Critical Shoulder Angle Values Research Articles

Can the presence of SLAP-5 lesions be predicted by using the critical shoulder angle in traumatic anterior shoulder instability?

Although SLAP-5 lesions are associated with recurrent dislocations, their causes and pathomechanisms have not been fully elucidated. This study aimed to investigate the association between SLAP-5 lesions and scapular morphology in traumatic anterior shoulder instability (ASI). We hypothesized that there may be a relationship between SLAP-5 lesions and scapular morphology in traumatic ASI patients. The study included 74 patients with isolated Bankart lesions and 69 with SLAP-5 lesions who underwent arthroscopic labral repair for ASI. Critical shoulder angle (CSA) was measured on the roentgenograms, while glenoid inclination (GI) and glenoid version (GV) were measured on magnetic resonance imaging (MRI) by two observers in two separate sessions blinded to each other. Both groups were compared in terms of CSA, GI, and GV. The mean ages of Bankart and SLAP-5 patients were 28.4±9.1 and 27.9±7.7 (P=0.89), respectively; their mean CSA values were 33.1°±2.6° and 28.2°±2.4°, respectively (P<0.001). The ROC analysis's cut-off value was 30.5°, with 75.0% sensitivity and 76.7% specificity (AUC = 0.830). SLAP-5 lesions were more common on the dominant side than isolated Bankart lesions (P=0.021), but no difference was found between the groups in terms of GI and GV (P=0.334, P=0.081, respectively). In ASI, low CSA values appeared to be related to SLAP-5 lesions, and the cut-off value of CSA for SLAP lesion formation was 30.5° with 75.0% sensitivity and 76.7% specificity. Scapula morphology may be related to the SLAP-5 lesions, and CSA can be used as an additional parameter in provocative diagnostic tests and medical imaging techniques for the detection of SLAP lesions accompanying Bankart lesions. III retrospective case-control study.

Role of Critical Shoulder Angle in Degenerative Type Rotator Cuff Tears: A Turkish Cohort Study.

BACKGROUND This retrospective study investigated the association between the critical shoulder angle (CSA) and the development of full-thickness rotator cuff tears (FTRCTs) in the Turkish population. The CSA is an imaging parameter that quantifies the relationship between the inclination of the glenoid and the lateral extension of the acromion in the coronal plane. The CSA is an anatomical measurement, and higher CSA values have been associated with an increased incidence of FTRCTs. However, there is a lack of data on CSA regarding the Turkish population. MATERIAL AND METHODS In this study, CSA measurements were recorded in 2 groups: 50 patients with FTRCT who had arthroscopic repair (group 1) and 50 age- and sex-matched individuals with no FTRCT detected by magnetic resonance imaging (group 2). Sex, age, affected side, dominant side, and smoking status were recorded for each patient. The CSA measurements of the affected sides were performed on true anterior-posterior view radiographs. RESULTS The results showed a statistically significant difference between the mean CSA values of group 1 (37.48°) and group 2 (33.53°), P<0.001. CSA values of 36 and above had a sensitivity of 73.58%, specificity of 74.47%, positive predictive value of 75%, and negative predictive value of 74.47% for detecting FTRCT. CONCLUSIONS CSA measurement on radiographs is a useful diagnostic tool in the Turkish population, and an above-average CSA value is associated with a significantly increased incidence of degenerative-type FTRCT.

Critical Shoulder Angle in Patients With Cuff Tears.

The pathogenesis of rotator cuff tears (RCTs) is multifactorial. Critical shoulder angle (CSA), which represents the lateral extension of the acromion over the cuff, has been proposed as an extrinsic risk factor. The aim of the present systematic review and meta-analysis was to analyze the available literature regarding the correlation between RCT and CSA. A review was carried out in accordance with the "Preferred Reporting Items for Systematic reviews and Meta-Analyses" guidelines on July 17, 2023, using the following databases: PubMed, Ovid, and Cochrane Reviews. The following keywords were used: "critical shoulder angle," "rotator cuff tears," and "rotator cuff lesions." The methodological quality of the studies was assessed with the MINORS SCORE. Twenty-eight studies were included. The average CSA among the 2110 patients with full-thickness RCT was 36.7 degrees, whereas the same value among the 2972 controls was 33.1 degrees. The average CSA in the 348 patients with partial-thickness RCT was 34.6 degrees, whereas it was 38.1 degrees in the 132 patients with massive RCT. The average MINORS score was 15.6. CSA values were significantly higher in patients with RCT compared with the asymptomatic population. In addition, it appears that CSA values increase with the severity of rotator cuff involvement.

