Association of a Large Lateral Extension of the Acromion with Rotator Cuff Tears

Nyffeler, Richard W.; Werner, Clément M. L.; Sukthankar, Atul; Schmid, Marius R.; Gerber, Christian

doi:10.2106/jbjs.d.03042

Cited by 237 publications

(381 citation statements)

References 12 publications

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“…Recently, Nyffeler et al [5] introduced the AI as a new biomechanical value which described the lateral extension of an acromion above the humeral head. They assumed that the force vector of deltoid muscle can increase the joint contraction and may induce subacromial abrasion of the rotator cuff tendons when the acromion extends more laterally.…”

Section: Discussionmentioning

confidence: 99%

“…In order to avoid the influence of the rotation of the scapula or humeral head, the AI was measured on the preoperative oblique coronal MR images done by Nyffeler et al [5] described for a true anteroposterior shoulder radiograph. Each patient was positioned supine with the humerus in neutral rotation and the arm adducted to the side.…”

Section: Methodsmentioning

confidence: 99%

“…Recently, Nyffeler et al [5] introduced an acromion index (AI), the lateral extension of an acromion above the humeral head, as a new biomechanical value and hypothesized that a large lateral extension of an acromion predisposes the supraspinatus tendon to degenerate because of its impingement between an acromion and the higher ascending force of a deltoid muscle. Torrens et al [6] also reported a relationship between the large coverage of a humeral head by an acromion and the rotator cuff tears, and it had similar results to Nyffeler's study [5]. The importance of an AI was strengthened by Zumstein et al [7], who found that the patients with re-tear following rotator cuff repair had higher AI than the patients without re-tear.…”

Section: Introductionmentioning

confidence: 99%

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Can a high acromion index predict rotator cuff tears?

Kim

Ryu

Hong

et al. 2012

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to identify the relationship between an acromion index (AI) and the size of a rotator cuff tear. The hypothesis of our study was that an AI will be higher in patients with a full-thickness tear than in patients with a partial-thickness articular-side tear, and that it can be used as a predictor for the size of a rotator cuff tear. Methods We included 284 patients who had been diagnosed with rotator cuff tears and had undergone arthroscopic rotator cuff repair at our institute. All patients were divided into five distinct groups (partial-thickness articular side tear, and four subgroups of full-thickness tears) depending on the size of the rotator cuff tear on arthroscopy. In each patient, an AI was measured on the pre-operative oblique coronal MR images and then analysed to determine the difference between groups. Results There were statistically significant differences between the partial-thickness articular side rotator cuff tear and large-tomassive rotator cuff tear groups (p<0.01), and the mean value of an AI was highest in the large-sized full-thickness tear group. The AI of the partial-thickness articular-side rotator cuff tear group was statistically different from the large-to-massive rotator cuff tear groups. ConclusionsThe AI can be a predictor which can differentiate a partial-thickness articular-side tear and a large-to-massive rotator cuff tear pre-operatively. However the AI could not provide useful guidance on predicting the differences in tear size in full-thickness tear patients. We suggest that a high AI can be one of the associated factors for progression to large-to-massive rotator cuff tears in a rotator cuff disease.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Can a high acromion index predict rotator cuff tears?

Kim

Ryu

Hong

et al. 2012

International Orthopaedics (SICOT)

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“…In accordance with this theory, Anetzberger et al demonstrated an association between lateral projection of both the acromion and coracoid with rotator cuff tears [2]. Similarly, the acromion index, which is expressed as a ratio between the distance from the plane of the glenoid and the lateral edge of the acromion and proximal humerus, has been linked with full thickness rotator cuff tears [9]. Superior migration of the humeral head during abduction may further reduce the supraspinatus outlet area, and has been linked with increasing glenoid inclination according to both biomechanical and computer modelling studies [6,13].…”

Section: Discussionmentioning

confidence: 87%

“…This mechanism, known as the external impingement theory, has since been supported by several studies associating features of scapula morphology with impingement symptoms and rotator cuff tears. These associated features refer to the size and shape of the coracoacromial arch and the orientation of the glenoid, and theoretically lead to a reduction in the functional supraspinatus outlet area [2][3][4][5][6][7][8][9][10][11][12][13][14]. Arthroscopic acromioplasty, which forms the mainstay of surgical management for subacromial impingement syndrome, has been developed in accordance with the external impingement theory.…”

Section: Introductionmentioning

confidence: 99%

Human evolution and tears of the rotator cuff

Craik

Mallina

Ramasamy

et al. 2013

International Orthopaedics (SICOT)

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Purpose Humans differ from other great ape species in their propensity to develop tears of the rotator cuff. The aim of this study was to compare the anatomical risk factors for subacromial impingement and rotator cuff tears amongst the great apes and to determine which features may be accentuated in humans and therefore play a more significant role in disease aetiology. Methods Orthogonal digital photographs of 22 human, 17 gorilla, 13 chimpanzee and 12 orangutan dry bone scapula specimens oriented in the glenoid plane were taken. Anatomical measurements were preformed using a calibrated digital image technique and the results scaled according to scapula vertebral border length. Results Of the ten anatomical features associated with subacromial impingement and rotator cuff tears in humans, none were shown to be accentuated and significantly different to the other species studied. However the human supraspinatus fossa was shown to be significantly smaller. Conclusions These results indicate that an alternative primary aetiological factor for rotator cuff tears must exist. A reduction in the size of the supraspinatus fossa in human scapulae suggests that structural insufficiency of the supraspinatus or a change in rotator cuff force vectors could play a role.

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Acromion morphology and prevalence of rotator cuff tear: A systematic review and meta‐analysis

et al. 2018

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The causes of degenerative rotator cuff (RTC) tears are unclear but certain acromion morphology may contribute. This study's objective was to determine using a systematic review and meta‐analysis the association of acromion type and acromial index with the prevalence of RTC tears. Six databases were searched electronically. Seventeen relevant studies between 1993 and 2017 were included in the meta‐analyses determining the association of RTC tears with acromion type (n = 11) or acromial index (n = 10). Effect sizes were calculated as an odds ratio (OR) for the studies reporting acromion type and as raw mean difference (RMD) for the studies reporting acromial index. Meta‐analysis was performed using a random‐effects model. There was a significant small‐to‐medium effect found in the meta‐analysis for acromion type (overall OR = 2.82, P = 0.000003), indicating an almost three times greater odds for a RTC tear in individuals with a type‐III acromion as compared with those with a type‐I or ‐II. A significant effect was also found for acromial index (RMD = 0.071, P < 0.0000001), indicating that a larger acromial index is associated with a greater likelihood of a RTC tear. Because of substantial heterogeneity in RMD for acromial index (Q‐df = 92, P < 0.00001; I2 = 89%), subgroup analyses and meta‐regressions were performed. Interestingly, the continent where the study was conducted (i.e., Europe vs. Asia) was the only moderator variable that could explain some of the acromial index heterogeneity. Overall, the findings from our analyses indicate that individuals with either a type‐III acromion and/or a larger acromial index have a greater likelihood for non‐traumatic RTC tears. Clin. Anat. 32:122–130, 2019. © 2018 Wiley Periodicals, Inc.

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Association of a Large Lateral Extension of the Acromion with Rotator Cuff Tears

Abstract: A large lateral extension of the acromion appears to be associated with full-thickness tearing of the rotator cuff.

Cited by 237 publications

References 12 publications

Can a high acromion index predict rotator cuff tears?

Can a high acromion index predict rotator cuff tears?

Human evolution and tears of the rotator cuff

Acromion morphology and prevalence of rotator cuff tear: A systematic review and meta‐analysis

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