The Critical Shoulder Angle Shows a Reciprocal Change in Magnitude When Evaluating Symptomatic Full-Thickness Rotator Cuff Tears Versus Primary Glenohumeral Osteoarthritis as Compared With Control Subjects: A Systematic Review and Meta-analysis

2020 ◽  
Vol 36 (2) ◽  
pp. 566-575 ◽  
Author(s):  
Geoffrey C.S. Smith ◽  
Victor Liu ◽  
Patrick H. Lam
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Meta Analysis ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Critical Shoulder Angle ◽  
Control Subjects ◽  
Glenohumeral Osteoarthritis ◽  
Shoulder Angle ◽  
Reciprocal Change

Critical shoulder angle is associated with full-thickness rotator cuff tears in patients with glenohumeral osteoarthritis

2017 ◽  
Vol 26 (12) ◽  
pp. e376-e381 ◽  
Author(s):  
Matthew T. Mantell ◽  
Ryan Nelson ◽  
Jeremiah T. Lowe ◽  
Donald P. Endrizzi ◽  
Andrew Jawa
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Critical Shoulder Angle ◽  
Glenohumeral Osteoarthritis ◽  
Shoulder Angle

Critical shoulder angle is an effective radiographic parameter that is associated with rotator cuff tears and osteoarthritis: a systematic review

2019 ◽  
Vol 4 (2) ◽  
pp. 113-120
Author(s):  
Gabriel Kuper ◽  
Ajaykumar Shanmugaraj ◽  
Nolan S Horner ◽  
Seper Ekhtiari ◽  
Nicole Simunovic ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Predictive Value ◽  
Rotator Cuff Tears ◽  
Radiographic Parameter ◽  
Rater Reliability ◽  
Critical Shoulder Angle ◽  
Patient Reported ◽  
Shoulder Angle ◽  
Shoulder Pathologies

ImportanceThe critical shoulder angle (CSA) is a relatively new radiographic parameter correlated with pathologies such as rotator cuff tears and osteoarthritis.ObjectiveThe purpose of this systematic review was to: (1) determine the degree of correlation between the CSA and shoulder pathologies, (2) determine the reliability of measuring CSA between (inter-rater reliability) and within (intrarater reliability) clinicians, (3) assess the accuracy of different imaging modalities used for measuring the CSA and (4) determine the association of CSA with patient outcomes after surgery.Evidence reviewThe electronic databases MEDLINE, EMBASE and PubMed were searched in March 2018 for relevant studies. The results are presented in a narrative summary.FindingsA total of 26 studies and 4563 patients satisfied the inclusion criteria. The majority of CSAs were measured using radiographs (98.2%) in neutral rotation (72.9%). Significant associations (p<0.05) were found between lower CSAs (<30°) and osteoarthritis, and higher CSAs (>35°) with primary rotator cuff tears and the risk of re-tear following a repair. The CSA has excellent intrarater (intraclass correlation coefficient (ICC) 0.903 to 0.996) and inter-rater reliability (ICC 0.869 to 0.980) when measured with radiographs. High variability in measurements was found when using MRI. The CSA, however, is not a clear, significant independent predictor (p>0.05) of outcomes after the surgical management of shoulder pathologies.Conclusions and relevanceThe CSA is an effective radiographic parameter that is associated with rotator cuff tears and osteoarthritis. Lower CSAs (<30°) are associated with osteoarthritis, whereas higher CSAs (>35°) are associated with primary rotator cuff tears and re-tear after arthroscopic repair. Currently, there is a limited predictive value of the CSA in patient-reported outcomes after rotator cuff repair. The CSA is measured with high intrarater and inter-rater reliability for both radiographs and CT scans. Measuring the CSA using radiographs with the arm in the neutral rotation is currently recommended. Future studies are required to further investigate how best use the CSA to guide patient management and its predictive value.Level of evidenceIV.

scholarly journals The Natural History of Full-Thickness Rotator Cuff Tears in Randomized Controlled Trials: A Systematic Review and Meta-analysis

2018 ◽  
Vol 47 (7) ◽  
pp. 1734-1743 ◽  
Author(s):  
Chetan Khatri ◽  
Imran Ahmed ◽  
Helen Parsons ◽  
Nicholas A. Smith ◽  
Thomas M. Lawrence ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Natural History ◽  
Treatment Response ◽  
Meta Analysis ◽  
Rotator Cuff Tears ◽  
Controlled Trials ◽  
Full Thickness ◽  
Randomized Controlled ◽  
History Of

Background: Rotator cuff tears are the most common tendon injury in the adult population, resulting in substantial morbidity. The optimum management for these patients is not known. Purpose: To assess the overall treatment response to all interventions in full-thickness rotator cuff tears among patients enrolled in randomized clinical trials. Study Design: Systematic review and meta-analysis. Methods: Randomized controlled trials (RCTs) were identified from a systematic search of Medline, Embase, CINHAL, and the Cochrane Central Register of Controlled Trials. Patients were aged ≥18 years with a full-thickness rotator cuff tear. The primary outcome measure was change in Constant shoulder score from baseline to 52 weeks. A meta-analysis to assess treatment response was calculated via the standardized mean change in scores. Results: A total of 57 RCTs were included. The pooled standardized mean change as compared with baseline was 1.42 (95% CI, 0.80-2.04) at 3 months, 2.73 (95% CI, 1.06-4.40) at 6 months, and 3.18 (95% CI, 1.64-4.71) at 12 months. Graphic plots of treatment response demonstrated a sustained improvement in outcomes in nonoperative trial arms and all operative subgroup arms. Conclusion: Patients with full-thickness rotator cuff tears demonstrated a consistent pattern of improvement in Constant score with nonoperative and operative care. The natural history of patients with rotator cuff tears included in RCTs is to improve over time, whether treated operatively or nonoperatively.

scholarly journals Neither critical shoulder angle nor acromion index were related with specific pathology 20 years later!

2021 ◽  
Author(s):  
Hanna C. Björnsson Hallgren ◽  
Lars Adolfsson
Keyword(s):  
Rotator Cuff ◽  
Elective Surgery ◽  
Rotator Cuff Tears ◽  
Level Of Evidence ◽  
Critical Shoulder Angle ◽  
Glenohumeral Osteoarthritis ◽  
The Difference ◽  
Acromion Index ◽  
Shoulder Angle

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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