The Impact of Coracoid Tip Orientation on Subscapularis Tear Incidence: an MRI-Based Study.

This study investigated the relationship between the position of the tip of the coracoid process (CP) relative to the glenoid with subscapularis (Ssc) tears. We hypothesized that the coracoid tip is more inferior, lateral and posterior in patients with Ssc tear. This research enrolled 34 isolated Ssc tears and 44 controls. We introduced the axial central glenoid-coracoid angle (acGCA) and sagittal central glenoid-coracoid angle (scGCA) to evaluate the position of the tip of the CP relative to the glenoid center on MRI images. In both groups, acGCA, scGCA on MRI and critical shoulder angle (CSA), glenoid inclination (GI) on true anterior-posterior shoulder radiography were evaluated. When both groups were compared in terms of acGCA, the acGCA values of the Ssc tear group were significantly higher than the control group (p<0.001). The best cut-off value of acGCA for Ssc tears was 28.3°. acGCA values higher than 28.3° showed 93.3% sensitivity and 93.1% specificity for Ssc tears (likelihood ratio:13.53, AUC: 0.979, 95% CI of AUC: 0.950- 0.999). In terms of acGCA, the power analysis between Ssc tears group and control group was 99.9% between Ssc tears and the control group (effect size d=2.63). When both groups were compared in terms of scGCA, the scGCA values of the Ssc tear group were significantly higher than the control group (p<0.001). The best cut-off value of scGCA for Ssc tears was 41.4°. Scores of scGCA greater than 41.8° showed 80% sensitivity and 89.7% specificity for Ssc tears (likelihood ratio: 7.73, AUC: 0.899 95% CI of AUC: 0.837-0.958). In terms of scGCA, the power analysis between Ssc tear and control group was 99.8% (effect size d=1.23). When both groups were compared in terms of CSA and GI; CSA and GI values in the Ssc tear group were significantly higher (p<0.001 and p<0.012, respectively). AcGCA values higher than 28.3° indicate that the coracoid tip is located more laterally and posteriorly; scGCA values higher than 41.8° indicate that the coracoid tip is located more inferiorly and these two new indexes are showing that more laterally, posteriorly and inferiorly coracoid tip is related to subscapularis tears. coracoid process, subscapularis tear, coracoid morphology, scapula morphology.

MRI is a Reliable Method for Measurement of Critical Shoulder Angle and Acromial Index.

Objective The objectives of this study are to compare absolute values of acromial index (AI) and critical shoulder angle (CSA) obtained in both radiographs and magnetic resonance image (MRI) of the shoulder; and to compare the interobserver and intra-observer agreement for AI and CSA values measured in these image modalities. Methods Patients who had medical indication of investigating shoulders conditions through radiographs and MRI were included. Images were taken to two fellowship-trained shoulder surgeons, which conducted measurements of AI and CSA in radiographs and in MRI. Twelve weeks after the first evaluation, a second evaluation was conducted. Inter- and intra-observer reliability was presented as an Intraclass Correlation Coefficient (ICC) and agreement was classified according to Landis & Koch criteria. The differences between two measurements were evaluated using Bland-Altman plots. Results 134 shoulders in 124 subjects were included. Mean intra-observer ICC for CSA in X-rays and in MRI were 0.936 and 0.940, respectively; for AI, 0.908 and 0.022. Mean inter-observer ICC for CSA were 0.892 and 0.752 in X-rays and MRI respectively; for AI, ICC values were 0.849 and 0.685. All individual analysis reached statistical power ( p < 0.001). Mean difference for AI values measured in X-rays and in MRI was 0.01 and 0.03 for observers 1 and 2, respectively. Mean difference for CSA values obtained in X-rays and MRI was 0.16 and 0.58 for observers 1 and 2, respectively. Conclusion Both MRI and X-rays provided high intra- and interobserver agreement for measurement of AI and CSA. Absolute values found for AI and CSA were highly correlated in both image modalities. These findings suggest that MRI is a suitable method to measure AI and CSA. Level of Evidence II , Diagnostic Study.

