Acromial roof in patients with concentric osteoarthritis and massive rotator cuff tears: multiplanar analysis of 115 computed tomography scans

Beeler, Silvan; Hasler, Anita; Getzmann, Jonas M.; Weigelt, Lizzy; Meyer, Dominik C.; Gerber, Christian

doi:10.1016/j.jse.2018.03.014

Cited by 31 publications

(52 citation statements)

References 35 publications

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“…Recently, more attention has been paid to the morphologic characteristics of the posterior acromion in the sagittal plane. 2,3,30 A wider posterior acromial coverage of the humeral head has been described as a risk factor for RCT. 2 We found no significant difference in terms of anterior or posterior acromial coverage between patients with PP and those without PP.…”

Section: Discussionmentioning

confidence: 99%

“…2,3,30 A wider posterior acromial coverage of the humeral head has been described as a risk factor for RCT. 2 We found no significant difference in terms of anterior or posterior acromial coverage between patients with PP and those without PP. Conversely, acromia of patients with PP were significantly higher with respect to the center of the glenoid than in patients without PP.…”

Section: Discussionmentioning

confidence: 99%

“…On the basis of previously published data concerning RCT extension, 44 CSA, 31 and posterior acromial morphologic features, 2 an a priori power analysis revealed that for a significance level of .05 (type I error), a sample size of 50 patients in each group was sufficient to provide a desired power of 80% to determine significant differences in RCT extension, CSA, and posterior acromial morphologic characteristics.…”

Section: Methodsmentioning

confidence: 99%

“…10,13,44 The role of the acromion in association with PP has not been investigated so far, although some studies have shown its association with mRCT. 2 The lateral extension of the acromion in the coronal plane has been investigated clinically and biomechanically and has been identified as a risk factor for RCTs in patients with a high critical shoulder angle (CSA). 4,31,32,35 More recently, a specific morphologic state of the posterior acromion in the sagittal plane has been described as a risk factor for mRCT, where patients with RCT have a wider posterior acromial coverage of the humeral head.…”

mentioning

confidence: 99%

“…4,31,32,35 More recently, a specific morphologic state of the posterior acromion in the sagittal plane has been described as a risk factor for mRCT, where patients with RCT have a wider posterior acromial coverage of the humeral head. 2…”

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confidence: 99%

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Scapular Morphologic Characteristics and Rotator Cuff Tear Pattern Are Independently Associated With Chronic Pseudoparalyis: A Matched-Pair Analysis of Patients With Massive Rotator Cuff Tears

et al. 2020

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Background: It is unclear which structural parameters determine the development or the absence of chronic pseudoparalysis (PP) in patients with massive rotator cuff tears (mRCTs). Purpose: To determine whether scapular morphologic characteristics and extent of rotator cuff tearing are independent factors associated with chronic PP. Study Design: Case-control study; Level of evidence, 3. Methods: In this retrospective case-control study, 50 patients with chronic mRCT (≥2 fully detached tendons) and active scapular plane abduction less than 90° (PP group) were age- and sex-matched with a cohort of 50 patients with chronic mRCT and an active scapular plane abduction greater than 90° (non-PP; NPP group). Analysis of standardized, plain radiographs included measurement of the critical shoulder angle (CSA) and the acromiohumeral distance (ACHD) on anteroposterior views and measurement of posterior acromial tilt, anterior and posterior acromial coverage, and posterior acromial height on standardized outlet views. Measurements on magnetic resonance imaging included fatty muscle infiltration, anterior (subscapularis) and posterior (infraspinatus/teres minor) tear extension, and global tear extension (anterior + posterior tear extension) in the parasagittal plane. Results: Overall, no significant difference was found in patients’ demographic characteristics ( P > .05). Univariate analyses confirmed significant differences between the PP and NPP groups in active scapular plane abduction (51°± 22° vs 135°± 29°; P < .001). Multivariate analyses revealed independent factors associated with PP compared with the NPP group: CSA (38.2°± 4.6° vs 35.2°± 3.7°; P = .001); ACHD (4.7 ± 2.2 vs 7.3 ± 2.6 mm; P < .001); posterior acromial height (22 ± 10 vs 17 ± 7 mm; P = .005); and anterior (–9°± 21° vs 25°± 12°; P < .001) and posterior (–18°± 14° vs 2°± 14°; P < .001) tear extension. The NPP group had significantly less involvement and fatty infiltration of the subscapularis (1.4 ± 0.6) compared with the PP group (2.2 ± 0.9) ( P < .001). Conclusion: This study confirms that global RCT extension and the quality of the inferior half of the subscapularis are significantly associated with chronic pseudoparalysis. The study further shows that acromial morphologic characteristics are relevant in the development of pseudoparalysis. Patients with pseudoparalysis have a larger CSA, less ACHD, and a higher positioned acromion in the sagittal plane.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Scapular Morphologic Characteristics and Rotator Cuff Tear Pattern Are Independently Associated With Chronic Pseudoparalyis: A Matched-Pair Analysis of Patients With Massive Rotator Cuff Tears

