scholarly journals Correlation of Multiple Acromion Morphological Parameters on Radiographs in a Chinese Population

2020 ◽  
Author(s):  
Mingyang Yu ◽  
Xiaoming Zhu ◽  
Shilong Zhao ◽  
Ailing De ◽  
Yao Zhang ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Linear Relationship ◽  
Chinese Population ◽  
Study Participant ◽  
Chinese Patients ◽  
Rotator Cuff Tears ◽  
The Mean ◽  
Acromion Index ◽  
Healthy Participants ◽  
Shoulder Angle

Abstract Background Previous clinical studies have reported associations between the acromion index (AI), lateral acromion angle (LAA), and critical shoulder angle (CSA) and the occurrence of rotator cuff tears. The objective of this study was to analyze the correlations of these different anatomic parameters. Materials and Methods Healthy Chinese participants ( n = 66) and Chinese patients with rotator cuff tears ( n = 70) identified between January 2014 and October 2015 were included in this study. Standardized true anteroposterior radiographs were used to measure the AI, LAA, and CSA in each study participant. Results The mean AI was significantly larger (0.71 standard deviation [SD], 0.05; range 0.58–0.89 vs. 0.64 SD, 0.06; range 0.55–0.78; P < 0.001), the mean LAA was significantly smaller (77.0° SD, 5.73; range 61.0°–94.5° vs. 82.0° SD, 7.33; range 67.6°–98.3°; P < 0.001), and the mean CSA was significantly larger (36.1° SD, 5.29; range 21.3°–42.4° vs. 31.6° SD, 5.29; range 21.4°–45.8°; P < 0.001) in patients with full-thickness rotator cuff tears compared with healthy participants. Conclusions There were a negative linear relationship between the AI and LAA (rotator cuff tears: R = −0.759, P < 0.01; healthy participants: R = −0.813, P < 0.01) and a positive linear relationship between the AI and CSA (rotator cuff tears: R = 0.854, P < 0.01; healthy participants: R = 0.912, P < 0.01) in patients with rotator cuff tear and healthy participants; we termed this phenomenon “The Acromion Rule.” The AI, LAA, and CSA are independent predictors of rotator cuff tears in a Chinese population.

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

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.

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.

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

Relationship Between Deltoid and Rotator Cuff Muscles During Dynamic Shoulder Abduction: A Biomechanical Study of Rotator Cuff Tear Progression

2018 ◽  
Vol 46 (8) ◽  
pp. 1919-1926 ◽  
Author(s):  
Felix Dyrna ◽  
Neil S. Kumar ◽  
Elifho Obopilwe ◽  
Bastian Scheiderer ◽  
Brendan Comer ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Dynamic Testing ◽  
Correlation Coefficients ◽  
Biomechanical Study ◽  
Rotator Cuff Tears ◽  
Shoulder Abduction ◽  
Mean Values ◽  
Critical Shoulder Angle ◽  
Anterior Deltoid ◽  
Shoulder Angle

