Different acromial roof morphology in concentric and eccentric osteoarthritis of the shoulder: a multiplane reconstruction analysis of 105 shoulder computed tomography scans

Beeler, Silvan; Hasler, Anita; Götschi, Tobias; Meyer, Dominik C.; Gerber, Christian

doi:10.1016/j.jse.2018.05.019

Cited by 25 publications

(25 citation statements)

References 37 publications

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“… 61 – 64 Recently, Beeler et al identified a flat acromion roof as a potential risk factor for posterior humeral head subluxation and posterior glenoid wear. 65 This hypothesis was confirmed in a subsequent study by Meyer et al, reporting a median of 4 degrees more glenoid retroversion and a 5-degree less steep acromion in type B2 and C compared to type A and B1 glenoids (P ≤ 0.022). 66 …”

Section: Anatomic Total Shoulder Arthroplasty (Atsa)mentioning

confidence: 67%

Biomechanics of anatomic and reverse shoulder arthroplasty

et al. 2021

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The biomechanics of the shoulder relies on careful balancing between stability and mobility. A thorough understanding of normal and degenerative shoulder anatomy is necessary, as the goal of anatomic total shoulder arthroplasty is to reproduce premorbid shoulder kinematics. With reported joint reaction forces up to 2.4 times bodyweight, failure to restore anatomy and therefore provide a stable fulcrum will result in early implant failure secondary to glenoid loosening. The high variability of proximal humeral anatomy can be addressed with modular stems or stemless humeral components. The development of three-dimensional planning has led to a better understanding of the complex nature of glenoid bone deformity in eccentric osteoarthritis. The treatment of cuff tear arthropathy patients was revolutionized by the arrival of Grammont’s reverse shoulder arthroplasty. The initial design medialized the centre of rotation and distalized the humerus, allowing up to a 42% increase in the deltoid moment arm. More modern reverse designs have maintained the element of restored stability but sought a more anatomic postoperative position to minimize complications and maximize rotational range of motion. Cite this article: EFORT Open Rev 2021;6:918-931. DOI: 10.1302/2058-5241.6.210014

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Section: Anatomic Total Shoulder Arthroplasty (Atsa)mentioning

confidence: 67%

Biomechanics of anatomic and reverse shoulder arthroplasty

et al. 2021

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“…The ALA corresponded to the distance between AA and AC in the sagittal (xy) plane, measured as an angle using AI as the third landmark. Again, it is similar to the "overall glenoid coverage" proposed by Beeler et al [7,8], but uses AI instead of the glenoid center as the middle point, to better correlate with the AA-AC segment (R 2 = 0.908 vs. R 2 = 0.093, respectively). In our series of normal scapulae, these two angles were only weakly correlated (R 2 = 0.127), and the variability range of ALA was five times lower.…”

Section: Discussionmentioning

confidence: 75%

“…However, a wide range of acromion angles have recently been described with increasing interest in characterizing the acromion morphology. The APA presents similarities with the "posterior glenoid coverage" proposed by Beeler et al as both are based on AAx and the medio-lateral scapular plane [7,8]. However, Beeler et al used the glenoid center as the middle point, while we used the AI instead not only because it is not affected by glenohumeral osteoarthritis, unlike the glenoid center, but also and primarily to better correlate the APA with the posterior extension of the acromion (AAx).…”

Section: Discussionmentioning

confidence: 88%

“…Compared with osteoarthritic shoulders, the acromion was more externally rotated (axial plane), more downward tilted (coronal plane), and had wider posterior coverage of the glenoid (sagittal plane) in shoulders with rotator cuff tears [7]. The same research group further found a significant difference between shoulders with concentric and eccentric primary glenohumeral OA, and concluded that a flatter acromion roof with less posterior glenoid coverage could contribute to static posterior subluxation of the humeral head and posterior glenoid wear [8]. Furthermore, Meyer et al were able to link a decreased posterior acromion slope and increased glenoid retroversion with static posterior subluxation of the humeral head and posterior glenoid wear [9].…”

Section: Introductionmentioning

confidence: 94%

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Association of the Posterior Acromion Extension with Glenoid Retroversion: A CT Study in Normal and Osteoarthritic Shoulders

Terrier

Becce

Vauclair

et al. 2022

JCM

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Posterior eccentric glenoid wear is associated with higher complication rates after shoulder arthroplasty. The recently reported association between the acromion shape and glenoid retroversion in both normal and osteoarthritic shoulders remains controversial. The three-dimensional coordinates of the angulus acromialis (AA) and acromioclavicular joint were examined in the scapular coordinate system. Four acromion angles were defined from these two acromion landmarks: the acromion posterior angle (APA), acromion tilt angle (ATA), acromion length angle (ALA), and acromion axial tilt angle (AXA). Shoulder computed tomography scans of 112 normal scapulae and 125 patients with primary glenohumeral osteoarthritis were analyzed with simple and stepwise multiple linear regressions between all morphological acromion parameters and glenoid retroversion. In normal scapulae, the glenoid retroversion angle was most strongly correlated with the posterior extension of the AA (R2 = 0.48, p < 0.0001), which can be conveniently characterized by the APA. Combining the APA with the ALA and ATA helped slightly improve the correlation (R2 = 0.55, p < 0.0001), but adding the AXA did not. In osteoarthritic scapulae, a critical APA > 15 degrees was found to best identify glenoids with a critical retroversion angle > 8 degrees. The APA is more strongly associated with the glenoid retroversion angle in normal than primary osteoarthritic scapulae.

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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%

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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Different acromial roof morphology in concentric and eccentric osteoarthritis of the shoulder: a multiplane reconstruction analysis of 105 shoulder computed tomography scans

Cited by 25 publications

References 37 publications

Biomechanics of anatomic and reverse shoulder arthroplasty

Biomechanics of anatomic and reverse shoulder arthroplasty

Association of the Posterior Acromion Extension with Glenoid Retroversion: A CT Study in Normal and Osteoarthritic Shoulders

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

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