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Background: Various radiographic measurements that describe humeral head coverage by the acromion and the effect on rotator cuff pathology have been reported. This study aimed to describe and validate a new radiographic measurement, the acromiohumeral centre edge angle (ACEA). Methods: We compared the ACEA on computed tomography (CT) and plain X-ray to determine whether X-ray is accurate for measuring this angle. We then compared the results from this control population with 107 patients with acute rotator cuff tears. We compared functional outcomes in rotator cuff tear patients to determine whether the ACEA has any effect on outcome after surgery. An intra-and inter-observer variability analysis was performed and we compared the ACEA to the acromial index (AI) on rotation X-rays. Results: The ACEA was comparable on CT and plain X-ray and was most accurate when true anteroposterior glenohumeral X-rays were used (15.94 vs. 15.87 on CT, p ¼ 0.476). The ACEA showed high intra-and inter-observer reproducibility and was unchanged on internal and external rotation X-rays (20.48 vs. 20.47, p ¼ 0.842), whereas the AI was significantly different (0.74 vs. 0.70, p < 0.001). The ACEA was significantly higher in our rotator cuff tear patients than the control population (23.9vs. 16.6 , p < 0.001), although a higher ACEA was not associated with poorer outcomes. Conclusion: The ACEA is a valid measurement for describing humeral head coverage by the acromion and can be accurately measured on plain radiographs with good reproducibility. It is unaffected by shoulder rotation and was significantly higher in patients with acute rotator cuff tears.

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Management of trauma has been tackled at a national level to improve patient care and mortality. Decision making through a multidisciplinary team approach has resulted in improved patient outcomes through a complex combination of changes. While the focus of trauma care delivery has been towards establishing an effective multidisciplinary trauma service, there are still improvements which can be made. This article reviews the history of trauma care in the UK, and the impact that multidisciplinary teams have had on the management of the multiply injured patient.