The Critical Shoulder Angle is Associated with Osteoarthritis in the Shoulder but Not Rotator Cuff Tears. A Retrospective Case Control Study

Abstract

Thirty-four patients (27.9%) had an initial full thickness tear and eighty-eight patients (72.1%) had a partial thickness tear. Out of the entire one hundred twenty-two patients, tear size increased in fifty-one patients (41.8%), not changed in sixty-five patients (53.3%), and decreased in six patients (4.9%). Twentyeight patients (82.4%) of full-thickness tears increased in size; while twenty-three patients (26.1%) of partialthickness tears increased in size. Full-thickness tears showed a higher enlargement rate than partial-thickness tears in the three groups categorized with follow-up period (6w12 months, P¼0.067; 12w24 months, P¼0.002; over 24 months, P<0.001). Having a full-thickness tear was the most important risk factor according to logistic regression analysis for progression (P < 0.001). Conclusion: This study found that 82.4% of symptomatic full-thickness rotator cuff tears increased in size, while 26.1% of symptomatic partial-thickness tears increased in size over a two-year period. Full-thickness tears showed a higher enlargement rate than partialthickness tears regardless of a follow-up period. The univariate and multivariate analyses presented in this study suggest that having a full-thickness tear was the most reliable risk factor for tear enlargement.

Letter to the Editor: Is Criticism About Inherent Biases in Rigorous Orthopaedic Trials Prone to Biases?

“…The concept of CSA has also been discussed in this journal. [10][11][12] CSA is an arbitrary measurement assessed in planar x-rays. Even the meta-analysis cited by Hohmann et al 2 concludes that "evidence is poor," 13 and there is no existing evidence suggesting that CSA would modify the treatment effect when surgery is compared with exercises or placebo surgery.…”

“…2,8 In our level V guideline, 2 we have very carefully considered the available evidence, summarized the supporting evidence in favor of and against SAD, and merely suggested to consider SAD if 5 specific points are met. Reito and Karjalainen 1 argue that the placebocontrolled trials by Beard et al 10 and Paavola et al 11 were rigorously conducted and of high evidence. Unfortunately, this is fundamentally wrong.…”