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

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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Short-Term Outcomes of the Grammont Reverse Shoulder Arthroplasty: Comparison between First and Second Generation Delta Prosthesis

Joints ◽

10.1055/s-0041-1731010 ◽

2021 ◽

Author(s):

Riccardo Luigi Alberio ◽

Marco Landrino ◽

Paolo Fornara ◽

Federico Alberto Grassi

Keyword(s):

Shoulder Arthroplasty ◽

Second Generation ◽

Reverse Shoulder Arthroplasty ◽

Total Shoulder Arthroplasty ◽

Radiographic Evaluation ◽

Glenoid Component ◽

Consecutive Series ◽

Short Term ◽

Component Loosening

Abstract Purpose This article compares short-term outcomes of two series of patients, who underwent reverse total shoulder arthroplasty (RTSA) with two different implants, both based on Grammont's principles: the Delta III (D-3) and the Delta Xtend (D-XT) prostheses. Methods The D-3 group included a consecutive series of 26 patients (mean age 75 years), that were treated between 2000 and 2006; the D-XT group included a consecutive series of 31 patients (mean age 72.5 years), for a total of 33 implants performed between 2011 and 2015. In both groups the most common diagnoses were cuff tear arthropathy (18 and 22 shoulders, respectively) and malunion of proximal humerus fractures (3 and 5). All procedures were performed by the same surgeon. Constant–Murley score (CMS) was used to assess clinical and functional outcomes. Radiographic evaluation included the true anteroposterior and axillary views. Results Twenty-three patients of the D-3 group and 22 patients (24 shoulders) of the D-XT group were evaluated at a mean follow-up of 42 months (range 26–84) and 44 months (range 26–66), respectively. Four complications occurred in the D-3 group (1 partial deltoid detachment, 1 dislocation, and 2 glenoid component loosening), while one early postoperative infection occurred in the D-XT group. Increases in elevation and CMS between preoperative and postoperative period were observed in both groups; only the D-XT group showed a slight improvement in rotations. The incidence of scapular notching was significantly different between the two groups: 100% for D-3 and 22.2% for D-XT in patients with a minimum follow-up of 5 years. Conclusion Prosthetic design evolution and greater acquaintance with this surgery have undoubtedly led to an improvement in short-term outcomes with second generation implants of RTSA. Future studies will have to ascertain whether newer implants, relying on biomechanical solutions alternative to Grammont's original concept, might provide additional advantages and minimize drawbacks.

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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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Higher Critical Shoulder Angle has an Increased Risk of Re-Tear After Arthroscopic Rotator Cuff Repair At Long Term Follow-Up

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2021.03.074 ◽

2021 ◽

Vol 30 (7) ◽

pp. e447

Author(s):

Kadir Büyükdogan ◽

Özgür Koyuncu ◽

Lercan Aslan ◽

Olgar Birsel ◽

Ilker Eren ◽

...

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Critical Shoulder Angle ◽

Increased Risk ◽

Long Term Follow Up ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair ◽

Shoulder Angle

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The Effect of Critical Shoulder Angle on Clinical Scores and Retear Risk After Rotator Cuff Tendon Repair at Short-term Follow Up

Scientific Reports ◽

10.1038/s41598-019-48644-w ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Tahsin Gürpınar ◽

Barış Polat ◽

Engin Çarkçı ◽

Murat Eren ◽

Ayşe Esin Polat ◽

...

Keyword(s):

Rotator Cuff ◽

Tendon Repair ◽

Short Term ◽

Rotator Cuff Tendon ◽

Critical Shoulder Angle ◽

Clinical Scores ◽

Shoulder Angle

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

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-021-06602-y ◽

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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Associations between radiographic parameters in the reverse shoulder arthroplasty and patient outcomes

Shoulder & Elbow ◽

10.1177/17585732211057887 ◽

2021 ◽

pp. 175857322110578

Author(s):

Ahmed Maksoud ◽

Colin Steinlechner ◽

Cheryl Baldwick ◽

William Tabi

Keyword(s):

