Rotator Cuff Tear Group Research Articles

Coracoid Impingement and Morphology Is Associated with Fatty Infiltration and Rotator Cuff Tears.

This study describes measurements between the coracoid, glenoid, and humerus; characterizes coracoid shape, rotator cuff fatty infiltration, and quantitatively evaluates coracoid impingement and its association with anterosuperior rotator cuff tears (ASCT). 193 shoulder magnetic resonance imaging (MRI) scans demonstrating: rotator cuff tear; isolated tear of the supraspinatus; tear of supraspinatus and subscapularis, were included. MRI measurements included coracohumeral interval (CHI), coracoid overlap (CO), coracoid recess (CR), coracoglenoid angle (CGA), and coracoglenoid interval (CGI) on axial slices; acromiohumeral interval (AHI) on coronal slices; and coracohumeral interval (CHI) and coracoacromial ligament (CAL) thickness on sagittal slices. The coracoid shape was classified as flat, curved, or hooked. An Independent T-test was used to compare the MRI measurements and the different rotator cuff tear groups. In 79% of the patients with ASCT tears, the coracoid was curved. Axial CHI, CGA, sagittal CHI, and AHI were decreased in ASCT when compared to no tears and isolated supraspinatus tears (p < 0.05). CO was increased in ASCT compared to no tears and isolated supraspinatus tears (p < 0.05). Patients with an ASCT had a significantly increased subscapularis and supraspinatus Goutallier fatty infiltration score when compared to no tear and isolated supraspinatus tears (p < 0.05). These quantitative measurements may be useful in identifying patients at risk for ASCT. Level of Evidence III.

A prospective observational case control study investigating the coronal plane scapular morphological differences in full-thickness posterosuperior cuff tears and primary glenohumeral osteoarthritis.

The critical shoulder angle (CSA) is a surrogate marker of the coronal plane morphology of the scapula. CSA differences between scapulae could be due to differences in glenoid inclination (GI) or the location of the most lateral part of the acromion relative to the inferior glenoid, or both. An understanding of the hierarchy of the scapular morphological changes associated with glenohumeral osteoarthritis (GHOA) and rotator cuff (RC) tears would allow accurate biomechanical modeling. A prospective observational case control study was undertaken in which the GI, "nonglenoid"-CSA, acromial vertical offset index, acromial horizontal offset index, acromial horizontal-vertical offset index, and coronal plane angulation of the acromion (CPAA-m) were measured on high-quality radiographs to compare coronal plane scapular anatomy in: (1) patients with asymptomatic atraumatic full-thickness RC tears, (2) patients with symptomatic primary GHOA, and (3) a control group with no RC tear or GHOA treated for glenohumeral instability or symptomatic labral pathology. Intraobserver reliability of the measurements was performed. In the GHOA group, the GI was lower (less superiorly inclined) than the RC tear group (difference between the means: -4.8°, 95% confidence interval [CI] [-8.8°, -0.9°], P = .014) and the control group (difference between the means: -7.9°, 95% CI [-11.8°, -3.9°], P = .000); there was no difference in the acromial measurements. In the RC tear group, the nonglenoid-CSA was higher (difference between the means: 7.7°, 95% CI [3.0°, 12.3°], P = .001), the acromial vertical offset index was lower (difference between the means: -0.13, 95% CI [-0.24, -0.01], P = .026), and the acromial horizontal-vertical offset index was higher (difference between the means: 0.15, 95% CI [0.01, 0.28], P = .030) than the control group; there was no difference in the acromial horizontal offset index or the GI. The CPAA-m was lower (greater coronal plane downslope of the acromion) in both GHOA (difference between the means: -9.6°, 95% CI [-18.6°, -0.5°], P = .036) and RC tears (difference between the means: -9.9°, 95% CI [-19.0°, -0.9°], P = .029) compared with the control group. The intraclass correlation coefficients for intraobserver reliability demonstrated excellent reliability for the measurements (all >0.900). Scapulae associated with GHOA have lower GI, but no spatial differences in the location of the lateral acromion compared with a normal population. Scapulae associated with RC tears have a lower vertical offset of the lateral acromion, but no difference in horizontal offset or GI compared with a normal population. The downslope of the acromion in the coronal plane is greater (lower CPAA-m) in both RC tears and GHOA than the normal population.