Does Morphology of the Shoulder Joint Play a Role in the Etiology of Rotator Cuff Tear?

The etiology of rotator cuff tears (RCTs) have been investigated for years and many underlying causes have been identified. Shoulder joint morphology is one of the extrinsic causes of RCTs. Morphometric measurements on MRI sections determined which parameters are an important indicator of RCT in patients with shoulder pain. The aim of this study was to determine the risk factors in the etiology of RCTs by evaluating the shoulder joint morphology with the help of previously defined radiological parameters. Between January 2019-December 2020, 408 patients (40-70 years old) who underwent shoulder MRI and met the criteria were included in the study. There were 202 patients in the RCT group and 206 patients in the control group. Acromion type, acromial index (AI), critical shoulder angle (CSA), acromiohumeral distance (AHD), lateral acromial angle (LAA), acromial angulation (AA), acromion-greater tuberosity impingement index (ATI), and glenoid version angle (GVA) were measured from the MRI images of the patients. AI (0.64 vs. 0.60, p = 0.003) CSA (35.3° vs. 32.4°, p = 0.004), ATI (0.91 vs. 0.83, P < 0.001), and AA (13.6° vs. 11.9°, p = 0.011) values were higher in the RCT group than in the control group and the difference was significant. AHD (8.1 mm vs. 9.9 mm, P < 0.001), LAA (77.2° vs. 80.9°, p = 0.004) and GVA (-3.9° vs. -2.5°, P < 0.001) values were lower in the RCT group than in the control group, and again the difference was significant. According to the receiver operating characteristic curve analysis, the cutoff values were 0.623 for AI and 0.860 for ATI. Acromion type, AI, CSA, AHD, LAA, AA, ATI, and GVA are suitable radiological parameters to evaluate shoulder joint morphology. High AI, CSA, AA, ATI, GVA and low AHD and LAA are risk factors for RCT.

Evaluation of the relationship between scapula morphology and anterior shoulder dislocation accompanying greater tuberosity fracture

IntroductıonIt is estimated that 5–30% of traumatic anterior shoulder dislocations are accompanied by greater tuberosity fracture (GTF), and the pathomechanism of these fractures is not yet clear. Our hypothesis is to examine the relationship between the scapula morphology and anterior shoulder dislocation (ASD) accompanying GTF. Materıals and methodsThe patients were divided into two groups according to the accompanying GTF. 40 patients with isolated traumatic ASD and 31 patients with accompanying GTF were included in the study. Critical shoulder angle (CSA), glenoid inclination (GI), acromial index (AI) and greater tuberosity angle (GTA) values were measured in two sessions by two independent observers in the standard antero-posterior radiographs of the patients in both groups. ResultsThe mean CSA was 40.82°±3.19° and 35.49°±2.19° in accompanying GTF group and the isolated ASD group, respectively. The mean CSA was significantly higher in accompanying GTF group than isolated ASD group(P<0.001). The GI was significantly higher in the isolated ASD than in accompanying GTF group (P = 0.001). The mean GI was 18.7°±6.85° and 10.45°±4.87° in accompanying GTF group and the isolated ASD, respectively. Cut-off value of CSA and GI was 38° (88.2% sensitivity,88.9% specificity) and 14.5° (70.6% sensitivity and 72.2% specificity), respectively. There was no significant difference regarding the mean GTA and AI values between GTF group and the isolated ASD group (P = 0.98, P = 0.63). ConclusıonsIncreased CSA and GI values are associated with traumatic anterior shoulder dislocation accompanied by greater tuberosity fracture.

