The Effectiveness of Using the Critical Shoulder Angle and Acromion Index for Predicting Rotator Cuff Tears: Accurate Diagnosis Based on Standard and Nonstandard Anteroposterior Radiographs

Tang, Yiyong; Hou, Jingyi; Li, Qingyue; Li, Fangqi; Zhang, Congda; Li, Weiping; Yang, Rui

doi:10.1016/j.arthro.2019.03.050

Cited by 31 publications

(25 citation statements)

References 27 publications

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“…Gerber et al showed that abnormally large CSAs are associated either with higher re-tear rates or with inferior strength of abduction after reconstruction [20]. As most of these authors suggested, we recommend that if the CSA is greater than 33°, acromioplasty should be performed during arthroscopic RCR to reduce large CSAs to normal range (30-33°) [21].…”

Section: Discussionmentioning

confidence: 90%

See 1 more Smart Citation

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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Section: Discussionmentioning

confidence: 90%

“…Gerber et al concluded that correcting a large CSA to 33°or less during arthroscopic rotator cuff repair (RCR) could help patients to achieve superior strength of abduction after the RCTs heal [20]. Similarly, we previously found that a reduction of a large CSA (≥33°) to a desired range (30-33°) may prevent RCTs and OA [21].…”

Section: Introductionmentioning

confidence: 85%

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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“…Deviations from a true AP view as little as 5 in anteversion change the CSA by greater than 2 . This was reflected in the research data of Tang et al 8 summed up in their tables, wherein the CSA and AI values were higher for other types of radiographs (nonstandard AP radiographs) in both the RCT and control (no-tear) groups. However, closer scrutiny of the data presented in the tables by the authors raised my eyebrows.…”

Section: See Related Article On Page 2553mentioning

confidence: 89%

“…However, in practice, a plain AP radiograph of the shoulder may not always conform to standards, leading to errors in the calculation of the aforementioned ratios and angles. This drawback spurred Tang, Hou, Li, Li, Zhang, Li, and Yang, 8 in their study on "The Effectiveness of Using Critical Shoulder Angle and Acromion Index for Predicting Rotator Cuff Tear: Accurate Diagnosis Based on Standard and Nonstandard Anteroposterior Radiographs," to analyze widely studied parameters such as the CSA and AI. 5,6,9 They did a commendable job!…”

Section: See Related Article On Page 2553mentioning

confidence: 99%

Editorial Commentary: Angles, Ratios, and Rotation—Is It Worth Splitting Hairs Over the Critical Shoulder Angle?

Pandey

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Various radiographic indices represent lateral acromial extension over the greater tuberosity and are said to be one of the etiologic factors in rotator cuff tears. There has been much debate regarding the accuracy of these parameters based on radiographic rotation and tilt. This commentary discusses the utility of the existing parameters and the "surgical worth" of seeking another accurate parameter that might avoid the measurement errors resulting from rotation.

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“…2 The true anteroposterior radiographic view of the glenoid is elusive because body habitus, posture, and resting scapulothoracic orientation confound the radiologist's ability to pinpoint the imaging plane(s). Multiple studies have shown that over 70% of retrospective imaging falls into a D1 classification, 3,4 in which the glenoid oval is visible (anteverted view) and the coracoid overlaps the superior glenoid (neutral flexionextension view). But do these D1 images preclude accurate assessment of the CSA?…”

Section: See Related Article On Page 438mentioning

confidence: 99%

Editorial Commentary: Is Your Critical Shoulder Angle Accurate? Only If You Can Verify That You Have the Correct Images

Henninger

Suter

Chalmers

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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The critical shoulder angle (CSA) has been the focus of significant research related to the etiology and prognosis of rotator cuff tears in recent years, but the accuracy of CSA measurements on plain anteroposterior (Grashey) radiographs has been questioned. Research to better understand what qualifies as a "tolerable" radiograph for reliable measurement of the CSA can inform best practices for obtaining plain radiographs. Optimal measurements rely on optimal images, and knowing how much room for error there is regarding malrotation provides surgeons with unbiased criteria to rule out inadequate images.

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The Effectiveness of Using the Critical Shoulder Angle and Acromion Index for Predicting Rotator Cuff Tears: Accurate Diagnosis Based on Standard and Nonstandard Anteroposterior Radiographs

Cited by 31 publications

References 27 publications

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

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

Editorial Commentary: Angles, Ratios, and Rotation—Is It Worth Splitting Hairs Over the Critical Shoulder Angle?

Editorial Commentary: Is Your Critical Shoulder Angle Accurate? Only If You Can Verify That You Have the Correct Images

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