Neither Critical Shoulder Angle Nor Acromion Index Were Related with Specific Pathology 20 Years Later!

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.

Download Full-text

Higher coracoacromial ligament thickness, critical shoulder angle and acromion index are associated with rotator cuff tears in patients who undergo arthroscopic rotator cuff repair

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2021.05.057 ◽

2021 ◽

Author(s):

Mustafa A. İncesoy ◽

Ahmet Kulduk ◽

Kadir İ. Yıldız ◽

Abdulhamit Misir

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Arthroscopic Rotator Cuff Repair ◽

Rotator Cuff Tears ◽

Coracoacromial Ligament ◽

Critical Shoulder Angle ◽

Arthroscopic Rotator Cuff ◽

Acromion Index ◽

Cuff Repair ◽

Shoulder Angle

Download Full-text

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.

Download Full-text

The Effectiveness of Using the Critical Shoulder Angle and Acromion Index for Predicting Rotator Cuff Tears: Accurate Diagnosis Based on Standard and Nonstandard Anteroposterior Radiographs

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2019.03.050 ◽

2019 ◽

Vol 35 (9) ◽

pp. 2553-2561 ◽

Cited By ~ 5

Author(s):

Yiyong Tang ◽

Jingyi Hou ◽

Qingyue Li ◽

Fangqi Li ◽

Congda Zhang ◽

...

Keyword(s):

Rotator Cuff ◽

Accurate Diagnosis ◽

Rotator Cuff Tears ◽

Critical Shoulder Angle ◽

Acromion Index ◽

Shoulder Angle

Download Full-text

Correlation of Multiple Acromion Morphological Parameters on Radiographs in a Geriatric Chinese Population and Its Clinical Significance

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211043990 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110439

Author(s):

Mingyang Yu ◽

Xiaoming Zhu ◽

Yao Zhang ◽

Lin Guo ◽

Dongyi Li ◽

...

Keyword(s):

Rotator Cuff ◽

Linear Relationship ◽

Chinese Population ◽

Geriatric Patients ◽

Rotator Cuff Tears ◽

Critical Shoulder Angle ◽

The Mean ◽

Acromion Index ◽

Healthy Participants ◽

Shoulder Angle

Introduction Previous clinical studies have reported associations between the acromion index, lateral acromion angle, and critical shoulder angle and the occurrence of rotator cuff tears. The objective of this study was to analyze the correlations of these different anatomic parameters in geriatric Chinese Population. Methods Healthy geriatric Chinese participants (n = 66) and geriatric Chinese patients with rotator cuff tears (n = 70) identified between January 2019 and October 2020 were included in this study. Standardized true anteroposterior radiographs were used to measure the acromion index, lateral acromion angle, and critical shoulder angle in each study participant. Results The mean acromion index was significantly larger, the mean lateral acromion angle was significantly smaller, and the mean critical shoulder angle was significantly larger in geriatric patients with full-thickness rotator cuff tears compared with geriatric healthy participants. Conclusion There were a negative linear relationship between the acromion index and lateral acromion angle and a positive linear relationship between the acromion index and critical shoulder angle in geriatric patients with rotator cuff tear and geriatric healthy participants; we termed this phenomenon “Hypothesis of Acromion Index.” The acromion index, lateral acromion angle, and critical shoulder angle are independent predictors of rotator cuff tears in a geriatric Chinese population.

Download Full-text