Predominance of the critical shoulder angle in the pathogenesis of degenerative diseases of the shoulder

Blonna, Davide; Giani, Andrea; Bellato, Enrico; Mattei, Lorenzo; Calò, Michel; Rossi, Roberto; Castoldi, Filippo

doi:10.1016/j.jse.2015.11.059

Cited by 116 publications

(105 citation statements)

References 21 publications

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“…In addition to specific acromial anatomy in the coronal plane in patients with osteoarthritis or a rotator cuff tear [10][11][12][13][14][15][16][17] ,we have observed that, in the sagittal plane, a relatively horizontally oriented acromion that is situated very high with respect to the center of the humeral head seems to be associated with recurrent posterior glenohumeral instability. It was therefore the purpose of this study to investigate whether stable and unstable shoulders are associated with different acromial morphology in the sagittal plane and to specifically test the hypothesis that recurrent posterior instability is associated with a more horizontal and higher position of the acromion in the sagittal plane than in stable shoulders or those with recurrent anterior instability.…”

mentioning

confidence: 81%

Posterior Acromial Morphology Is Significantly Associated with Posterior Shoulder Instability

Meyer

Ernstbrunner

Boyce

et al. 2019

The Journal of Bone and Joint Surgery

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BACKGROUND The purpose of this paper was to determine whether acromial morphology influences anteroposterior shoulder stability. We hypothesized that a more horizontal and higher position of the acromion in the sagittal plane would be associated with posterior instability. METHODS In this retrospective study, patients with unidirectional posterior instability were age and sex-matched to a cohort of patients with unidirectional anterior instability. Both cohorts were compared with a control group of patients with no instability and no degenerative glenohumeral (rotator cuff and/or joint surface) or acromial changes. Measurements on radiographs included posterior acromial tilt, anterior and posterior acromial coverage (AAC and PAC), posterior acromial height (PAH), and the critical shoulder angle (CSA). RESULTS The number of patients enrolled in each instability group was 41, based on a priori power analysis. The control group consisted of 53 shoulders. Of the measured anatomic factors, PAH showed the most significant association with posterior instability (odds ratio [OR] = 1.8; p < 0.001) in the logistic regression model. PAH was significantly greater in the posterior instability group compared with the anterior instability group (30.9 versus 19.5 mm; p < 0.001). With a cutoff value of PAH of 23 mm, the OR for posterior instability was 39. Shoulders with posterior instability were also significantly different from normal shoulders with regard to PAH (p < 0.001), AAC (p < 0.001), and PAC (p < 0.001) whereas, in the shoulders with anterior instability, all of these values except the AAC (p = 0.011) did not differ from those of normal shoulders. CONCLUSIONS Specific acromial morphology is significantly associated with the direction of glenohumeral instability. In shoulders with posterior instability, the acromion is situated higher and is oriented more horizontally in the sagittal plane than in normal shoulders and those with anterior instability; this acromial position may provide less osseous restraint against posterior humeral head translation. A steep "Swiss chalet roof-type" acromion virtually excluded recurrent posterior instability in an albeit relatively small cohort of patients. Additional investigation is needed to determine the relevance of these findings for future treatment. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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mentioning

confidence: 81%

Posterior Acromial Morphology Is Significantly Associated with Posterior Shoulder Instability

Meyer

Ernstbrunner

Boyce

et al. 2019

The Journal of Bone and Joint Surgery

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“…Moreover, high agreement was sustained across various groups of patients with pathologies such as rotator cuff tears,8 10 14 15 22–24 26–33 35 osteoarthritis,8 10 14 15 27–29 35 repaired rotator cuffs,12 20 21 34 shoulder arthroplasty,36 37 adhesive capsulitis,22 cuff tear arthropathy,27 impingement,27 tendinitis calcarea,27 those without rotator cuff tears in need of either subacromial or GH injections,19 and instability 15. Included studies in this review also determined a high inter-rater agreement between a shoulder and elbow specialist in practice for 10 years and a graduate medical student,29 radiologists and orthopaedic surgeons14 15 19 and between orthopaedic surgeons themselves 8 21 22 28 30 31 35–37. This may reflect the ease by which the CSA can be reliably measured among individuals of varying degree of training.…”

Section: Discussionmentioning

confidence: 99%

Critical shoulder angle is an effective radiographic parameter that is associated with rotator cuff tears and osteoarthritis: a systematic review

et al. 2019

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“…In another biomechanical study, Gerber et al showed that larger CSAs (> 35°) increased the supraspinatus tendon load by 35% to compensate for the increased shear force [24]. In an observational clinical study, Moor and colleagues found a significantly higher prevalence of rotator cuff tears (RCTs) in patients with CSAs > 35°and this correlation has since been supported by several more recent studies [25][26][27][28]. Garcia et al found that patients with CSA > 38°had increased risk of re-tear following rotator cuff repair (odds ratio 14.8), with higher CSAs associated with worse ASES scores at short-term follow-up [29].…”

Section: Critical Shoulder Anglementioning

confidence: 90%

Partial and Full-Thickness RCT: Modern Repair Techniques

Nathani

Smith

Wang

2018

Curr Rev Musculoskelet Med

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Purpose of Review The purpose of this article is to review the recent literature concerning modern repair techniques related to partial-and full-thickness rotator cuff tears. Recent Findings The understanding of rotator cuff pathology and healing continues to evolve, beginning with emerging descriptions of the anatomic footprint and natural history of rotator cuff tears. Significant controversy remains in treatment indications for partial-thickness rotator cuff lesions as well as optimal surgical repair techniques for both partial-and full-thickness tears. Techniques such as margin convergence and reduction of the so-called "comma" tissue have improved the ability to anatomically reduce large and retracted tears. Repair strength and contact pressures are improved with double-row repairs and transosseusequivalent techniques compared to traditional single-row repairs. Future work is directed towards obtaining reliable radiographic healing and demonstrating clinical superiority and cost-effectiveness of a single technique. Summary Much recent work regarding rotator cuff anatomy and pathology has been reported. Newer techniques improve repair strength. Despite these advances, significant questions remain concerning surgical indications and clinical outcomes.

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Predominance of the critical shoulder angle in the pathogenesis of degenerative diseases of the shoulder

Cited by 116 publications

References 21 publications

Posterior Acromial Morphology Is Significantly Associated with Posterior Shoulder Instability

Posterior Acromial Morphology Is Significantly Associated with Posterior Shoulder Instability

Critical shoulder angle is an effective radiographic parameter that is associated with rotator cuff tears and osteoarthritis: a systematic review

Partial and Full-Thickness RCT: Modern Repair Techniques

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