The Effect of Coracoacromial Ligament Excision and Acromioplasty on Superior and Anterosuperior Glenohumeral Stability

Su, Wei-Ren; Budoff, Jeffrey E.; Luo, Zong Ping

doi:10.1016/j.arthro.2008.10.004

Cited by 64 publications

(44 citation statements)

References 20 publications

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“…A recent cadaveric study by Wellmann et al showed increased anterior and superior translation during passive testing and muscle force loading after sectioning the CAL. 43 These findings have been confirmed by Su et al 40 Violating the acromion and the CAL yields unfavorable results. We believe that if debridement of large rotator cuff defects is considered, both the acromion and the CAL need to be respected as the antero-superior restraint in shoulder abduction.…”

Section: Discussionsupporting

confidence: 60%

See 1 more Smart Citation

Reversed arthroscopic subacromial decompression for symptomatic irreparable rotator cuff tears: Mid-term follow-up results in 34 shoulders

Verhelst

Vandekerckhove

Sergeant

et al. 2010

Journal of Shoulder and Elbow Surgery

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Section: Discussionsupporting

confidence: 60%

“…7 Second, the coracoacromial ligament (CAL) is left intact to prevent antero-superior escape of the humeral head. 27,40 The aim of our study was to verify the value of the RASD for large to massive irreparable cuff tears in the elderly.…”

mentioning

confidence: 99%

Reversed arthroscopic subacromial decompression for symptomatic irreparable rotator cuff tears: Mid-term follow-up results in 34 shoulders

Verhelst

Vandekerckhove

Sergeant

et al. 2010

Journal of Shoulder and Elbow Surgery

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“…Based on this speculation, the acromial morphological variation is the consequence, rather than the cause, of the subacromial impingement [25]. Accordingly, acromioplasty is not only incapable of eliminating the impingement source, but also undermining the glenohumeral stabilizing mechanism, which may further aggravate rotator cuff injury [26]. Thus, the key in the subacromial impingement treatment is to restore the integrity and function of rotator cuff tendon, but not acromioplasty.…”

Section: Discussionmentioning

confidence: 99%

Relationship between acromial morphological variation and subacromial impingement: A three-dimensional analysis

et al. 2017

PLoS ONE

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Purpose: To evaluate the association of acromial morphology and subacromial impingement. Methods: Bilateral shoulder computed tomography was performed in 138 patients who received shoulder arthroscopy. Measured parameters included: acromial tilt (AT), modified acromial tilt (mAT), acromial slope (AS), acromiohumeral interval (AHI), lateral acromial angle (LAA), acromial index (AI), critical shoulder angle (CSA), acromial anterior protrusion (AAP), and acromial inferior protrusion (AIP). Acromial morphological characteristics were compared between groups. Side-to-side differences were assessed between affected and non-affected shoulders. Intra- and inter-observer agreements for each parameter were calculated. Results: AT (25.90 vs. 29.41°), mAT (18.88 vs. 22.64°), and AHI (5.46 vs. 6.47 mm) were significantly smaller in impinged patients. The impingement group demonstrated significantly larger AI (63.50 vs. 59.84%), CSA (31.78 vs. 28.74°), AAP (7.13 vs. 5.32 mm), and AIP (5.51 vs. 4.04 mm). Regarding side-to-side comparison, the acromial morphology was significantly different between the affected and non-affected shoulders in impinged patients, while the difference was slight and insignificant in control patients. All, except AS and LAA, measured parameters demonstrated good intra- and inter-observer agreements. Conclusions: Three-dimensional reconstructed CT scan is a reliable method to measure shoulder morphology. The acromial morphological variation is related with sub acromial impingement, however, the causal relationship of them should be further explored.

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“…[12345] The majority of early reports focused primarily on the role of the coracoacromial ligament in the rotator cuff deficient shoulder. [1567] The inferior concave surface of the coracoacromial ligament acts as a static restraint, along with the acromion, to superior translation of the humeral head.…”

Section: Introductionmentioning

confidence: 99%

A biomechanical assessment of superior shoulder translation after reconstruction of anterior glenoid bone defects: The Latarjet procedure versus allograft reconstruction

Degen

Giles

Boons

et al. 2013

Int J Shoulder Surg

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Background:The coracoacromial ligament (CAL) is an important restraint to superior shoulder translation. The effect of CAL release on superior stability following the Latarjet is unknown; therefore, our purpose was to compare the effect of two Latarjet techniques and allograft reconstruction on superior instability.Materials and Methods:Eight cadaveric specimens were tested on a simulator. Superior translation was monitored following an axial force in various glenohumeral rotations (neutral, internal, and external) with and without muscle loading. Three intact CAL states were tested (intact specimen, 30% glenoid bone defect, and allograft reconstruction) and two CAL deficient states (classic Latarjet (classicLAT) and congruent-arc Latarjet (congruentLAT)).Results:In neutral without muscle loading, a significant increase in superior translation occurred with the classicLAT as compared to 30% defect (P = 0.046) and allograft conditions (P = 0.041). With muscle loading, the classicLAT (P = 0.005, 0.002) and the congruentLAT (P = 0.018, 0.021) had significantly greater superior translation compared to intact and allograft, respectively. In internal rotation, only loaded tests produced significant results; specifically, classicLAT increased translation compared to all intact CAL states (P < 0.05). In external rotation, only unloaded tests produced significant results with classicLAT and congruentLAT allowing greater translations than intact (P ≤ 0.028). For all simulations, the allograft was not significantly different than intact (P > 0.05) and no differences (P = 1.0) were found between classicLAT and congruentLAT.Discussion:In most simulations, CAL release with the Latarjet lead to increased superior humeral translation.Conclusion:The choice of technique for glenoid bone loss reconstruction has implications on the magnitude of superior humeral translation. This previously unknown effect requires further study to determine its clinical and kinematic outcomes.

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The Effect of Coracoacromial Ligament Excision and Acromioplasty on Superior and Anterosuperior Glenohumeral Stability

Cited by 64 publications

References 20 publications

Reversed arthroscopic subacromial decompression for symptomatic irreparable rotator cuff tears: Mid-term follow-up results in 34 shoulders

Reversed arthroscopic subacromial decompression for symptomatic irreparable rotator cuff tears: Mid-term follow-up results in 34 shoulders

Relationship between acromial morphological variation and subacromial impingement: A three-dimensional analysis

A biomechanical assessment of superior shoulder translation after reconstruction of anterior glenoid bone defects: The Latarjet procedure versus allograft reconstruction

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