Background: Previous biomechanical studies regarding deltoid function during glenohumeral abduction have primarily used static testing protocols. Hypotheses: (1) Deltoid forces required for scapular plane abduction increase as simulated rotator cuff tears become larger, and (2) maximal abduction decreases despite increased deltoid forces. Study Design: Controlled laboratory study. Methods: Twelve fresh-frozen cadaveric shoulders with a mean age of 67 years (range, 64-74 years) were used. The supraspinatus and anterior, middle, and posterior deltoid tendons were attached to individual shoulder simulator actuators. Deltoid forces and maximum abduction were recorded for the following tear patterns: intact, isolated subscapularis (SSC), isolated supraspinatus (SSP), anterosuperior (SSP + SSC), posterosuperior (infraspinatus [ISP] + SSP), and massive (SSC + SSP + ISP). Optical triads tracked 3-dimensional motion during dynamic testing. Fluoroscopy and computed tomography were used to measure critical shoulder angle, acromial index, and superior humeral head migration with massive tears. Mean values for maximum glenohumeral abduction and deltoid forces were determined. Linear mixed-effects regression examined changes in motion and forces over time. Pearson product-moment correlation coefficients ( r) among deltoid forces, critical shoulder angles, and acromial indices were calculated. Results: Shoulders with an intact cuff required 193.8 N (95% CI, 125.5 to 262.1) total deltoid force to achieve 79.8° (95% CI, 66.4° to 93.2°) of maximum glenohumeral abduction. Compared with native shoulders, abduction decreased after simulated SSP (–27.2%; 95% CI, –43.3% to –11.1%, P = .04), anterosuperior (–51.5%; 95% CI, –70.2% to –32.8%, P < .01), and massive (–48.4%; 95% CI, –65.2% to –31.5%, P < .01) cuff tears. Increased total deltoid forces were required for simulated anterosuperior (+108.1%; 95% CI, 68.7% to 147.5%, P < .01) and massive (+57.2%; 95% CI, 19.6% to 94.7%, P = .05) cuff tears. Anterior deltoid forces were significantly greater in anterosuperior ( P < .01) and massive ( P = .03) tears. Middle deltoid forces were greater with anterosuperior tears ( P = .03). Posterior deltoid forces were greater with anterosuperior ( P = .02) and posterosuperior ( P = .04) tears. Anterior deltoid force was negatively correlated ( r = −0.89, P = .01) with critical shoulder angle (34.3°; 95% CI, 32.0° to 36.6°). Deltoid forces had no statistical correlation with acromial index (0.55; 95% CI, 0.48 to 0.61). Superior migration was 8.3 mm (95% CI, 5.5 to 11.1 mm) during testing of massive rotator cuff tears. Conclusion: Shoulders with rotator cuff tears require considerable compensatory deltoid function to prevent abduction motion loss. Anterosuperior tears resulted in the largest motion loss despite the greatest increase in deltoid force. Clinical Relevance: Rotator cuff tears place more strain on the deltoid to prevent abduction motion loss. Fatigue or injury to the deltoid may result in a precipitous decline in abduction, regardless of tear size.

scholarly journals Outcomes of the Star Repair for Large and Massive Rotator Cuff Tears: A Modified Triple-Row Technique

2020 ◽  
Vol 8 (9) ◽  
pp. 232596712095299
Author(s):  
Mohamed G. Morsy ◽  
Hesham M. Gawish ◽  
Mostafa A. Galal ◽  
Ahmed H. Waly
Keyword(s):  
Quality Of Life ◽  
Rotator Cuff ◽  
Rotator Cuff Tears ◽  
Functional Evaluation ◽  
Massive Rotator Cuff Tears ◽  
Health Related ◽  
The Mean ◽  
Cuff Repair ◽  
Disease Specific

Background: Large and massive rotator cuff repairs constitute a true challenge for arthroscopic shoulder surgeons. Retear rates as high as 20% have been reported after arthroscopic double-row and suture-bridge techniques used for these tears. Hypothesis: A modified triple-row repair will provide satisfactory clinical results with lower risk for retear. Study Design: Case series; Level of evidence, 4. Methods: Between March 2016 and August 2017, a total of 52 patients with large and massive rotator cuff tears received a modified triple-row cuff repair. A middle repositioning anchor was inserted between the medial and the lateral rows. The middle anchor sutures were loaded to lateral knotless anchors in a star-shaped configuration. Functional evaluation was performed using the American Shoulder and Elbow Surgeons score, University of California, Los Angeles score, Constant-Murley score, and Simple Shoulder Test. Subjective evaluation was carried out using a visual analog scale for pain and a subjective shoulder value score. Health-related as well as disease-specific quality-of-life scores were also used. Retear rates were assessed by means of musculoskeletal ultrasonography. Patients were evaluated for a minimum of 24 months. Results: This study included 34 female and 18 male patients with a mean age of 57.17 ± 6.7 years. There were 35 patients (67.3%) with large tears and 17 patients (32.7%) with massive tears. Significant improvement from preoperative values was seen in all functional and subjective scores ( P < .001). The mean forward flexion was 163° ± 9.7°, and the mean lateral abduction was 159.4° ± 9.4°. All patients had excellent scores on the general health-related and disease-specific quality-of-life scales. No retears were reported at the end of the follow-up period. Conclusion: The star-shaped, modified triple-row cuff repair is a valid and effective solution for surgical management of large and massive rotator cuff tears, providing excellent results and low risk for retears.