Are there differences in arthroscopic and histological features between traumatic and degenerative rotator cuff tears in elderly patients? A prospective dual-center analysis

BackgroundDiscriminating traumatic rotator cuff tears (RCTs) from degenerative RCTs is sometimes difficult in elderly patients because the prevalence of asymptomatic RCTs increases with age. Little intraoperative information is available on the characteristics of traumatic and degenerative RCTs in elderly patients. The purpose of this study was to compare the arthroscopic findings and histological changes of the coracoacromial ligament (CAL) between traumatic and degenerative RCTs in elderly patients.MethodsForty-two shoulders of 42 patients aged ≥ 65 years underwent arthroscopic rotator cuff repair. Nineteen patients had traumatic full-thickness RCTs (Group T), and 23 had degenerative full-thickness RCTs (Group D). The quality of the rotator cuff tissue and the condition of the long head of the biceps were examined. The grade of CAL was evaluated both arthroscopically and histologically. The stiffness of the musculotendinous unit was calculated by measuring the force and displacement using a tensiometer. The arthroscopic and histological findings of the two groups were compared.ResultsAlthough the mean tendon displacement was comparable, the stiffness was different between Group T and Group D (0.56 ± 0.31 and 1.09 ± 0.67 N/mm, respectively; p < 0.001). Both arthroscopic and histological analysis of the CAL showed that the degenerative changes in the CAL were milder in Group T than in Group D (p < 0.001 and p < 0.001, respectively). There was a moderate positive correlation between the arthroscopic findings of CAL degeneration and the histopathological changes in this ligament (r = 0.47, p = 0.002).ConclusionsTraumatic RCTs were characterized by preserved elasticity of the musculotendinous unit and milder CAL degeneration compared with degenerative RCTs even in elderly patients.

Concomitant Glenohumeral Instability and Rotator Cuff Injury: An Epidemiologic and Case-Control Analysis in Military Cadets.

Concomitant rotator cuff tear and glenohumeral instability in a large cohort of young and active patients has not been examined. The purpose of this study was to investigate the incidence, associated variables, and outcomes in military cadets undergoing shoulder stabilization procedures with these concomitant pathologies. A retrospective cohort study of a consecutive series of collegiate patients who underwent shoulder stabilization from 2014 to 2018 at a single service academy was conducted. Exclusion criteria were noncadets, revision instability cases, multidirectional instability, and prior rotator cuff repair. A nested case-control analysis was done in a matched series of patients with and without MRI evidence of rotator cuff tear. Baseline demographics, VAS pain scale, physical therapy duration, and time to surgery were analyzed. Postoperative metrics included rate of recurrent instability, subjective outcomes, VAS pain scale, and military-specific criteria. Three hundred twenty-four cadets met the inclusion criteria, including 272 men and 52 women averaging 20.53 ± 1.80 years of age. MRI demonstrated concomitant rotator cuff tears in 5.56% of cases. A matched case-control comparison between patients with (rotator cuff tear group) and without (no rotator cuff tear group) rotator cuff tear showed no differences in preoperative data, recurrent instability rate, or postoperative VAS pain scores (0.24 versus 0.88, P = 0.207) at mean 44-month follow-up. Fifteen of 17 patients (88.2%) in each group returned to full activity (P > 0.999). No patients failed to graduate due to shoulder concerns. No patients in the rotator cuff tear group underwent a medical board for separation from the military compared with 2 (11.8%) in the no rotator cuff tear group (P = 0.163). The incidence of concomitant rotator cuff tears in this study of military cadets undergoing shoulder stabilization was 5.56%. In a matched cohort comparison, the presence of a rotator cuff tear on preoperative MRI was not associated with inferior clinical outcomes.

The effect of sagittal orientation of the acromion relative to the scapular spine on the location of rotator cuff tears.

The aim of this study was to investigate the effect of the angle between the scapular spine and acromion in the sagittal plane on the location of chronic rotator cuff tears (RCTs). The magnetic resonance images of patients who had undergone an arthroscopic shoulder surgery were evaluated. The patients were divided into two groups: patients who had undergone RCT repair and those who had experienced different shoulder surgery as a control group. The RCT group (study group) was then subgrouped in terms of the location of the tear as posterior-superior RCT type 3, 4, 5 or combination (group A) and anterior-superior RCT type 1,2,3 or combination using the Patte sagittal classification (group B). A novel angle, scapular spine-acromion angle (SSAA), was described in the sagittal plane and compared between the groups and subgroups. A total of 96 patients underwent an arthroscopic RCT repair with a mean age of 59.5 years (range, 36-65 years), and the control group was composed of 40 patients with a mean age of 52.5 (range, 41-63 years). Comparison the group B (mean value: 73.41°±5.98°, median: 73,8°, range: 60.6°-89.7°) has significantly higher degrees of SSAA than group A (mean value: 63.92°±6.82°, median: 64,8°, range: 52.3°-77.9°) (P < 0.001). This study demonstrated a higher incidence of posterior- superior RCTs in patients with lower SSAA and anterior-superior RCTs in patients with higher SSAA in the sagittal plane compared to the control group. So sagittal acromial orientation might influence the RCT location. Level III, Diagnostic Study.

