Higher Critical Shoulder Angle and Acromion Index Are Associated With Increased Retear Risk After Isolated Supraspinatus Tendon Repair at Short-Term Follow Up

Abstract Purpose The critical shoulder angle (CSA) and the acromion index (AI) are measurements of acromial shape reported as predictors of degenerative rotator cuff tears (RCT) and glenohumeral osteoarthritis (GH OA). Whether they are the cause or effect of shoulder pathologies is uncertain since pre-morbid radiographs most often are lacking. The main aim of this study was to investigate if CSA or AI were related to the development of RCT or GH OA after 20 years. A secondary aim was to investigate if the CSA and AI had changed over time. Methods In the hospital archive, 273 preoperative plain shoulder radiographs were found of patients scheduled for elective surgery other than cuff repair and arthroplasty. Forty-five images fulfilled the strict criteria published by Suter and Henninger (2015) and were used to measure CSA and AI with two independent assessors. No patient had any sign of OA in the index radiographs or any information in the medical records indicating RCT. After a median of 20 (16–22) years, 30 of these patients were radiologically re-examined with bilateral true frontal views and ultrasound of the rotator cuff. There were 19 men (20 study shoulders) and 11 females (12 study shoulders). Results Mean age at follow-up was 56 (32–78) years. There was no correlation between CSA (r = 0.02) (n.s) or AI (r = − 0.13) (n.s) in the primary radiographs and OA at follow-up. Nor was any correlation found between index CSA (r = 0.12) (n.s) or AI (r = − 0.13) (n.s) and RCT at follow-up. Mean difference in CSA was − 1.7 (− 10–3) degrees and mean AI difference was − 0.04 (− 0.13–0.09) between the first and the second radiographs, 20 years later. Bilaterally, mean CSA was 32 and AI 0.61 at follow-up. Conclusion In this study, no correlation between the CSA, AI and development of OA or RCT could be found. The mean CSA and AI decreased over a 20-year period but the difference was very small. No difference was found between the study shoulders and the contralaterals. These findings question previously reported etiological associations between scapular anatomy and the development of OA or RCT and thereby the use of these calculations as the basis of treatment. Level of evidence III.

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Radiographic shoulder parameters and their relationship to outcomes following rotator cuff repair: a systematic review

Shoulder & Elbow ◽

10.1177/1758573219895987 ◽

2020 ◽

pp. 175857321989598

Author(s):

Musa B Zaid ◽

Nathan M Young ◽

Valentina Pedoia ◽

Brian T Feeley ◽

C Benjamin Ma ◽

...

Keyword(s):

Systematic Review ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

Patient Reported Outcomes ◽

Critical Shoulder Angle ◽

Patient Reported ◽

Acromion Index ◽

Bony Morphology ◽

Cuff Repair ◽

Shoulder Angle

Background Anatomic parameters, such as the critical shoulder angle and acromion index, have emerged as methods to quantify scapular anatomy and may contribute to rotator cuff pathology. The purpose of this paper is to investigate the published literature on influences of scapular morphology on the development of re-tears and patient-reported outcomes following rotator cuff repair. Methods A systematic review of the Embase and PubMed databases was performed to identify published studies on the potential influence of scapular bony morphology and re-tear rates and patient-reported outcomes after rotator cuff repair. Studies were reviewed by two authors. Results A total of 615 unique titles and 49 potentially relevant abstracts were reviewed, with eight published manuscripts identified for inclusion. Two of three papers reported no relationship between these acromion index and rotator cuff re-tear rate, while one paper found an increased re-tear rate. All three studies on critical shoulder angle found a significant association between critical shoulder angle and cuff re-tear rate. There was no clear relationship between any bony morphologic measurement and patient-reported outcomes after rotator cuff repair. Conclusions Rotator cuff re-tear rate appears to be significantly associated with the critical shoulder angle and glenoid inclination, while not clearly associated with acromial morphologic measurements.

