Bilateral coracohumeral distance discrepancy is associated with subscapularis tear in rotator cuff rupture patients

Abstract

Purpose To describe the bilateral coracohumeral morphological discrepancy in rotator cuf rupture patients with and without subscapularis (SSC) involvement and to investigate its association with SSC tears. Methods Two hundred and thirteen consecutive patients who were scheduled to have arthroscopic rotator cuf repair were prospectively enrolled in the current study. Patients with acute traumatic rotator cuf rupture, glenohumeral osteoarthritis, bilateral rotator cuf rupture, recurrent shoulder instability, systemic inlammatory disease, and previous shoulder surgery history were excluded. Coracohumeral distance (CHD), coracoid overlap (CO), lesser tuberosity index (LTI) and acromiohumeral interval (AHI) were measured bilaterally using CT scans. Based on arthroscopic indings, patients were included in either the SSC tear group (n = 72) or the control group (n = 141). ResultsIn the SSC tear group, the afected shoulder possessed a signiicantly smaller CHD [95% conidence interval (CI) 6.1-7.2 vs. 7.2-8.0 mm, p < 0.0001], larger LTI (95% CI 9.4-9.9 vs. 9.0-9.6 mm, p < 0.0001), and smaller AHI (95% CI 5.0-5.5 vs. 7.1-7.5 mm, p < 0.0001) than the contralateral normal shoulder. In the control group, there was no signiicant diference between bilateral CHD and CO, and the AHI bilateral discrepancy was less distinct. CO did not difer signiicantly in the bilateral comparison in either group. Among all evaluated parameters, bilateral CHD discrepancy was the best predictor of SSC tears, with an area under the curve (AUC) of 0.882. A cutof value of 0.5 mm had a sensitivity of 76.4% and speciicity of 99.3% for SSC tears. ConclusionThe CHD values are signiicantly diferent between afected and contralateral shoulders in SSC tear patients. Bilateral CHD discrepancy is closely associated with subcoracoid impingement and SSC tears, and its presence warrants speciic intraoperative SSC inspection. Level of evidence Level II.

Identifying key factors associated with subscapularis tendon tears and developing a risk prediction model to assist diagnosis

“…But in clinical practice, we found that it was difficult to select an ideal measurement plane on MRI according to the defined method, and the clinical practicability was poor. Based on previous literature reports, clinical importance, and practicality, three coracoid morphological parameters including CHD, CO, and CHI were considered potential candidates for SSC tendon tears [ 24 , 29 , 39 ]. To further evaluate the relationship between coracoid morphology and SSC tendon tears, we measured CHD (axial plane), CHD (oblique sagittal plane), CHI (axial plane), and CO (axial plane) respectively.…”

Evaluation of Preoperative Magnetic Resonance Imaging Parameters with Arthroscopic Validation of Subscapularis Tendon Abnormalities in 187 Patients at a Single Center in Turkey

“…Leite et al emphasized that narrowing the coracohumeral distance and an increase in the coracoid overlap distance are good indicators of SS ruptures [8]. Likewise, Zhu et al in a prospective study comparing bilateral shoulders, stated that coraco-humeral distance was the best predictor of SS ruptures (P<0.0001) [28]. In the present study, coraco-humeral distance decrease and coracoid overlap increase were found to be statistically significant indicators, similar to these studies (both P<0.001).…”

Clinical Approach to Inconclusive Subscapularis Tear Diagnosis: a Meta-analysis

“…Leite et al showed that the CO had a strong predictive value for SSC tears, and when the CO value was 16.6 mm, the sensitivity and specificity for the prediction of SSC muscle tears reached the optimal value [13]. However, Zhu et al found that a CO value of 10 mm had the most appropriate sensitivity and specificity for the prediction of SSC tears, and the predictive value was higher than that of CHD [9]. Cetinkaya et al identified the CO as the most valuable predictor of SSC tears [23].…”

“…There were 1 092 patients included in the four studies [9,15,19,25]; the experimental group had 532 patients, and the control group had 560 patients. There was no heterogeneity (I 2 = 0 %, P = 0.77).…”