Are differences in shoulder morphology and hand dominance risk factors for rotator cuff tears?

The purpose of this study was to evaluate whether there was a difference in shoulder morphology and hand dominance between a healthy shoulder and a shoulder with rotator cuff tear (RCT) in the same patient. Between 2015 and 2020, 120 shoulders from 60 patients with complete RCT and contralateral intact rotator cuffs were enrolled in this retrospective analysis. Physical examinations, shoulder radiographs, and magnetic resonance imaging (MRI) pictures of the patients were reviewed. On radiographs, the AT, CSA, LAA, and AI values were compared between shoulders with complete RCT and contralateral healthy shoulders from the same individuals. Additionally, the association between hand dominance and RCT was evaluated. This study enrolled 60 patients. 59.17% of the participants are female, and 40.83% are male. The mean age of the patients was 54.5±7.1 years. There were statistically significant differences in AI, CSA, and LAA measurements between the study group (RCT group) and the control group. There was no significant difference in AT between the two groups. There are morphological differences between a healthy shoulder and a shoulder with an RCT in the same patient, and these differences (LAA/CSA/AI/AT) may have an effect on the prevalence of RCT.

L’angle critique de l’épaule et l’indice acromial sont-ils corrélés à la taille des lésions de la coiffe des rotateurs

PurposeScapular morphology is an extrinsic factor playing role in rotator cuff tear (RCT) etiology. The objective of this study was to evaluate the relationship between critical shoulder angle (CSA) and acromion index (AI) with partial-bursal side and full thickness RCT and the size of the RCT. HypothesisThe hypothesis was that CSA and AI would be greater in partial bursal-side RCT and full-thickness RCT patients and would increase with the size of the RCT. MethodsThis retrospective study assessed 218 patients who had standard shoulder radiographs and magnetic resonance imaging. Patients were divided into three groups: intact rotator cuff (68), partial bursal-side RCT (34) and full-thickness RCT (116). In the second part, full-thickness RCT patients were divided into four groups according to RCT size; small (<1cm), medium (1–3cm), large (3–5cm) and massive (>5cm). AI and CSA measurements were evaluated from radiographs. ResultsThe mean CSA was 32.8° in control group, 34.3° in partial group and 36.9° in full-thickness group. The mean AI was 0.66, 0.68 and 0.72, respectively. Significant difference was found in AI and CSA between full thickness RCT and intact RC group (p<0.01), and partial RCT and full thickness RCT group (p<0.05) in paired comparisons. In full thickness RCT size groups, the mean CSA was 34.2°, 36.4°, 39.0° and 40.8° and mean AI was 0.70, 0.71, 0.73 and 0.79, respectively. Significant difference was found between small-large, small-massive and medium-massive groups for CSA in paired comparisons and between small-massive, medium-massive groups for AI. ConclusionCSA and AI were significantly greater in full-thickness RCT patients and the size of the RCT increased with CSA and AI. The greater CSA and AI could be predictors for larger RCT. Level of evidenceIII; cross-sectional design; prognosis study.

Mild inflammation persists in the glenohumeral joint of patients with shoulder instability: Cross-sectional study