EVALUATING THE ROLE OF SCAPULA MORPHOLOGY IN ROTATOR CUFF TEARS: WHICH IS THE MOST USEFUL PREDICTOR?

Objective: The aim of this study was to determine the relationships between glenoid inclination (GI), acromial index (AI), critical shoulder angle (CSA), superior inclination (SI), and symptomatic degenerative full-thickness supraspinatus tears (SSTs). Materials and Methods: Patients who were diagnosed with SSTs (n=39) between 2015 and 2017 were assessed retrospectively. Controls were matched to age, gender, and side. Measured GI, AI, CSA, and SI values were compared between the SSTs and control groups (n=39). The mean age for the SSTs group was 52.74±5.49 years, and the mean age for the control group was 51.15±5.22 years. Results: The mean GI for the SSTs group was 19.97°±5.62°, and it was 13.72°±6.55° for the control group (p&lt;0.001). The mean AI was 0.7±0.08 and 0.67±0.07 in the SSTs and control groups, respectively (p=0.035). The mean CSA for the SSTs group was 35.05°±4.09° and it was 33.06°±3.42° for the control group (p=0.022). The mean SI was 25.13°±5.71° and 25.91°±5.81° in the SSTs and control groups, respectively (p=0.552). For a cut-off value of GI ≥17.35°, sensitivity was 79.54%, and specificity was 79.51% (p=0.001). For a cut-off value of AI ≥0.67, sensitivity was 61.54% and specificity was 56.4% (p=0.031). For a cut-off value of CSA ≥33.45°, sensitivity was 64.12%, and specificity was 64.54% (p=0.014). Conclusion: Higher measurement values of glenoid inclination, acromial index, and critical shoulder angle were associated with symptomatic degenerative full-thickness supraspinatus tears, and no correlation was found with superior inclination measurement. The glenoid inclination measurement had the highest sensitivity and specificity in predicting symptomatic degenerative full-thickness supraspinatus tears.

Anterolateral Acromioplasty Does Not Change the Critical Shoulder Angle and Acromion Index in a Clinically Relevant Amount

Assessment on whether radiographic parameters of the acromion measured in radiographs change significantly after anterolateral acromioplasty. This retrospective study included patients that underwent an arthroscopic anterolateral acromioplasty between January 2014 and September 2020. n= 435 subjects with high-quality preoperative and postoperative radiographs according to Suter-Henninger criteria were included in the final assessment. All measurements were independently performed by the first and second author in a blinded fashion using dicomPACS software: acromion index (AI), critical shoulder angle (CSA), lateral acromial angle (LAA), beta angle, acromio-humeral distance (AHD), Aoki angle, frontal supraspinatus outlet angle (FSOW), and acromion type, according to Bigliani. SPSS software was used for statistical analysis. The beta angle and the CSA did not significantly change after operation (alpha power 0.32 and 0.11, respectively). In a subgroup analysis of patients with a pathological CSA >35° (n= 194), the CSA changed from 38.62 (range: 35.08-47.52, SD 2.83) to 38.04 (range: 29.18-48.12, SD 3.77) postoperatively (P= .028) (Fig 8). All other parameters changed significantly after operation (AI, AHD, FSOW, and Aoki; P= .001, LAA; P= .039) (Fig.9). The interobserver and intraobserver reliability was good to excellent in the majority of measured values. Mean patient age was 59.2 years (range: 18.1-87.1; SD 11.3), mean height was 1.73 meters (range: 1,50-1.98, SD 0.09), mean weight was 80.2 kg (range: 37.0-133.0, SD 16.68), and mean body mass index was 26.6 (range: 0.0-46.1, SD 4.73). Anterolateral acromioplasty producing a flat acromion undersurface did not result in a significant change of the CSA in the study population. Pathological preoperative CSA values of >35° were significantly reduced but not to normal values, but only by a small amount that puts the clinical relevance into question. IV, diagnostic study, case series.

