Arthroscopic Correction of the Critical Shoulder Angle Through Lateral Acromioplasty: A Safe Adjunct to Rotator Cuff Repair

Gerber, Christian; Catanzaro, Sabrina; Betz, Michael; Ernstbrunner, Lukas

doi:10.1016/j.arthro.2017.08.255

Cited by 116 publications

(117 citation statements)

References 35 publications

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“…Although it has not yet been clarified which sub-component (glenoid inclination, lateral acromial roof extension, acromial height) has the greatest impact, arthroscopic lateral acromioplasty is already performed. [8][9][10][11][12][13] Our data could support lateral acromioplasty. But nevertheless, an assessment about the effectiveness and necessity of lateral acromioplasty cannot be investigated by this study.…”

Section: Discussionsupporting

confidence: 57%

“…There is a great interest to change the radiological CSA towards to “normal” values and thereby reducing an overload of the rotator cuff. Although it has not yet been clarified which sub‐component (glenoid inclination, lateral acromial roof extension, acromial height) has the greatest impact, arthroscopic lateral acromioplasty is already performed . Our data could support lateral acromioplasty.…”

Section: Discussionmentioning

confidence: 60%

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Critical shoulder angle: Acromial coverage is more relevant than glenoid inclination

Beeler

Hasler

Götschi

et al. 2019

Journal Orthopaedic Research

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It is still unknown whether glenoid inclination or lateral acromial roof extension is a more important determinant for development of rotator cuff tears (RCT) or osteoarthritis (OA) of the shoulder. It was the purpose of this study, to evaluate whether there is a potential predominance of one of these factors in pathogenesis of RCT or concentric OA. We analyzed 70 shoulders with advanced degenerative RCT and 54 shoulders with concentric OA undergoing primary shoulder arthroplasty (anatomical or reverse) using antero-posterior radiography and multiplanar computed tomography. The two groups were compared in relation to glenoid inclination, lateral acromion roof extension, acromial height and critical shoulder angle (CSA). All measured parameters were highly significantly different between RCT and concentric OA (p < 0.001). Based on Cohen's d effect size, group differences were most distinct in lateral acromial roof extension (1.36 , 0.92 ) compared with acromial height (1.06 , 0.73 ) and glenoid inclination (0.60 , 0.61 ). However, no single factor showed an effect size which was as high as that of the CSA (1.63 ). Interestingly, a ratio of lateral acromion roof extension and acromial height could enhance the effect size (1.60 , 1.16 ) near to values of the CSA (1.63 ). In summary, lateral acromial roof extension has a greater influence in pathogenesis of degenerative RCT and concentric OA than acromial height or glenoid inclination. This article is protected by copyright. All rights reserved.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 60%

Critical shoulder angle: Acromial coverage is more relevant than glenoid inclination

Beeler

Hasler

Götschi

et al. 2019

Journal Orthopaedic Research

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“…This is a major advantage of the frequency matching technique in which the nearest neighbors are selected for each case to serve as a control despite any slight differences in the matching variable distribution. Because of potential residual confounding, regression models were also controlled for age, sex, and BMI [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. Fourth, this study showed that attention should be given to the deltoid origin at the anterior acromion to the middle third of the lateral acromion border in open rotator cuff repairs since the deltoid origin is thinner in this area.…”

Section: Discussionmentioning

confidence: 94%

“…All patients underwent radiological assessment with a 3-Tesla (3T) MRI at a minimum of one year following rotator cuff repair. The rotator cuff 's integrity was evaluated using the method described by Sugaya et al [18] The supraspinatus and infraspinatus were evaluated for any fatty infiltration according to the method of Fuchs et al [19] The deltoid origin muscle thickness was assessed with MRI according to Gerber et al [20] for integrity, scarring, and thickness. The deltoid origin thickness was measured in four zones: the anterior acromion and the anterior third, middle third, and posterior third at the inferior surface of the lateral acromion border according to the scapular plane ( Fig.…”

Section: Radiological Outcome Assessmentmentioning

confidence: 99%

Evaluation of Deltoid Origin Status Following Open and Arthroscopic Repair of Large Rotator Cuff Tears: A Propensity-Matched Case-Control Study

Kholinne¹,

Kwak

Sun

et al. 2020

Clin Shoulder Elbow

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Background:The purpose of this study was to evaluate and compare deltoid origin status following large rotator cuff repair carried out using either an open or an arthroscopic method with a propensity score matching technique. Methods: A retrospective review of 112 patients treated for full-thickness, large rotator cuff tear via either a classic open repair (open group) or an arthroscopic repair (arthroscopic group) was conducted. All patients included in the study had undergone postoperative magnetic resonance imaging (MRI) and clinical follow-up for at least 12 and 18 months after surgery, respectively. Propensity score matching was used to select controls matched for age, sex, body mass index, and affected site. There were 56 patients in each group, with a mean age of 63.3 years (range, 50-77 years). The postoperative functional and radiologic outcomes for both groups were compared. Radiologic evaluation for postoperative rotator cuff integrity and deltoid origin status was performed with 3-Tesla MRI. Results: The deltoid origin thickness was significantly greater in the arthroscopic group when measured at the anterior acromion (P=0.006), anterior third (P=0.005), and middle third of the lateral border of the acromion level (P=0.005). The deltoid origin thickness at the posterior third of the lateral acromion was not significantly different between the arthroscopic and open groups. The arthroscopic group had significantly higher intact deltoid integrity with less scarring (P=0.04). There were no full-thickness deltoid tears in either the open or arthroscopic group. Conclusions: Open rotator cuff repair resulted in a thinner deltoid origin, especially from the anterior acromion to the middle third of the lateral border of the acromion, at the 1-year postoperative MRI evaluation. Meticulous reattachment of the deltoid origin is as essential as rotator cuff repair when an open approach is selected.

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“…In a prospective study of 49 patients (mean age 56 years, mean follow-up 30 months), it was found that reported improvements in patient-reported outcomes have no effects on the deltoid muscle origin, after arthroscopic alteration of the CSA 40. A biomechanical study has identified that with a smaller CSA, the load from the SSP is transferred to the deltoid, thus theoretically protecting the SSP and generating increased abduction power with the more effective use of the deltoid 41.…”

Section: Discussionmentioning

confidence: 99%

Critical shoulder angle is an effective radiographic parameter that is associated with rotator cuff tears and osteoarthritis: a systematic review

et al. 2019

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Arthroscopic Correction of the Critical Shoulder Angle Through Lateral Acromioplasty: A Safe Adjunct to Rotator Cuff Repair

Cited by 116 publications

References 35 publications

Critical shoulder angle: Acromial coverage is more relevant than glenoid inclination

Critical shoulder angle: Acromial coverage is more relevant than glenoid inclination

Evaluation of Deltoid Origin Status Following Open and Arthroscopic Repair of Large Rotator Cuff Tears: A Propensity-Matched Case-Control Study

Critical shoulder angle is an effective radiographic parameter that is associated with rotator cuff tears and osteoarthritis: a systematic review

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