ObjectiveApproximately two-thirds of patients with history of shoulder dislocation may develop osteoarthritis (OA) of the glenohumeral joint. However, the biochemical mechanisms underlying the association between dislocation and OA are largely unknown. This study aimed to investigate macrophage markers and inflammatory cytokine expression associated with shoulder instability (SI) in comparison to rotator cuff tears (RCTs). DesignThis study included 30 patients with SI and 30 patients with RCTs. Synovial membrane samples were harvested from the rotator interval during the arthroscopic anatomical repair for both groups. The localization of tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, and cluster of differentiation (CD) 68 in synovial membranes was determined by immunohistochemistry. Transcript-level expressions of the inflammatory cytokines (TNFA and IL1B) and macrophage markers pan-CD68 and -M1 (CD80 and CD86) were quantified. CD80 and CD86 expression in macrophages from the SI group was confirmed using flow cytometry. ResultsTNF-α, IL-1β, and CD68 were expressed in the synovial lining layer of the synovial tissue in both groups. In addition, the mRNA expressions of TNFA, IL1B, CD68, and CD80 were significantly higher in the SI group compared to the RCT group (P ​= ​0.012, 0.014, 0.022, 0.003, respectively). In samples from the SI group, 96.3% of CD68+/CD14+ macrophages were CD86-positive, whereas 2.5% of CD68+/CD14+/CD86+ cells were CD80-positive. ConclusionsPatients with SI had higher mRNA levels of TNFA, IL1B, CD68, and CD80 than those with RCTs. These findings may partially explain the biochemical mechanism underlying the frequent development and progression of osteoarthritis in patients with SI.

Ultrasound shear wave elastography-derived tissue stiffness is positively correlated with rotator cuff tear size and muscular degeneration.

The purpose of this study is to describe rotator cuff muscle stiffness in patients with different degrees of rotator cuff tear (RCT) severity and to assess its predictive ability for RCT reparability. One hundred and thirty-three consecutive patients who were scheduled to undergo arthroscopic shoulder surgery were prospectively enrolled. Tendon retraction, fatty infiltration, and muscle atrophy were evaluated using magnetic resonance imaging. Shear modulus of supraspinatus (SSP) and infraspinatus (ISP) muscles were measured by ultrasound shear wave elastography (SWE). The tear size and reparability were determined intraoperatively. There were 97 patients in RCT group and 36 patients in control group. Bilateral shear modulus discrepancy (Δshear modulus) was used to represent rotator cuff stiffness. Severely fatty-infiltrated rotator cuff muscles possessed a significantly higher stiffness compared with their counterparts (SSP: CI 27.8-31.8 vs. 13.5-15.6kPa, ISP: CI 33.2-38.1 vs. 8.8-11.2kPa, p < 0.001). The same trend applied to muscles with distinct tendon retraction (SSP: CI 27.7-32.3 vs. 10.9-14.9kPa, ISP: CI 33.2-38.6 vs. 6.5-11.0kPa, p < 0.001) and obvious muscle atrophy (SSP: CI 27.9-32.1 vs. 13.6-15.8kPa, ISP: CI 32.9-38.2 vs. 9.0-11.7kPa, p < 0.001). Irreparable massive RCT (MRCT) patients had significantly stiffer SSP (CI 27.7-31.9 vs. 13.5-16.5kPa, p < 0.001) and ISP (CI 33.5-37.8 vs. 10.3-14.8kPa, p < 0.001) than reparable MRCT. The Δshear modulus of the ISP was a highly accurate predictor of RCT reparability. A cutoff value of 18.0kPa had a sensitivity of 100% and specificity of 98.8% for irreparable MRCT. Ultrasound SWE-derived rotator cuff muscle stiffness is closely correlated with RCT size and severity. I.

A study of association between acromion types and shoulder pathology

INTRODUCTION: Shoulder impingement and rotator cuff tear are commonly seen in shoulder pathology. Pathological changes in the soft tissue around the shoulder can be due to intrinsic degenerative in tendons or extrinsic mechanical compression due to acromion types. Changes in acromion morphology have been postulated, which might be one of the causes of impingement syndrome and rotator cuff tears. But few study results have shown that role of the acromion is doubtful. Our primary objective was to determine acromion types and their prevalence rate with shoulder pathology. MATERIALS AND METHODS: Our study was a prospective study. Eighty-five patients who met the inclusion criteria were included in the study. According to Bigliani et al., acromion types were classified as type 1 acromion that has a flat undersurface, type 2 acromion that has a curved undersurface, and type 3 acromion that has a hooked undersurface on supraspinatous outlet view radiographs. Types of acromion were correlated with shoulder pathology (shoulder impingement and rotator cuff tear). RESULTS: Out of 85 patients with shoulder pathology, 43 patients had impingement shoulder syndrome and 42 patients had rotator cuff tear. Mean age for the impingement shoulder syndrome group was 39.6 years and for the rotator cuff tear group it was 58.6 years. Overall right shoulder is affected more as compared with the left shoulder. Type 2 acromion was seen in 64.7% study population, type 1 was seen in 23.5%, and type 3 was seen in 11.8%. CONCLUSION: In our study, type 2 acromion is more frequently seen in shoulder pathology involving rotator cuff tear and impingement syndrome.