Evaluation of anatomical variations with morphological measurements and their relationship with rotator cuff tear and acromion types

Introduction: There many more anatomical measurements such as the acromiohumeral distance and lateral acromion angle and acromial configuration was reported as might be associated with rotator cuff tear. In our study, we aimed to reveal the effect of acromion index, acromiohumeral distance, lateral acromion angle, critical shoulder angle values and the acromion type in the development of rotator cuff tear. &#x0D; Material and Method: In our retrospective study, 58 patients and 29 asymptomatic volunteers who underwent shoulder magnetic resonance imaging examinations were examined. acromion index, acromion humaral distance, lateral acromion angle and critical shoulder angle were measured and their relationship with rotator cuff tear and acromion types were evaluated. &#x0D; Results: Type III (hooked) of acromial shapes, higher acromion index and critical shoulder angle values, lower acromiohumeral distance and lateral acromion angle values are more frequently seen in rotator cuff tear patients, in our study. &#x0D; Conclusion: Thus, we revealed anatomical malformations that predispose to rotator cuff tear concerning the shoulder joint.

Critical shoulder angle (CSA): age and gender distribution in the general population

ObjectiveAnatomical parameters and pathologies that can affect the critical shoulder angle (CSA) are subjects of discussion. To date, we do not know if the CSA value changes in the different decades of life in a population characterized by the same ethnicity, nor if there are differences related to gender or side. This study hypothesizes that age and gender may affect the CSA.MethodsPatients older than 15 years old affected by a shoulder trauma and who were discharged with a diagnosis of shoulder contusion were enrolled. A true AP view of the shoulder was obtained as well as data regarding age and gender of all participants. The CSA was measured by three authors, and interoperator reliability was assessed. Eight subcategories, according to decades of life, were considered. Finally, the studied population was divided into three subcategories according to CSA values (< 30°; 30–35°; ≥ 35°).ResultsThe initial sample comprised 3587 shoulder X-rays. The interobserver reproducibility was high, with an intraclass correlation coefficient of 0.865 (95% CI 0.793–0.915).Two thousand eight hundred seventy-three radiograms were excluded. The studied group comprised 714 patients [431 females, 283 males; mean age (SD): 47.2 (20.9) years, range: 11–93 years]. The mean CSA was 33.6° (range: 24–50°; SD: 3.9°). The mean CSA values in females and males were 33.7°and 33.5°, respectively. The mean CSA values of the right and left shoulders were 33.3° and 33.9°, respectively (p > 0.05). Linear regression analysis showed a CSA increase by 0.04° every year. The mean CSA in subjects aged between 15 and 19 years was significantly lower than all the other groups, except for patients older than 80 years.No significant differences were found between CSA subcategories, gender, or side.ConclusionsIn the general population, the mean CSA value was 33.6°. No significant differences were found regarding the mean CSA value according to gender or side. A significant positive linear correlation between CSA and age was detected. In each decade of life, the CSA value, which is genetically determined, shows a large variability.Level of evidence: IV.

COMPARISON OF SCAPULAR MORPHOLOGY IN DEGENERATIVE AND TRAUMATIC ROTATOR CUFF TEARS

Background: Degenerative cuff tears have impingement pathophysiology due to altered scapular morphology as measured by increased critical shoulder angle (CSA), decreased lateral acromial angle (LAA) and increased acromion index (AI). But scapular morphology in traumatic tears has neither been studied nor compared with degenerative tears. Aim: To compare scapular morphology with CSA, LAA, AI between traumatic and degenerative tears and determine their reliability. Methods: This observational study includes 100 patients (50 with traumatic and degenerative tears). We analyzed MRI and standardized AP shoulder radiograph of these patients. Parameters, such as CSA, LAA, AI, were measured on AP radiographs by two separate observers in a blinded manner. The 1st observer repeated measurements after four weeks. We compared age, gender, degree of cuff tear, and CSA values, LAA, and AI between the two groups. Results: On comparison using chi-square test, degenerative group had significantly higher age, higher CSA (mean 37.55, SD 0.88 versus traumatic group mean 36.6, SD 0.95, [Formula: see text]-[Formula: see text], highly significant), higher AI (mean 0.73, SD 0.02 versus traumatic mean 0.69, SD 0.04 [Formula: see text]-[Formula: see text], highly significant), and lower LAA (77.14, SD 2.03 versus traumatic mean 78.36, SD 2.73, [Formula: see text]-value 0.013, significant). Interobserver and intraobserver reliability of parameters using the intraclass correlation coefficient (ICC) revealed excellent (CSA, LAA) and good (AI) agreement. ROC curve analysis calculated sensitivity (0.7) and specificity (0.66) to diagnose degenerative tear for CSA above 37.05[Formula: see text]. Conclusion: Scapular morphology in traumatic tears differs from degenerative. CSA, LAA, AI can be reliably measured on standardized shoulder AP radiographs.