scholarly journals Failed Dermal Allograft Procedures for Irreparable Rotator Cuff Tears Can Still Improve Pain and Function: The “Biologic Tuberoplasty Effect”

2019 ◽  
Vol 7 (8) ◽  
pp. 232596711986343 ◽  
Author(s):  
Raffy Mirzayan ◽  
Michael A. Stone ◽  
Michael Batech ◽  
Daniel C. Acevedo ◽  
Anshuman Singh
Keyword(s):  
Rotator Cuff ◽  
Clinical Improvement ◽  
Rotator Cuff Tears ◽  
Type I ◽  
Type Ii ◽  
Bone Contact ◽  
Type Iii ◽  
Goutallier Classification ◽  
Functional Scores ◽  
The Mean

Background:Acellular dermal matrices (ADMs) have been used in the treatment of shoulders with massive rotator cuff tears (MRCTs). Despite clinical improvement, correlation of clinical findings with ADM integrity on imaging has not been investigated.Hypothesis:The pain in shoulders with MRCTs is partially due to bone-to-bone contact between the tuberosity and acromion. Coverage of the tuberosity with an intact graft or a graft that is torn in a way that the tuberosity remains covered will act as an interpositional tissue, preventing bone-to-bone contact and leading to clinical improvement.Study Design:Case series; Level of evidence, 4.Methods:Between 2006 and 2016, a total of 25 shoulders with MRCTs underwent a procedure with an ADM. Pre- and postoperative visual analog scale (VAS) results, American Shoulder and Elbow Surgeons (ASES) score, Hamada grade, and Goutallier classification were reviewed. A postoperative magnetic resonance imaging (MRI) was obtained in 22 (88%) shoulders. The status of the graft was divided into the following categories: type I, intact graft; type II, graft tear with tuberosity covered; and type III, graft tear with tuberosity uncovered (bare).Results:The mean patient age was 61 years (range, 49-73 years), and the mean follow-up was 25.6 months (range, 10-80 months). Mean length from surgery to postoperative MRI was 13.9 months (range, 6-80 months). The graft was torn in 59% (13/22 shoulders). Significant improvements were found in VAS and ASES scores (7 vs 0.7 and 32.6 vs 91.2, respectively; P < .01) for type I grafts and in VAS and ASES scores (8.1 vs 1.3 and 26.3 vs 84.6, respectively; P < .01) for type II grafts. No difference was found in postoperative VAS and ASES (0.7 vs 1.3 and 91.2 vs 84.6, respectively; P = .8) between type I and type II grafts. No improvement was seen in VAS (7.3 vs 5.7; P = .2) or ASES (30.6 vs 37.2; P = .5) for type III grafts.Conclusion:MRI appearance of the graft has a significant impact on functional outcomes. Patients with an intact graft or a graft tear leaving the tuberosity covered have lower pain and higher functional scores than those in whom the torn graft leaves the tuberosity uncovered.

scholarly journals Risk Factors, Pathobiomechanics and Physical Examination of Rotator Cuff Tears

2016 ◽  
Vol 10 (1) ◽  
pp. 277-285 ◽  
Author(s):  
Samuel G. Moulton ◽  
Joshua A. Greenspoon ◽  
Peter J. Millett ◽  
Maximilian Petri
Keyword(s):  
Risk Factors ◽  
Rotator Cuff ◽  
Physical Examination ◽  
Diagnostic Accuracy ◽  
Literature Search ◽  
Glenohumeral Joint ◽  
Rotator Cuff Tears ◽  
Critical Shoulder Angle ◽  
Common Risk Factors ◽  
Shoulder Angle

Background: It is important to appreciate the risk factors for the development of rotator cuff tears and specific physical examination maneuvers. Methods: A selective literature search was performed. Results: Numerous well-designed studies have demonstrated that common risk factors include age, occupation, and anatomic considerations such as the critical shoulder angle. Recently, research has also reported a genetic component as well. The rotator cuff axially compresses the humeral head in the glenohumeral joint and provides rotational motion and abduction. Forces are grouped into coronal and axial force couples. Rotator cuff tears are thought to occur when the force couples become imbalanced. Conclusion: Physical examination is essential to determining whether a patient has an anterosuperior or posterosuperior tear. Diagnostic accuracy increases when combining a series of examination maneuvers.

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

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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