The impact of full-thickness rotator cuff tear on shoulder function and quality of life in patients who sustain a proximal humerus fracture-a prospective cohort study.

BackgroundOnly few studies have investigated the impact of rotator cuff integrity on patients with proximal humerus fracture (PHF). We aimed to determine if the presence of a rotator cuff tear impairs shoulder function and health-related quality of life (HRQoL) after nonsurgically treated PHF.MethodsSixty-seven patients with PHF were recruited prospectively in a cohort. Presence of a full-thickness rotator cuff tear was determined by ultrasound examination. After 6 and 12 months, Constant-Murley Score; Disability of the Arm, Shoulder and Hand; the Visual Analog Scale; EuroQol-5 Domain; and the 15D scores were compared between the patients with a rotator cuff tear and patients with an intact rotator cuff.ResultsThe prevalence of a full-thickness rotator cuff tear was 34%. After 12 months, the mean Constant-Murley Score was 65.7 (standard deviation 16.3) in the intact rotator cuff group vs. 53.9 (16.0) in the rotator cuff tear group (mean diff. 11.8, 95% confidence interval 2.5; 21.2) and was found to be a clinically relevant difference. A significantly lower HRQoL was found on the EuroQol-5 Domain score after 12 months in the rotator cuff tear group with a median score of 1 (interquartile range 0.23) in the intact rotator cuff group vs. 0.75 (interquartile range 0.34) in the rotator cuff tear group (P = .03). In the remaining outcome measures, no statistically significant between-group differences were detected.ConclusionRotator cuff tear in older adults with nonsurgically treated PHF may be considered a prognostic factor for poorer shoulder function and HRQoL. This knowledge can support the planning of treatment.

A lower critical coracoid process angle is associated with type-B osteoarthritis: a radiological study of normal and diseased shoulders.

BackgroundDegenerative rotator cuff tears and osteoarthritis (OA) are associated with differences in coronal plane scapular morphology, with particular focus on the effect of the critical shoulder angle (CSA) on shoulder biomechanics. The effect, if any, of axial plane scapular morphology is less well established. We have noticed wide disparity of axial coracoid tip position in relation to the face of the glenoid and sought to investigate the significance of this through measurement of the critical coracoid process angle (CCPA), which incorporates coracoid tip position and glenoid version.MethodsCCPA, CSA, and glenoid retroversion were measured by three independent reviewers from the cross-sectional two-dimensional computed tomography (CT) and magnetic resonance imaging of 160 patients in four equal and matched case-control groups: (1) a control group of patients with a radiologically normal shoulder and no history of shoulder symptoms who had a CT thorax for another reason, (2) patients with primary OA with Walch type-A glenoid wear pattern on CT scan, (3) patients with type-B glenoid primary OA, and (4) patients with magnetic resonance imaging–proven atraumatic tears of the posterosuperior rotator cuff.ResultsInterobserver agreement was excellent for all measured parameters. The median CCPA was significantly lower in the type-B OA group (9.3˚) than that in controls (18.7˚), but not significantly different in the other study groups. There was a trend toward greater glenoid retroversion in the type-B OA group, but receiver operating characteristic curve analysis demonstrated the CCPA to be by far the most powerful discriminator for type-B OA. The optimal cutoff value was calculated for the CCPA at 14.3˚ with a sensitivity of 93% and specificity of 90% for type-B OA. Compared with controls, the CSA was significantly higher in the rotator cuff tear group and lower in both OA groups, but did not differentiate between type-A and type-B OA.ConclusionCombined with a lower CSA, a lower CCPA (<14.3˚) is strongly predictive of type-B glenoid OA. The authors propose a simple model of pectoralis major biomechanics to explain the effect of this axial plane anatomical variation, which requires further investigation.