et al. 2020

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Aktuelle Aspekte der Behandlung der Rotatorenmanschette

2022

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ZusammenfassungRotatorenmanschettenrupturen gehören zu den häufigsten muskuloskeletalen Erkrankungen und können mit ausgeprägten Schmerzen und Funktionseinschränkungen einhergehen. Für ihre Entstehung ist eine Vielzahl von Faktoren relevant, u. a. die individuelle Anatomie des Akromions. Mit Hilfe der heutigen technischen Möglichkeiten wurde nun festgestellt, dass zusätzlich zu seiner lateralen Ausdehnung auch die sagittale Ausdehnung des Akromions eine Rolle zu spielen scheint. Die bildgebende Darstellung der Rotatorenmanschette (RM) hat von den technischen Fortschritten der letzten Jahrzehnte ebenfalls profitiert. Magnetresonanztomographie (MRT) und MR-Arthrographie werden heute flächendeckend eingesetzt. Letztere bietet die höchste Sensitivität für die Entdeckung selbst kleiner Partialläsionen. Neue Sequenzen und Nachbearbeitungsmöglichkeiten können als hilfreiche tools für die operative Planung eingesetzt werden. Grundsätzlich richtet sich die Behandlung der RM neben der Symptomatik nach der Rupturgenese und -morphologie sowie der erwarteten Gewebequalität des Muskel-Sehnen-Kontinuums. Auch das Gesamtprofil, die Erwartungshaltung und die Rehabilitationsmöglichkeiten des Patienten sind wichtig. Die heutigen operativen Techniken werden durch spannende Entwicklungen der Industrie mitbestimmt, die in den letzten Jahren immer bessere Fadenankersysteme, aber auch Augmentationsmaterialien auf den Markt gebracht hat. Letztere zielen nicht nur auf die mechanische Verstärkung der Sehnenrekonstruktion, sondern auch auf die Optimierung der biologischen Eigenschaften des Konstrukts ab. Hinsichtlich Fixation konnte die biomechanische Forschung zeigen, dass zweireihige oder Suture-Bridge-Fixationen einreihigen oder transossären Fixationen überlegen sind. Diese Überlegenheit im Labor spiegelt sich noch nicht klar in den klinischen Ergebnissen wider, dennoch sind die meisten Chirurgen heute auf diese Technik übergegangen. Was die postoperative Nachbehandlung angeht, stellen jüngste randomisiert-kontrollierte Untersuchungen das Konzept der postoperativen Immobilisation in Abduktion in Frage. Hier scheint das letzte Wort noch nicht gesprochen zu sein.

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Lateral Acromioplasty With the Aim of Reducing the Critical Shoulder Angle Using Techniques Based on the Lateral Acromial Border Result in Larger-Than-Necessary Resections

Smith

Sawang

2022

Arthroscopy, Sports Medicine, and Rehabilitation

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Acromial roof in patients with concentric osteoarthritis and massive rotator cuff tears: multiplanar analysis of 115 computed tomography scans

Cited by 31 publications

References 35 publications

Scapular Morphologic Characteristics and Rotator Cuff Tear Pattern Are Independently Associated With Chronic Pseudoparalyis: A Matched-Pair Analysis of Patients With Massive Rotator Cuff Tears

Scapular Morphologic Characteristics and Rotator Cuff Tear Pattern Are Independently Associated With Chronic Pseudoparalyis: A Matched-Pair Analysis of Patients With Massive Rotator Cuff Tears

Aktuelle Aspekte der Behandlung der Rotatorenmanschette

Lateral Acromioplasty With the Aim of Reducing the Critical Shoulder Angle Using Techniques Based on the Lateral Acromial Border Result in Larger-Than-Necessary Resections

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