Abstract
The authors aimed to investigate whether standard acromioplasty can reduce critical shoulder angle (CSA) effectively and to investigate the effects of postoperative CSA on the clinical outcomes and retear rates. Patients are divided in to three groups: group 1 (24 patients): CSA under 35° before surgery, group 2 (25 patients): CSA over 35° before surgery and under 35° after surgery and group 3 (17 patients): CSA over 35° before and after surgery. Standard acromioplasty was performed if CSA is over 35 and no acromioplasty was performed if the CSA is already under 35. Preoperative and postoperative CSAs, UCLA, Constant-Murley clinical score and visual analog scale (VAS) pain score were measured. The size of the rotator cuff tear was classified by the Patte classification in preoperative MRI and the quality of the repair was evaluated as retear if discontinuity detected in the postoperative first year MRI. There were 31 female and 35 male patients with a mean age of 59.3 ± 4.5 years (range, 48–68) at the time of surgery. The mean CSA is reduced from 37.8° ± 1.4 to 34.9° ± 1.2 (p < 0.001) significantly for patients who underwent acromioplasty. In 25 (59.5%) of the 42 patients, the CSA was reduced to under 35°, whereas in the other 17 (40.5%) patients, it remained over 35°. The mean Constant and UCLA score was 46.4 ± 6.6; 18.5 ± 1.6 preoperatively and 82.4 ± 6.2; 31.1 ± 1.9 postoperatively respectively (p < 0,001). The mean VAS decreased from 4.94 ± 1.09 to 0.79 ± 0.71 (p < 0.001). No Clinical difference was seen between patients in which CSA could be reduced under 35° or not in terms of Constant-Murley score, UCLA and VAS score. Retear was observed in 2 (8.3%) patients in group 1, in 4 (16%) patients in group 2 and in 3 patients (17.6%) in group 3. There was not any significant difference between the patients who had retear or not in terms of neither the CSA values nor the change of CSA after the surgery. Standard acromioplasty, which consists of an anterolateral acromial resection, can reduce CSA by approximately 3°. This is not always sufficient to decrease the CSAs to the favorable range of 30°–35°. In addition, its effect on clinical outcomes does not seem to be noteworthy.
Highlights
Lateral acromion creates a more-lateral deltoid origin and results in greater shear and lesser compressive vector of the deltoid on the glenohumeral joint[4]
Katthagen et al showed that acromioplasty is capable of reducing the critical shoulder angle (CSA) in a cadaver study[5]
Patients with full-thickness rotator cuff tear who did not respond to conservative treatment which included anti-inflammatory drugs, subacromial injections and physical therapy process for 6 months were appointed for arthroscopic rotator cuff repair
Summary
Lateral acromion (higher CSA) creates a more-lateral deltoid origin and results in greater shear and lesser compressive vector of the deltoid on the glenohumeral joint[4]. Differences in CSA lead to considerable differences in joint forces[4] They found that increased CSA is associated with decreased compressive and increased shear forces. They stated that an additional 35% of supraspinatus muscle force is needed to reach the stability equal to the normal shoulder anatomy when the CSA is increased to 38°. Moor et al found CSA, between 30° and 35° on patients without neither osteoarthritis nor rotator cuff tear[3]. They indicated that angles >35° are associated with a high prevalence of RCTs, whereas shoulders with a CSA of
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