Are critical shoulder angle and acromion index correlated to the size of a rotator cuff tear

PurposeScapular morphology is an extrinsic factor playing role in rotator cuff tear (RCT) etiology. The objective of this study was to evaluate the relationship between critical shoulder angle (CSA) and acromion index (AI) with partial-bursal side and full thickness RCT and the size of the RCT. HypothesisThe hypothesis was that CSA and AI would be greater in partial bursal-side RCT and full-thickness RCT patients and would increase with the size of the RCT. MethodsThis retrospective study assessed 218 patients who had standard shoulder radiographs and magnetic resonance imaging. Patients were divided into three groups: intact rotator cuff (68), partial bursal-side RCT (34) and full-thickness RCT (116). In the second part, full-thickness RCT patients were divided into four groups according to RCT size; small (<1cm), medium (1-3cm), large (3-5cm) and massive (>5cm). AI and CSA measurements were evaluated from radiographs. ResultsThe mean CSA was 32.8̊ in control group, 34.3̊ in partial group and 36.9̊ in full-thickness group. The mean AI was 0.66, 0.68 and 0.72 respectively. Significant difference was found in AI and CSA between full thickness RCT and intact RC group (p<0.01), and partial RCT and full thickness RCT group (p<0.05) in paired comparisons. In full thickness RCT size groups the mean CSA was 34.2̊, 36.4̊, 39.0̊ and 40.8̊ and mean AI was 0.70, 0.71, 0.73 and 0.79 respectively. Significant difference was found between small-large, small-massive, medium-massive groups for CSA in paired comparisons and between small-massive, medium-massive groups for AI. ConclusionCSA and AI were significantly greater in full-thickness RCT patients and the size of the RCT increased with CSA and AI. The greater CSA and AI could be predictors for larger RCT. Level of evidenceIII; Cross-Sectional Design; Prognosis Study.

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.

High Critical Shoulder Angle Values Are Associated With Full-Thickness Posterosuperior Cuff Tears and Low Values With Primary Glenohumeral Osteoarthritis

To compare critical shoulder angle (CSA) measurements using high-quality radiographs in the following groups: Group 1: symptomatic atraumatic full-thickness rotator cuff (RC) tears; Group 2: symptomatic primary glenohumeral osteoarthritis (GHOA); and Group 3: no RC tear or primary GHOA being treated for glenohumeral instability or symptomatic labral pathology (control group). A prospective observational case control study with 10 shoulders in each group was performed GHOA and full-thickness RC tears were diagnosed by radiographs and magnetic resonance imaging (MRI). For these three groups, the exclusion criteria were the following: Group 1) partial thickness RC tears, traumatic RC tears, isolated subscapularis tears, and advanced cuff tear arthropathy with erosion of the superior glenoid; Group 2) secondary causes of glenohumeral arthritis; coexistent full-thickness RC tear; and Group 3) glenoid bone lesions that may affect the CSA measurement. Only shoulders with adequate radiographic quality (Suter-Henninger type A and C) were eligible. A one-way ANOVA, followed by Tukey multiple pairwise-comparisons test, was performed to compare the groups. Interobserver and intraobserver reliability was assessed using Intraclass Correlation Coefficients (ICC). Mean CSA values were 37.4° ± 4.7 (RC tear group), 28.9° ± 2.4 (GHOA group), and 32.8° ± 1.1 (control group). The CSA of the RC group was higher than the control group (P= .006) and the GHOA group (P= .000). The CSA of the GHOA group was lower than the control group (P= .027). Intraobserver and interobserver reliabilities for the CSA measurement were excellent (Observer 1 [ICC]: .986 [95% CI .970-.993]; Observer 2 [ICC]: .976[95% CI .951-.989]; and Observer 1v2: 0.968[95% CI .933-.985]). There is a difference in the CSA between patients with symptomatic atraumatic full-thickness RC tears (4.6° higher than the control group), symptomatic GHOA (3.8° lower than the control group), and glenohumeral instability or labral pathology with no RC tear or GHOA. Level 2, prospective observational case control diagnostic study.

Sharpened lateral acromion morphology (SLAM sign) as an indicator of rotator cuff tear: a retrospective matched study.

BackgroundBigliani types of acromion and critical shoulder angle (CSA) have been implicated as indicators of rotator cuff disease. A sharpened inferolateral edge of acromion (termed as Sharpened Lateral Acromion Morphology or SLAM sign) is frequently observed in anteroposterior radiographs of the glenohumeral joint in patients with rotator cuff tears (RCT). We aimed to evaluate the association of the SLAM sign with RCT in comparison to high CSA (≥35°) and Bigliani type 3 (hooked) acromion.MethodsA cohort of 100 consecutive patients undergoing non-arthroplasty surgery for RCT and 106 patients with primary frozen shoulder were matched manually in 1:1 ratio based on age and gender to yield study population with 50 patients in each group. The 2 groups were compared for the presence of the SLAM sign, high CSA, and type 3 acromion on the radiographs.ResultsAll the 3 parameters were found more prevalent in the RCT group than the frozen shoulder group (SLAM, 46% vs. 0; high CSA, 60% vs. 40%; type 3 acromion, 18% vs. 4%) (P < .05). The SLAM sign showed stronger correlation with RCT than high CSA and type 3 acromion (Ps = 0.562 vs. 0.220 vs. 0.224 respectively).ConclusionThe SLAM sign is a simple and easily identifiable radiological predictor of rotator cuff disease.

