Critical shoulder angle does not influence retear rate after arthroscopic rotator cuff repair

Como, Christopher; Hughes, Jonathan D.; Lesniak, Bryson P.; Lin, Albert

doi:10.1007/s00167-021-06652-2

Cited by 9 publications

(6 citation statements)

References 31 publications

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“…25,26 However, some studies have reported opposite results. 4,27 In the present study, CSA values were significantly different between the groups with and without retear, with the maximum value in the FR group. This supports the concept that a wide lateral acromion is associated with postoperative tendon healing, as evidenced by the association of the CSA with failure of postoperative repair.…”

Section: Discussioncontrasting

confidence: 40%

A high acromion-greater tuberosity impingement index increases the risk of retear after arthroscopic rotator cuff repair

Ling-hui¹,

Ma³

et al. 2022

J Orthop Surg (Hong Kong)

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Background No evaluation has been done on the relationship of the acromion–greater tuberosity impingement index (ATI) with retear after arthroscopic rotator cuff repair (ARCR). Our purpose was to evaluate whether a higher ATI is associated with retear after ARCR. Methods 132 patients received ARCR and underwent MRI scan at a one year follow-up to assess tendon healing, and the findings were graded no retear (NR), partial-thickness retear (PR) or full-thickness retear (FR). The ATI, the critical shoulder angle (CSA), acromion index (AI) and lateral acromial angle (LAA) were measured with postoperative radiographs. Functional scores were obtained preoperatively and at a one year follow-up. Results Postoperative Constant scores and ASES scores were significantly different between groups with inferior outcomes in the FR group ( p < 0.05 for all). The UCLA score was significantly better in the NR group compared with the PR and FR groups ( p < 0.05), and in the PR group compared with the FR group ( p < 0.05). For ATI and CSA, the values of the PR and FR groups were larger than the NR group ( p < 0.05 for all), but there were no significant differences between the PR and FR groups ( p > 0.05 for all). No significant differences were observed with regard to the AI and LAA ( p > 0.05, respectively). The repair integrity was positively related to the ATI (0.304, p < 0.05) and CSA (0.252, p < 0.05), but not related to the AI or LAA ( p > 0.05 for both). ATI was not related to any functional scores ( p > 0.05 for all). Conclusion This study revealed that the ATI was positively related to rotator cuff retear. Patients with retears had significantly greater ATIs after ARCR. Level of Evidence: III, case–control study.

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Section: Discussioncontrasting

confidence: 40%

A high acromion-greater tuberosity impingement index increases the risk of retear after arthroscopic rotator cuff repair

Ling-hui¹,

Ma³

et al. 2022

J Orthop Surg (Hong Kong)

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“…In addition, higher CSAs increase the rate of retears following RCR 33–38 . However, other studies have questioned the diagnostic value and reliability of the CSA 39–42 . One important reason fueling the debate was the inherent measurement error of the CSA reported in previous studies.…”

Section: Discussionmentioning

confidence: 99%

The Critical Shoulder Angle Can be Accurately and Reliably Determined from Three‐Dimensional Computed Tomography Images

Long

Zhou

et al. 2023

Orthopaedic Surgery

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ObjectiveAnteroposterior (AP) radiographs do not necessarily offer the optimal approach to measuring the critical shoulder angle (CSA) due to the malposition of the scapula. Three‐dimensional computed tomography (3D‐CT) may offer some advantages, including the ability to rotate the scapula for position alignment and pre‐operative planning for reducing CSA. This study aimed to investigate the accuracy and reliability of CSA measurement in 3D‐CT and to determine whether there is an association between CSA and rotator cuff tears (RCTs).MethodsIn this retrospective study we identified 200 patients who received shoulder arthroscopy from 2019 to 2021, including 142 patients (81 females, 61 males) with RCTs and 58 patients (14 females, 44 males) with non‐RCTs. For each participant, CSA was measured from standard shoulder AP radiographs and anterior views of 3D‐CT of the scapula by two independent assessors. Inter‐ and intra‐observer agreements were assessed by the intraclass correlation coefficient (ICC). The relationship between the two measurement methodologies was determined by Spearman's correlation coefficient and Bland–Altman plots. Discriminative capacity was calculated by using receiver operating curve (ROC) analyses in the whole cohort and age sub‐groups above and below 45 years.ResultsWe found perfect inter‐observer (ICC >0.96) and intra‐observer (ICC >0.97) reliabilities for CSA measurements obtained from the standard AP radiographs and the 3D‐CT. There was a strong correlation between the two methods (r = 0.960, P < 0.001). The mean CSA was 31.7° ± 4.2° in the standard AP radiographs and 31.8° ± 4.4° in the 3D‐CT (mean difference 0.02°, P = 0.940; bias 0.02°, limits of agreement −2.29° to +2.33°). ROC analysis of the whole cohort showed that the CSA measured in the standard AP radiographs (area under the ROC curve [AUC] = 0.812, P < 0.001) and the 3D‐CT (AUC = 0.815, P < 0.001) predicted RCT with high confidence. ROC analysis of patients aged ≥45 years showed that the CSA measured from the standard AP radiographs (AUC = 0.869, P < 0.001) and the 3D‐CT (AUC = 0.870, P < 0.001) were very good at predicting RCTs.ConclusionCSA measured from standard AP radiographs and 3D‐CT showed high consistency, and the CSA could be accurately and reliably measured using 3D‐CT. CSAs measured from standard AP radiographs and 3D‐CT could predict RCTs, especially in patients aged ≥45 years.

