BackgroundAmong the many causes of rotator cuff tears, scapular morphology is associated with the accelerating degenerative process of the rotator cuff. Acromion index (AI) was previously introduced and compared in two populations.MethodsWe enrolled 100 Korean patients diagnosed with full-thickness rotator cuff tears by magnetic resonance imaging and intraoperative arthroscopic findings between January and December 2013. Another 100 Korean patients with an intact rotator cuff tendon identified on magnetic resonance imaging and other shoulder diseases, such as frozen shoulder and instability, were enrolled as controls. We retrospectively compared these 100 rotator cuff tear patients (mean age, 63 years) and 100 controls (mean age, 51 years) in this study. Two independent orthopedic surgeons assessed the AI on radiographs. We performed an interobserver reliability test of the AI assessment, and then compared the AI between two groups.ResultsThe measurement of the AI showed excellent reliability (intraclass correlation coefficient, 0.82). The mean AI in the rotator cuff tear group was 0.68 and it was significantly different between groups (p<0.001, 95% confidence interval). The AI was not related to tear size.ConclusionsOur study showed that the AI was an effective predictive factor for rotator cuff tears in a Korean population.
Introduction: Anatomy of the anterior cruciate ligament (ACL) remains controversial. The double bundle ACL anatomical description remains the most accepted and used nowadays. In 2012, Smigielski et al. proposed a new anatomical concept: the ribbon-like structure of the ACL. The aim of this anatomical study was to verify this new concept and analyze the torsion of the ACL fibers. Methods: Sixty fresh cadaveric knees were dissected by two surgeons, according to an identique and predetermined protocol using a precise microsurgical dissection technique. After complete excision of the synovial membrane surrounding the ACL, the morphology of the ligamentous fibers, their femoral and tibial insertion and their torsion were measured. The femoral and tibial bony insertion were closely studied to determine their form, size and relationship to one another. Results: Ten knees were excluded because of an absent ACL or severe osteoarthritis rendering the inter-condylar notch unusable. The macroscopic anatomy of the ACL was the same in all-remaining cases: ACL formed a flat ribbonlike structure with only one bundle. None of the dissected ACL ligaments were found to have two bundles. With the knee at 90 degrees of flexion, an average ACL torsion of 74 degrees (66-92) was noted in relationship with its femoral and tibial insertion. After derotation, all ACL fibers became parallel. The femoral and tibial insertion zones were found to form two oblique lines with much smaller dimensions in regard to the previously proposed larger insertion zones. Conclusion: We confirm that a single ribbon-like structure bundle forms the ACL. The oblique line insertions create by femoral and tibial insertions easily explain the torsion of the ACL fibers at 90 degrees knee flexion and gives birth to this double bundle illusion in this position. Double-bundle ACL reconstruction techniques could not be therefore labelled anatomical.
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