Correlación de la morfología de la glenoides y la cobertura del acromion con rupturas de manguito rotador

BackgroundThe purpose of this study was to determine if there is a difference between the critical shoulder angle measured by MRI in patients with rotator cuff tear and healthy patients, also to evaluate the intraobserver reliability in this measure. Other variables were included as well, lateral acromial extension, acromial height, glenoid version, glenoid inclination and lateral acromial angle. Materials and methodsTwo groups were evaluated, the control group consisted in a total of 16 patients and the group with rotator cuff tear consisted of 15 patients. The critical shoulder angle, glenoid inclination, glenoid version, acromial height, lateral acromial extension and lateral acromial angle were measured on MRI. A student T test was used for comparison of means between both groups, Pearson correlation coefficient was used for evaluating the association between variables. The intraobserver reliability was evaluated using the intraclass correlation coefficient. ResultsA result of 0.961 was obtained for the intraobserver reliability using the intraclass correlation coefficient for the critical shoulder angle. For the comparison of means of the critical shoulder angle in the control group and the rotator cuff tear group a result of 32.3° (3.6) vs. 35.01° (2.4) was obtained with a statistically significant difference of p=0.02. Likewise, statistically significant differences were obtained in the glenoid inclination and glenoid version in both groups (81.56° SD 4.04 vs 77.11° SD 3.84; p=0.004) and (−4.47° SD 4.56 vs −1.58° SD 3.94; p=0.04). DiscussionCritical shoulder angle measured by MRI is statistically significant different in control group and in rotator cuff tear group.Evidence Level: III.

Acromial Index in Indian Population and it’s Significance on Rotator Cuff Tears

Background: The etiopathogenesis of rotator cuff tears remains debatable. Among the many causes, abnormal scapular morphology has been found to accelerate the degenerative process of rotator cuff tears. The morphology and lateral extension of the acromion process were assessed indetail by Nyffeler et al. and the Acromion Index (AI) was introduced, which measures the lateral extension of the acromion. It was theorized that a large lateral extension of the acromion increased the chances of the supraspinatus tendon to degenerate because of impingement between the acromion and the deltoid muscle. The AI was compared between patients with rotator cuff tears and patients with an intact rotator cuff. Methods: 21 Indian patients presenting to the orthopaedics OPD, Yenepoya Medical College, with rotator cuff tears were taken up for this study between August 2020 and February 2021. Another 21 patients with intact rotator cuff and other shoulder diseases such as frozen shoulder were included in this study. Patients with rotator cuff tears were included in group A, and patients with intact rotator cuff were included in group B. Both groups had the AI measured on radiographs, and their values were compared. Results: The mean Acromial Index (AI) in the rotator cuff tear group was 0.74 and in the intact rotator cuff group it was 0.59, which was statistically significant. There was no statistical difference in AI between male and female patients. The mean age of the patients in the rotator cuff group was 50.8 years, and in non rotator cuff tear group, it was 50.2 years. Conclusion: Acromial Index is a useful predictive tool for detecting rotator cuff tears in the Indian population. Further studies are required to assess its usefulness in predicting the progression of a rotator cuff tear. Keywords: Rotator cuff tear; Acromial Index; Shoulder.