Patient Outcomes ◽

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Scapular Notching ◽

Critical Shoulder Angle ◽

Radiological Parameters ◽

Predictive Parameters ◽

The Relationship ◽

Shoulder Angle

Background Various radiological parameters have been measured in the Reverse Shoulder Arthroplasty (RSA) and correlated to patient outcomes, to determine best baseplate position. Results remain unclear with respect to certain parameters such as inferior baseplate tilt. We have investigated our series of patients to clarify the relationship between radiological parameters and patient outcomes. Methods We conducted a UK based bi-centre retrospective review of 156 prostheses. Critical shoulder angle (CSA), RSA angle (RSAA), Overhang and Deltoid Lever Arm (DLA) were measured on preoperative and postoperative radiographs. Range of motion and Oxford Shoulder Score (OSS) (range 1–8 years) were obtained. We assessed for scapular notching at minimum 1 year follow up (n = 138). Results Decreased postoperative CSA and increased DLA were associated with higher OSSs (P = 0.001 and 0.019). Increased overhang and DLA were associated with increased flexion (P = 0.033 and 0.024 respectively). Multivariate analysis showed that CSA and DLA affected notching rate (P = 0.002 and 0.007). Conclusions Baseplate tilt in relation to the acromion (CSA) and DLA are the most predictive parameters for notching and OSS. We recommend considering a maximum CSA of 26 degrees to decrease notching rate and improve OSS. We recommend considering an Overhang of at least 6 mm to improve FF.

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Lateral Acromioplasty has a Positive Impact on Rotator Cuff Repair in Patients with a Critical Shoulder Angle Greater than 35 Degrees

Journal of Clinical Medicine ◽

10.3390/jcm9123950 ◽

2020 ◽

Vol 9 (12) ◽

pp. 3950

Author(s):

Edoardo Franceschetti ◽

Edoardo Giovannetti de Sanctis ◽

Alessio Palumbo ◽

Riccardo Ranieri ◽

Paola Casti ◽

...

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tears ◽

Mathematical Formula ◽

Plain Radiographs ◽

Critical Shoulder Angle ◽

Group A ◽

Cuff Repair ◽

Shoulder Angle ◽

Massive Tears

Background: A Critical Shoulder Angle (CSA), evaluated on plain radiographs, greater than 35° is considered predictive of rotator cuff tears. The present prospective comparative study aimed, firstly, to develop a formula to calculate the amount of acromion that should be resected performing a lateral acromioplasty and, secondly, verify whether lateral acromioplasty to reduce the CSA associated with arthroscopic cuff repair decreased the rate of recurrence of the tears, and impacted favorably on clinical postoperative outcomes. Methods: Patients undergoing arthroscopic rotator cuff repair (RCR) for rotator cuff tears with a CSA greater than 35° were included in this study and divided into two groups, based on whether the CSA had been reduced by arthroscopic resection of the lateral portion of the acromion. A new mathematical formula was developed in order to quantify the amount of bone to be resected while performing the lateral acromioplasty. Patients with traumatic tears, previous surgery, osteoarthritis or plain radiographs, not classified as A1 according to Suter-Henninger, were excluded. Clinical and radiographic outcomes were assessed at a minimum of 2 years of follow-up considering the tear size. Results: 289 patients were included in this study. Thirty-seven were lost to follow-up. Group A (Lateral acromioplasty) patients included: 38 small tears, 30 medium tears, 28 large tears and 22 massive tears; Group B (control group) was composed of 40 small tears, 30 medium tears, 30 large tears and 23 massive tears. The Constants Score value and retear Rate were, respectively, significant higher (p = 0.007 and p = 0.004) and lower (p = 0.029 and p = 0.028) in Group A, both in the Small-and Medium-size subgroups. No complications were outlined. The mediolateral width of the acromion was reduced, according to the preoperatively calculated measure. Conclusion: Arthroscopic lateral acromioplasty decreased the CSA within the favorable range (30°–35°) in all patients treated, resecting the amount of bone predicted by the mathematical formula. Lateral acromioplasty is a safe and reproducible technique which may prevent recurrence of rotator cuff tears in patients with small and medium lesions. Level of evidence: II.

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