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Lateral acromioplasty for correction of the critical shoulder angle

Obere Extremität ◽

10.1007/s11678-020-00578-w ◽

2020 ◽

Vol 15 (3) ◽

pp. 228-232

Author(s):

Mark Tauber ◽

Peter Habermeyer ◽

Nikolaus Zumbansen ◽

Frank Martetschläger

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Constant Score ◽

Logical Consequence ◽

Clinical Results ◽

Rotator Cuff Tears ◽

Critical Shoulder Angle ◽

Cuff Repair ◽

Shoulder Angle

Abstract The critical shoulder angle (CSA) was introduced as a radiological parameter associated with a higher incidence of rotator cuff tears. As a logical consequence, correcting the CSA together with rotator cuff repair should prevent re-tear and provide reliable and good clinical results. We present an all-arthroscopic technique resecting the lateral edge of the acromion (lateral acromioplasty) in order to reduce and correct the CSA after preoperative planning. Preliminary results from 20 patients with an average age of 62 years after rotator cuff repair are reported showing good clinical outcome with a Constant score of 88 points and no re-tear after an average follow-up of 16 months. The CSA was reduced from 39.7° to 32.1°. Previous concerns regarding weakening of the deltoid origin were not confirmed and there were no complications linked to lateral acromioplasty.

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Glenoid component loosening associated with increased critical shoulder angle at midterm follow-up

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2017.10.002 ◽

2018 ◽

Vol 27 (3) ◽

pp. 449-454 ◽

Cited By ~ 10

Author(s):

Jonathan P. Watling ◽

Javier E. Sanchez ◽

Samuel P. Heilbroner ◽

William N. Levine ◽

Louis U. Bigliani ◽

...

Keyword(s):

Glenoid Component ◽

Critical Shoulder Angle ◽

Component Loosening ◽

Shoulder Angle

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Supraspinatus tendon load during abduction is dependent on the size of the critical shoulder angle: A biomechanical analysis

Journal of Orthopaedic Research® ◽

10.1002/jor.22621 ◽

2014 ◽

Vol 32 (7) ◽

pp. 952-957 ◽

Cited By ~ 99

Author(s):

Christian Gerber ◽

Jess G. Snedeker ◽

Daniel Baumgartner ◽

Arnd F. Viehöfer

Keyword(s):

Supraspinatus Tendon ◽

Biomechanical Analysis ◽

Critical Shoulder Angle ◽

Shoulder Angle

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Does the critical shoulder angle decrease after acromioplasty? A systematic review and meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-022-02927-7 ◽

2022 ◽

Vol 17 (1) ◽

Author(s):

Mingtao Zhang ◽

Zhitao Yang ◽

Borong Zhang ◽

Tao Liu ◽

Jin Jiang ◽

...

Keyword(s):

Meta Analysis ◽

Case Series ◽

Patient Characteristics ◽

Rotator Cuff Tears ◽

Cochrane Library ◽

Shoulder Injuries ◽

Critical Shoulder Angle ◽

The Mean ◽

Shoulder Angle

Abstract Background Rotator cuff tears are one of the most common shoulder injuries in the older population. This study aimed to determine whether acromioplasty reliably decreases the critical shoulder angle (CSA) and describe any associated complications. Methods A systematic literature review was performed according to PRISMA guidelines using PubMed, EMBASE, Web of Science, and Cochrane Library Database. Two reviewers independently screened the titles and abstracts using prespecified criteria. Studies where the acromioplasty was performed as a surgical procedure were included. Patient characteristics and degree of CSA reduction were collected from each individual study. All statistical analyses were performed using Review Manager (RevMan) 5.4.1 software. A random-effects model was used for meta-analysis. Results A total of 9 studies involving 1236 patients were included in the meta-analysis. The age of patients ranged from 23 to 82 years. The follow-up period ranged from 12 to 30 months. Of the 9 studies, 8 (88.9%) were retrospective, 1 (11.1%) was prospective, 5 were comparative, and 4 were case series. The mean CSA was significantly reduced from 36.1° ± 4.6° to 33.7° ± 4.2 (p < 0.05). The meta-analysis showed an overall best estimate of the mean difference in pre- and postoperative CSA equal to 2.63° (95% confidence interval: 2.15, 3.11] (p < 0.00001). Conclusions Acromioplasty can significantly reduce CSA, notably in cases of high preoperative CSA. In addition, the effect of lateral acromioplasty on the CSA was more significant compared to anterolateral acromioplasty. Acromioplasty was not associated with complications during the short-term follow-up.

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