Is shoulder geometry important for rotator cuff tears?

This study is aiming to evaluate some specific anatomic shoulder parameters such as the lateral acromial angle (LAA), acromial index (AI), coracohumeral distance (CHD) and critical shoulder angle (CSA) in rotator cuff tears. A total of 100 cases consisting of 50 patients with rotator cuff tears and 50 patients without rotator cuff tears, who underwent shoulder MRI (mangnetic resonance imaging) examination in Istanbul Medipol University Orthopedics and Traumatology Department, participated in this study. In this retrospective study, CCA, LAA, AI and CSA were evaluated in MRI in order to shed light on the theories of rotator cuff tears. There was no significant difference (P˃.05) in acromial index and coracohumeral distance in the patient group. Lateral acromial angle and critical shoulder angle were significantly different in the patient group compared to the control group (P<.05). There was a weak negative correlation between CSA and CHD. In our study, we found that patients with smaller LAA and higher CSA values in MRI images are prone to have rotator cuff tears. Further studies are needed in order to evaluate whether this association has predictive value.

Is There A Relationship Between Critical Shoulder Angle and Fatty Degeneration and Number of Damaged Tendons in Rotator Cuff Arthropathy Patients?

The aim of this study was to investigate the correlation of critical shoulder angle (CSA) in rotator cuff arthropathy patients with number of damaged rotator cuff tendons and muscle fatty degeneration. Rotator cuff arthropathy patients were included in this study. True antero-posterior radiographs (Grashey view) were used to measure the angle by the first author. The critical shoulder angles were measured on radiographs. The Magnetic resonance images (MRI) of same patients were assessed in terms of number of tendon involvements and fatty degeneration of rotator cuff muscles. There were 28 rotator cuff arthropathy patients comprising 16 females and 12 males. The mean age was 69.928.84 years. The right shoulder was affected in 20 patients. The left side was affected in 8 patients. The damaged rotator cuff tendons were as follows; supraspinatus tendon was affected in all patients, infraspinatus tendon was affected in 25 patients, teres minor was affected in 14 patients, and subscapularis tendon was affected in 24 patients. The critical shoulder angle was found 37.601.66 CSA values were found to be higher in patients having fatty degeneration than others having no fatty degeneration, and it was statistically significant (p<0.001). The CSA values were found to be higher in patients with having increased number of damaged tendons and with having fatty degeneration of rotator cuff muscles. The higher CSA means the worse rotator cuff arthropathy patients, therefore care should be taken for planning surgical treatment options.

Implication of bone morphology in degenerative rotator cuff lesions: A prospective comparative study between greater tuberosity angle and critical shoulder angle