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

PurposeTo evaluate the effect of several shoulder anatomical parameters in the development of rotator cuff tear (RCT). MethodsBetween 2014 and 2018, all consecutive patients who underwent arthroscopic rotator cuff repair due to full-thickness rotator cuff tear with a minimum 2-year follow-up were identified. Inclusion criteria were (1) age>18 years, (2) patients with degenerative RCT, (3) full-thickness RCTs, (4) patients underwent arthroscopic RCR due to unresponsive conservative treatment, (5) minimum 2-year follow-up period. Exclusion criteria were traumatic RCT, history of previous shoulder surgery, shoulder deformity, neurologic or neuromuscular dysfunction, glenohumeral and/or acromioclavicular joint arthritis, cuff-tear arthropathy, history of fracture around shoulder and inadequate or low-quality magnetic resonance images (MRI). Acromion index (AI), Critical shoulder angle (CSA), Coracoacromial ligament (CAL) thickness, Subacromial space (SS) width, Acromiohumeral distance (AHD), CAL/SS ratio, Lateral acromial angle (LAA) and glenoid version angle (GVA) parameters were measured on MRI. Intra- and interobserver reliability were measured. Regression analysis was used to evaluate the association between anatomical parameters and RCT development. Receiver operating curves (ROC) were created for independent risk factors. The correlation between measurement parameters were evaluated. ResultsThere were 1029 patients met the inclusion criteria. After exclusions, 437 patients were included. Age- and sex matched 437 patients without any shoulder pathologies were selected as control group. There was almost perfect intra- (ICC>0.85) and interobserver (ICC> 0.81) reliability regarding all measurement parameters. There was significant difference between RCT group and control group regarding AI (0.67±0.07 vs. 0.61±0.08, p<0.001), CSA (33.58±3.93 vs. 31.50±4.01, p<0.001), CAL thickness (1.81±0.64 vs. 1.53±0.50, p<0.001), CAL/SS ratio (0.29±0.14 vs. 0.23±0.10, p<0.001) and GVA (-16.69±6.69 vs. -15.37±5.95, p=0.002) parameters. AI (OR: 1.998, P<0.001), CAL thickness (OR: 2.801, p<0.000) and CSA (OR: 3.055, p<0.001) were found to be independently associated with the increased risk of RCT development. Area under curve (AUC) of the AI, CSA, and CAL thickness were 71.4%, 71.3%, and 70.2%, respectively. Cut-off values for AI, CSA, and CAL thickness were 0.62, 36.4° and 1.47 mm, respectively. There was significantly positive strong correlation between AI and CSA (p<0.001, r=0.814). ConclusionHigher AI, CSA and CAL thickness independently associated with full-thickness RCT development. In clinical practice, these parameters may be useful in the prediction of rotator cuff rupture.

Evaluation of critical shoulder angle and acromion index in patients with anterior shoulder instability and rotator cuff tear.

The aim of this study was to evaluate glenohumeral morphologic differences and their correlation between glenohumeral instability and rotator cuff pathology. Two-hundred radiographs and 100 MRI scans of 100 patients in whom the diagnosis of Anterior Shoulder Instability (Anl) or Rotator Cuff Tear (RCT) was arthroscopically verified were retrospectively identified and included in the study. All the patients were categorized into two groups: 50 patients with Anl (23 female, 28 male; mean age = 29 ± 7.4) and 50 patients with RCT (28 female, 22 male). Two separate control groups were then formed, one of which included contralateral shoulders of patients in the AnI group, and the other consisted of contralateral shoulders of patients in the RCT group. The x-ray and MRI scans were examined by an orthopedic surgeon and a radiologist. The Acromial Index (AI) and the Critical Shoulder Angle (CSA) were measured on true anteroposterior shoulder radiographs; Glenoid Inclination (GI), Glenoid Version (GV), and Acromion Angulation (AA) were measured on MRI. In the AnI group, the measurements were as followed: AI, 0.66 ± 0.03; CSA, 33 ° ± 2.85; GI, 3.4° ± 6.2; GV, 4.1 ± 4.3; and AA, 12.9 ± 8.3. In the RCT group, AI 0.71 ± 0.04; CSA, 36° ± 2.69; GI, 9.1 ± 5; GV, 6.7 ° ± 5.7; and AA, 14.3° ± 8.7. A moderate correlation was found between CSA and GI (r = 0.41, P = 0.001) and between AI and GI (r = 0.42, P = 0.014). A weak correlation was found between AI and GI in the AnI group (r = 0.22, P = 0.001). The inter- and intra-observer intraclass correlation coefficients were respectively 0.81 and 0.84 for AI, 0.88 and 0.92 for CSA, 0.72 and 0.76 for GI, 0.69 and 0.73 for GV, and 0.72 and 0.77 for AA. The results of this study have shown that lower AI, GI, and antevert GV may be associated with AnI. Investigating CSA, AI, and GV could be useful for diagnostic evaluation of patients with AnI. Level III, Diagnostic Study.