The Relationship Between the Critical Shoulder Angle and the Incidence of Chronic, Full-Thickness Rotator Cuff Tears and Outcomes After Rotator Cuff Repair: A Systematic Review

Docter, Shgufta; Khan, Moin; Ekhtiari, Seper; Veillette, Christian; Paul, Ryan; Henry, Patrick; Leroux, Timothy

doi:10.1016/j.arthro.2019.05.044

Cited by 43 publications

(24 citation statements)

References 42 publications

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“…This is in line with a recent systematic review that has demonstrated that there may be an association of a greater CSA with retears. 13 However, indications for ALA do not only involve rotator cuff repair: Katthagen and Millett 15 suggested that ALA should be considered for patients with a CSA >38° if the rotator cuff is at risk (severe tendinopathy or partial-thickness tears >50%) when operatively treating subacromial impingement syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, a large CSA may be associated with a greater retear rate following rotator cuff repair. 13 , 14 Thus, reduction of a large CSA to a “favorable” range of 30° to 34° may potentially prevent progression of rotator cuff tears or protect rotator cuff repair from re-tear. 15 Furthermore, subacromial spurs and sclerosis of the greater tuberosity are commonly encountered in shoulders with rotator cuff tears.…”

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confidence: 99%

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Influence of Radiographic Parameters on Reduction of the Critical Shoulder Angle With Arthroscopic Lateral Acromioplasty—A Mathematical Model

Katthagen

Nolte

Moatshe

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Objectives To develop a mathematical model for the preoperative planning of arthroscopic lateral acromioplasty (ALA) and to evaluate the role of radiographic parameters with regards to the critical shoulder angle (CSA). Methods Anteroposterior (AP) radiographs of patients who underwent rotator cuff surgery were screened to identify true AP radiographs. Radiographs were assessed for (1) native CSA, (2) CSA after simulated resection of a spur if present, (3) amount of ALA necessary to achieve a CSA of 34°, (4) CSA after 5-mm ALA, (5) lateral acromion angle, (6) acromion index, and (7) sclerosis of the greater tuberosity. Results A total of 1191 radiographs were screened. Of the 124 patients included, the native CSA was large (≥35°) in 56 patients (45%). In 30 patients (24%), a subacromial spur was detected and resection reduced the CSA by a median of 2°. Spur resection alone reduced the CSA to ≤34° in 19 patients (15.3%). Mean amount of ALA to achieve a CSA of 34° was 3.9 ± 1.8 mm, and this value strongly correlated with the CSA before ALA (R = 0.88, P < .001). The linear regression model to determine the amount of ALA to achieve a CSA of 34° was as follows: The multiple R 2 for this model was 0.777. Mean reduction of CSA by 5-mm ALA was 3.8 ± 0.8° and 75% of large CSAs were reduced to a CSA of 30-34°. The acromion index had no significant independent influence on the model ( P = .427), whereas lateral acromion angle was an independently significant predictor of required ALA to achieve a CSA of 34° ( P = .019). Sclerosis of the greater tuberosity was significantly associated with a CSA of 35° or greater ( P = .003). Conclusions The amount of ALA needed to reduce a large CSA to 34° correlates with the CSA before ALA and can preoperatively be planned with the use of a simple equation. Level of Evidence Level III; cross-sectional design; epidemiology study.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Influence of Radiographic Parameters on Reduction of the Critical Shoulder Angle With Arthroscopic Lateral Acromioplasty—A Mathematical Model

Katthagen

Nolte

Moatshe

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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“…This may suggest that soft tissue repair alone, without restoring elevated preoperative supraspinatus load seen with higher CSA, does not seem to mitigate the risk of tendon retear. However, often higher retear rates have not been associated with poor outcome scores, suggesting caution in interpreting those imaging results [24][25][26].…”

Section: Discussionmentioning

confidence: 99%

Lateral Acromioplasty has a Positive Impact on Rotator Cuff Repair in Patients with a Critical Shoulder Angle Greater than 35 Degrees

Franceschetti

Sanctis

Palumbo

et al. 2020

JCM

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Background: A Critical Shoulder Angle (CSA), evaluated on plain radiographs, greater than 35° is considered predictive of rotator cuff tears. The present prospective comparative study aimed, firstly, to develop a formula to calculate the amount of acromion that should be resected performing a lateral acromioplasty and, secondly, verify whether lateral acromioplasty to reduce the CSA associated with arthroscopic cuff repair decreased the rate of recurrence of the tears, and impacted favorably on clinical postoperative outcomes. Methods: Patients undergoing arthroscopic rotator cuff repair (RCR) for rotator cuff tears with a CSA greater than 35° were included in this study and divided into two groups, based on whether the CSA had been reduced by arthroscopic resection of the lateral portion of the acromion. A new mathematical formula was developed in order to quantify the amount of bone to be resected while performing the lateral acromioplasty. Patients with traumatic tears, previous surgery, osteoarthritis or plain radiographs, not classified as A1 according to Suter-Henninger, were excluded. Clinical and radiographic outcomes were assessed at a minimum of 2 years of follow-up considering the tear size. Results: 289 patients were included in this study. Thirty-seven were lost to follow-up. Group A (Lateral acromioplasty) patients included: 38 small tears, 30 medium tears, 28 large tears and 22 massive tears; Group B (control group) was composed of 40 small tears, 30 medium tears, 30 large tears and 23 massive tears. The Constants Score value and retear Rate were, respectively, significant higher (p = 0.007 and p = 0.004) and lower (p = 0.029 and p = 0.028) in Group A, both in the Small-and Medium-size subgroups. No complications were outlined. The mediolateral width of the acromion was reduced, according to the preoperatively calculated measure. Conclusion: Arthroscopic lateral acromioplasty decreased the CSA within the favorable range (30°–35°) in all patients treated, resecting the amount of bone predicted by the mathematical formula. Lateral acromioplasty is a safe and reproducible technique which may prevent recurrence of rotator cuff tears in patients with small and medium lesions. Level of evidence: II.

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“…[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.…”

mentioning

confidence: 99%

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

Reito

Karjalainen

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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The Relationship Between the Critical Shoulder Angle and the Incidence of Chronic, Full-Thickness Rotator Cuff Tears and Outcomes After Rotator Cuff Repair: A Systematic Review

Cited by 43 publications

References 42 publications

Influence of Radiographic Parameters on Reduction of the Critical Shoulder Angle With Arthroscopic Lateral Acromioplasty—A Mathematical Model

Influence of Radiographic Parameters on Reduction of the Critical Shoulder Angle With Arthroscopic Lateral Acromioplasty—A Mathematical Model

Lateral Acromioplasty has a Positive Impact on Rotator Cuff Repair in Patients with a Critical Shoulder Angle Greater than 35 Degrees

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

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