BackgroundDegenerative rotator cuff tear is a frequent and multifactorial pathology. The role of bone morphology of the greater tuberosity and lateral acromion has been validated, and can be measured with two plain radiographic markers on true anteroposterior views: the greater tuberosity angle (GTA) and the critical shoulder angle (CSA). However, the interdependence of both markers remains unknown, as well as their relationship with the level of professional and sports activities involving the shoulder. The aim of this prospective comparative study was to describe the correlation between the GTA and CSA in patients with degenerative rotator cuff tears. HypothesisGTA and CSA are independent factors from one another and from demographic factors, such as age, dominance, sports, or professional activities. Patient and methodsAll patients presenting to a shoulder specialized clinic were assigned to two groups. The first consisted of patients with a symptomatic degenerative rotator cuff tear visible on MRI and the control group consisted of patients with any other shoulder complaints and no history or visible imaging of any rotator cuff lesion. ResultsThere were 51 shoulders in 49 patients in the rotator cuff tear group (RCT) and 53 shoulders in 50 patients in the control group. Patient demographics were similar in both groups. Mean GTA was 72.1°±3.7 (71.0–73.1) in the RCT group and 64.0°±3.3 (63.1–64.9) in the control group (p<0.001). Mean CSA was 36.7°±3.7 (35.7–37.8) in the RCT group, and 32.1°±3.7 (31.1–33.1) in the control group (p<0.001). A summation of GTA and CSA values over 103° increased the odds of having a rotator cuff tear by 97-fold (p<0.001). There was no correlation between GTA and CSA, nor between GTA or CSA and age, sex, tear size, or dominance. Patients with different levels of professional and sports activities did not have significantly different GTA or CSA values. ConclusionGTA and CSA are independent radiologic markers that can reliably predict the presence of a degenerative rotator cuff tear. A sum of both values over 103° increases the odds of having a rotator cuff tear by 97-fold. These markers are not correlated with patient demographic or environmental factors, suggesting that the variability of the native acromion and greater tuberosity morphology may be individual risk factors for rotator cuff tear. Level of evidenceII; diagnostic study.

The Effect of Acromial Morphology on the Functional Outcomes of Degenerative Rotator Cuff Tear Surgery.

The aim of this study was to investigate how the critical shoulder angle (CSA) and acromion index (AI) affect the outcome of arthroscopic rotator cuff tear (RCT) repair. A total of 287 patients, who underwent arthroscopic surgery due to degenerative rotator cuff tear, were evaluated. The Constant Shoulder Score (CSS), Oxford Shoulder Score (OSS) and Visual Analogue Scale (VAS) were evaluated preoperatively and postoperatively. The AI and CSA were measured on true anteroposterior shoulder radiographs. The patients were separated into two groups according to their CSA and AI values (control group ≤ 38°, increased CSA > 38°, and control group ≤ 0.7, increased AI > 0.7). The relationship between CSS, OSS and VAS was examined in all the groups. The evaluation was made of a total of 287 patients with a mean age of 60.29 ± 8.55years. The mean duration of follow-up of the patients was 34.00 ± 18.97months (range 12-80months). There was a statistically significant difference between the preoperative and postoperative clinical scores of the patients (p < 0.05). No relationship was determined between CSA, AI and CSS, OSS or VAS during follow-up (p > 0.05). The interobserver ICC for CSA and AI were determined to be 0.962 and 0.967, respectively (95% CI) indicating a high correlation (p < 0.001). CSA and AI do not affect functional outcomes in the postoperative period, so they are not significant at the time of degenerative arthroscopic rotator cuff repair decisions.

The critical shoulder angle, the acromial index, the glenoid version angle and the acromial angulation are associated with rotator cuff tears.

To compare the critical shoulder angle (CSA), acromion index (AI), acromion angulation (AA) and glenoid version angle (GVA) between patients with full-thickness rotator cuff tears (RCTs) and patients with intact rotator cuffs. Between 2014 and 2018, the CSA, AI, AA and GVA were measured in consecutively included patients aged > 40years who underwent shoulder arthroscopy for full-thickness RCTs. A total of 437 patients with RCTs and a mean age of 51.2years (± 5.8) were included, 35.7% of whom were male. In the control group, there were n = 433 patients (36.3% male) with an intact rotator cuff, and the mean age was 50.7years (± 5.3). The mean AI for the RCT group was 0.7 ± 0.1, which was significantlyhigher than the mean AI for the control group (0.6 ± 0.1, p < 0.001). The mean CSA for the RCT group was 33.6° ± 3.9°, which was significantly higher than the mean CSA for the control group (31.5° ± 4°, p < 0.001). The mean AA for the RCT group was 13.9° ± 9°, which was significantlyhigher than the mean AA for the control group (12.4 ± 8.6, p = 0.012). The mean GVA for the RCT group was - 3.5° ± 4.6° and significantly retroverted compared with the mean GVA for the control group (- 2.2° ± 4.6°, p < 0.001). The cutoff values determined by the ROC curve analyses were as follows: 0.6 for AI, 31.4° for CSA, 9.6° for AA and - 2.6° for GVA. The CSA, AI, GVA and AA values measured by MRI were determined to be significantly related to full-thickness rotator cuff ruptures. The AI, CSA, AA and GVA may be considered risk factors for degenerative rotator cuff tears. Assessing the CSA, AI, GVA and AA can be helpful for diagnostic evaluation of patients with full-thickness RCTs. III.