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“…1,5,6,9,10,16,20,22,23 Multiple parameters from plain radiographs, such as critical shoulder angle, acromion index, and lateral acromial angle, showed no relationships with retears. 11,13,43 Studies of the usefulness of MRI-related factors, such as tear size, fatty infiltration, and muscle atrophy as prognostic indicators, have demonstrated relatively few discrepancies. 4,16,18,20,21,24,34 Compared with patient and plain radiograph factors, MRI-related factors are direct and more accurate indicators of tendon status.…”

Section: Discussionmentioning

confidence: 99%

“…3,12,16,23,31,37 Moreover, studies of the associations of findings on plain radiography and magnetic resonance imaging (MRI), such as critical shoulder angle and glenoid inclination angle, with the risk of retears have produced inconsistent results. 11,13,32,45 Furthermore, several studies have evaluated rapid and accurate methods to predict retears based on patient characteristics and imaging studies; however, the results have been inconclusive. 16,22 Fatty infiltration of the rotator cuff is one of the few consistent predictors of retears across multiple studies, as it may reflect the quality of rotator cuff tendons.…”

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confidence: 99%

Prediction of Retear After Arthroscopic Rotator Cuff Repair Based on Intraoperative Arthroscopic Images Using Deep Learning

Cho

Kim

2023

Am J Sports Med

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Background: It is challenging to predict retear after arthroscopic rotator cuff repair (ARCR). The usefulness of arthroscopic intraoperative images as predictors of the ARCR prognosis has not been analyzed. Purpose: To evaluate the usefulness of arthroscopic images for the prediction of retear after ARCR using deep learning (DL) algorithms. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: In total, 1394 arthroscopic intraoperative images were retrospectively obtained from 580 patients. Repaired tendon integrity was evaluated using magnetic resonance imaging performed within 2 years after surgery. Images obtained immediately after ARCR were included. We used 3 DL architectures to predict retear based on arthroscopic images. Three pretrained DL algorithms (VGG16, DenseNet, and Xception) were used for transfer learning. Training and test sets were split into 8:2. Threefold stratified validation was used to fine-tune the hyperparameters using the training data set. The validation results of each fold were evaluated. The performance of each model in the test set was evaluated in terms of accuracy, area under the receiver operating characteristic curve (AUC), F1-score, sensitivity, and specificity. Results: In total, 1138 and 256 arthroscopic images were obtained from 514 patients and 66 patients in the nonretear and retear groups, respectively. The mean validation accuracy of each model was 83% for VGG16, 89% for Xception, and 91% for DenseNet. The accuracy for the test set was 76% for VGG16, 87% for Xception, and 91% for DenseNet. The AUC was highest for DenseNet (0.92); it was 0.83 for VGG16 and 0.91 for Xception. For the test set, the specificity and sensitivity were 0.93 and 0.84 for DenseNet, 0.89 and 0.84 for Xception, and 0.70 and 0.80 for VGG16, respectively. Conclusion: The application of DL algorithms to intraoperative arthroscopic images has demonstrated a high level of accuracy in predicting retear occurrences.

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Critical shoulder angle does not influence retear rate after arthroscopic rotator cuff repair

Cited by 9 publications

References 31 publications

A high acromion-greater tuberosity impingement index increases the risk of retear after arthroscopic rotator cuff repair

A high acromion-greater tuberosity impingement index increases the risk of retear after arthroscopic rotator cuff repair

The Critical Shoulder Angle Can be Accurately and Reliably Determined from Three‐Dimensional Computed Tomography Images

Prediction of Retear After Arthroscopic Rotator Cuff Repair Based on Intraoperative Arthroscopic Images Using Deep Learning

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