21/2022] Open
Abstract
The shoulders with critical shoulder angle (CSA) of greater than 33-35° are associated with rotator cuff tears, whereas a CSA of less than 30° is likely to be osteoarthritic. However, anterior acromioplasty or lateral acromioplasty could not reduce high CSAs to the desired range (30-33°), with satisfactory accuracy and efficacy. Thus, we introduce a computer image-guided precise acromioplasty (CIG-PAP) technique, an individualized treatment based on three-dimensional planning. We believe that the introduction of this technique will provide an alternative approach to reduce a large CSA to the desired range (30-33°).
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