High performance of critical shoulder angle for diagnosing rotator cuff tears on radiographs

Song, Jae Gwang; Yun, Seong Jong; Song, Young Woong; Lee, Sun Hwa

doi:10.1007/s00167-018-5247-1

Cited by 33 publications

(20 citation statements)

References 46 publications

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“…The clinical implications of our results are that the CSA and AI measures should be questioned as important prognostic factors for the development of RCT or GH OA and that lateral acromioplasty probably does not prevent RCT’s as suggested [ 14 , 25 ].…”

Section: Discussionmentioning

confidence: 87%

Neither critical shoulder angle nor acromion index were related with specific pathology 20 years later!

Hallgren

Adolfsson

2021

Knee Surg Sports Traumatol Arthrosc

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Purpose The critical shoulder angle (CSA) and the acromion index (AI) are measurements of acromial shape reported as predictors of degenerative rotator cuff tears (RCT) and glenohumeral osteoarthritis (GH OA). Whether they are the cause or effect of shoulder pathologies is uncertain since pre-morbid radiographs most often are lacking. The main aim of this study was to investigate if CSA or AI were related to the development of RCT or GH OA after 20 years. A secondary aim was to investigate if the CSA and AI had changed over time. Methods In the hospital archive, 273 preoperative plain shoulder radiographs were found of patients scheduled for elective surgery other than cuff repair and arthroplasty. Forty-five images fulfilled the strict criteria published by Suter and Henninger (2015) and were used to measure CSA and AI with two independent assessors. No patient had any sign of OA in the index radiographs or any information in the medical records indicating RCT. After a median of 20 (16–22) years, 30 of these patients were radiologically re-examined with bilateral true frontal views and ultrasound of the rotator cuff. There were 19 men (20 study shoulders) and 11 females (12 study shoulders). Results Mean age at follow-up was 56 (32–78) years. There was no correlation between CSA (r = 0.02) (n.s) or AI (r = − 0.13) (n.s) in the primary radiographs and OA at follow-up. Nor was any correlation found between index CSA (r = 0.12) (n.s) or AI (r = − 0.13) (n.s) and RCT at follow-up. Mean difference in CSA was − 1.7 (− 10–3) degrees and mean AI difference was − 0.04 (− 0.13–0.09) between the first and the second radiographs, 20 years later. Bilaterally, mean CSA was 32 and AI 0.61 at follow-up. Conclusion In this study, no correlation between the CSA, AI and development of OA or RCT could be found. The mean CSA and AI decreased over a 20-year period but the difference was very small. No difference was found between the study shoulders and the contralaterals. These findings question previously reported etiological associations between scapular anatomy and the development of OA or RCT and thereby the use of these calculations as the basis of treatment. Level of evidence III.

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Section: Discussionmentioning

confidence: 87%

Neither critical shoulder angle nor acromion index were related with specific pathology 20 years later!

Hallgren

Adolfsson

2021

Knee Surg Sports Traumatol Arthrosc

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“…Pandey et al [ 30 ] reported that higher CSAs are associated with a full-thickness tear but not with partial tears. A meta-regression analysis revealed that the sensitivity of CSA could be higher for differentiating full-thickness RCTs and normal patients [ 9 ]. However, another study reported that the mean CSA in patients with full-thickness tears was 34.3 ± 4.2° and those with partial-thickness tears was 32.6 ± 3.2° ( p = 0.08) [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…The correlation between degenerative RCTs and the CSA has recently received increasing attention [ 8 , 9 ]. The CSA, first mentioned in RCT research in 2013 by Moor et al [ 10 ], is defined as the angle between the superior and inferior bony margin of the glenoid and the lateral margin of the acromion (Fig.…”