Lateral acromioplasty cannot sufficiently reduce the critical shoulder angle if preoperatively measured over 40°.

To investigate whether arthroscopic lateral acromion resection can sufficiently reduce the critical shoulder angle (CSA) without damaging deltoid muscle insertion. Ninety patients who underwent arthroscopic rotator cuff (RC) repair were retrospectively analysed. According to the preoperative CSA, patients were categorized as Group I (CSA < 35°) and Group II (CSA ≥ 35°). Additional arthroscopic lateral acromion resection was performed in Group II. The CSA was measured 1week postoperatively, while RC integrity and the deltoid attachment were assessed at 3, 6 and 12months via ultrasound. Deltoid function was evaluated using the Akimbo test, in which patients place their hands on the iliac crest with abduction in the coronal plane and internal rotation of the shoulder joint while simultaneously flexing the elbow joint and pronating the forearm. Large and massive RC tears were more prevalent in Group II (p = 0.017). In both groups, the CSA reduction was statistically significant (Group I = 1°: range 0°-3°, Group II = 3.7°: range 1°-8°; p < 0.001). When the preoperative CSA was > 40°, the respective postoperative CSA remained > 35° in 83.3% of cases (p < 0.001). Final shoulder strength was correlated with the amount of CSA reduction (rho = 0.41, p = 0.002). The postoperative CSA was higher, but not significantly different (n.s.), in patients with re-torn (36°, range 32°-40°) than with healed RC (33°, range 26°-38°). No clinical detachment or hypotrophy of the deltoid was observed with the Akimbo test and ultrasound evaluation. Arthroscopic lateral acromion resection is a safe procedure without affecting deltoid muscle origin or function, and it is effective in significantly reducing the CSA. However, the CSA cannot always be reduced to < 35°, especially in patients with preoperative CSA values > 40°. III.

THE RELATIONSHIP BETWEEN THE MORPHOMETRIC PARAMETERS OF SCAPULA AND SUPRASPINATUS TENDONITIS

OBJECTIVE: Tendonitis is one of the most frequent shoulder lesions. The aim of this study is to evaluate the correlation of the radiological parameters including critical shoulder angle (CSA), glenoid inclination (GI) and acromion index (AI) with supraspinatus tendonitis.MATERIALS AND METHODS : Seventy-four patients [47 men, 27 women, mean age 29±5.2 (range 18-40)] were included in the study. Two groups were formed as Group I (n=33) and Group II (n=41) according to supraspinatus tendon intensity revealed by shoulder magnetic resonance images. Critical shoulder angle, glenoid inclination and acromion index parameters were measured on shoulder radiographs obtained in neutral position. The relationship of the radiologic parameters and the presence of supraspinatus tendonitis was evaluated. RESULTS: The mean CSA was 37.9°, the mean GI was 17.2°, and the mean AI was 0.8 in Group I. The mean CSA was 38.3°, the mean GI was 17.1°, and the mean AI was 0.8 in Group II. No statistically significant difference was found between the groups. The CSA values of the women were statistically significantly higher than that of the men (p=0.04). CONCLUSIONS: Higher CSA values are found to be associated with the risk of rotator cuff tear and lower CSA values with osteoarthritis. Higher angles are associated with increased risk of supraspinatus tendonitis tear. Supraspinatus tendonitis is not associated with the morphometric parameters including CSA, AI and GI. New morphometric parameters should be identified and their relation with supraspinatus tendonitis should be investigated for early diagnosis.

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

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.