Section: Introductionmentioning

confidence: 99%

Does the critical shoulder angle decrease after acromioplasty? A systematic review and meta-analysis

et al. 2022

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Background Rotator cuff tears are one of the most common shoulder injuries in the older population. This study aimed to determine whether acromioplasty reliably decreases the critical shoulder angle (CSA) and describe any associated complications. Methods A systematic literature review was performed according to PRISMA guidelines using PubMed, EMBASE, Web of Science, and Cochrane Library Database. Two reviewers independently screened the titles and abstracts using prespecified criteria. Studies where the acromioplasty was performed as a surgical procedure were included. Patient characteristics and degree of CSA reduction were collected from each individual study. All statistical analyses were performed using Review Manager (RevMan) 5.4.1 software. A random-effects model was used for meta-analysis. Results A total of 9 studies involving 1236 patients were included in the meta-analysis. The age of patients ranged from 23 to 82 years. The follow-up period ranged from 12 to 30 months. Of the 9 studies, 8 (88.9%) were retrospective, 1 (11.1%) was prospective, 5 were comparative, and 4 were case series. The mean CSA was significantly reduced from 36.1° ± 4.6° to 33.7° ± 4.2 (p < 0.05). The meta-analysis showed an overall best estimate of the mean difference in pre- and postoperative CSA equal to 2.63° (95% confidence interval: 2.15, 3.11] (p < 0.00001). Conclusions Acromioplasty can significantly reduce CSA, notably in cases of high preoperative CSA. In addition, the effect of lateral acromioplasty on the CSA was more significant compared to anterolateral acromioplasty. Acromioplasty was not associated with complications during the short-term follow-up.

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“…The acromial morphology has been identified as one of the important etiologic factors of degenerative RCTs [6][7][8]. Numerous studies have revealed that a type III acromion, higher acromion index, lower lateral acromion angles, and larger critical shoulder angles (CSAs) are significantly associated with degenerative RCTs [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Effect of arthroscopic acromioplasty on reducing critical shoulder angle: a protocol for a prospective randomized clinical trial

Long

Hou

Tang

et al. 2020

BMC Musculoskelet Disord

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Background The critical shoulder angle (CSA), which helps to predict patients who are at risk of rotator cuff tears (RCTs) with large degree and who are susceptible to osteoarthritis with low angle, has been identified as one of the most vital acromial parameters; anterolateral and lateral acromioplasties have been proven to be valid ways to reduce CSA. However, no study has compared the effect of different acromioplasties on the reduction of the large CSA (≥33°) clinically. Additionally, either anterolateral or lateral acromioplasty could not precisely correct large CSAs to a favorable range (30–33°) in each patient. Thus, we will propose a novel precise acromioplasty technique for the purpose of reducing CSA accurately and effectively, and compare the effectiveness of different acromioplasties on the reduction of the CSA. Methods A total of 60 RCT patients who have indications for arthroscopic rotator cuff repair and with pre-operative CSA ≥33° will be recruited in outpatient center of Sun Yat-sen Memorial Hospital. Eligible participants will be randomly allocated to Group A (anterolateral acromioplasty), Group B (lateral acromioplasty) or Group C (precise acromioplasty) via a random, computer-generated number system. Three surgical plans will be made for each participant respectively by one professional surgeon according to the results of randomization allocation. The post-operative CSA will be measured 2 days post-operation. Follow-up will be maintained at 3, 6, and 12 months after surgery including the visual analog scale score, the University of California at Los Angeles score, the Constant Shoulder Score and the American Shoulder and Elbow Surgeon Shoulder Assessment Form. Finally, all outcomes will be assessed by two researchers who are blinded to the recruitment and allocation. Discussion This is the first clinical trial to evaluate the impact of different acromioplasties on the reduction of the CSA. Additionally, this study will provide a new precise acromioplasty technique, which is a novel precision and individualized treatment to prevent degenerative RCTs by reducing the CSA. Trial registration ChiCTR2000032343. Registered on April 26th, 2020.

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High performance of critical shoulder angle for diagnosing rotator cuff tears on radiographs

Cited by 33 publications

References 46 publications

Neither critical shoulder angle nor acromion index were related with specific pathology 20 years later!

Neither critical shoulder angle nor acromion index were related with specific pathology 20 years later!

Does the critical shoulder angle decrease after acromioplasty? A systematic review and meta-analysis

Effect of arthroscopic acromioplasty on reducing critical shoulder angle: a protocol for a prospective randomized clinical trial

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