Critical shoulder angle is associated with full-thickness rotator cuff tears in patients with glenohumeral osteoarthritis

Mantell, Matthew; Nelson, Ryan; Lowe, Jeremiah T.; Endrizzi, Donald P.; Jawa, Andrew

doi:10.1016/j.jse.2017.05.020

Cited by 46 publications

(31 citation statements)

References 28 publications

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“…Viehöfer et al [34] showed that a higher CSA requires more rotator cuff activity to preserve joint stability. This leads to higher risk of rotator cuff failure [35–37]. Additionally, Watling et al [38] found a high CSA being associated with glenoid component loosening and failure.…”

Section: Discussionmentioning

confidence: 99%

Overstuffing in resurfacing hemiarthroplasty is a potential risk for failure

et al. 2019

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PurposeLiterature describes the concern of an overstuffed shoulder joint after a resurfacing humeral head implant (RHHI). The purpose of this study was to evaluate inter-observer variability of (1) the critical shoulder angle (CSA), (2) the length of the gleno-humeral offset (LGHO), and (3) the anatomic center of rotation (COR) in a patient population operated with a Global Conservative Anatomic Prosthesis (CAP) RHHI. The measurements were compared between the revision and non-revision groups to find predictive indicators for failure.MethodsPre- and postoperative radiographs were retrieved from 48 patients who underwent RHHI from 2007 to 2009 using a Global CAP hemiarthroplasty for end-stage osteoarthritis. This cohort consisted of 36 females (12 men) with a mean age of 77 years (SD 7.5). Two musculoskeletal radiologist and two specialized shoulder orthopedic surgeons measured the CSA, LGHO, and COR of all patients.ResultsThe inter-observer reliability showed excellent reliability for the CSA, LGHO, and the COR, varying between 0.91 and 0.98. The mean COR of the non-revision group was 4.9 mm (SD 2.5) compared to mean COR of the revision group, 8 mm (SD 2.2) (p < 0.01). The COR is the predictor of failure (OR 1.90 (95%Cl 1.19–3.02)) with a cut of point of 5.8 mm. The mean CSA was 29.8° (SD 3.9) There was no significant difference between the revision and non-revision groups (p = 0.34). The mean LGHO was 2.6 mm (SD 3.3) post-surgery. The mean LGHO of the revision group was 3.9 (SD 1.7) (p = 0.04) post-surgery. Despite the difference in mean LGHO, this is not a predictor for failure.ConclusionThe CSA, LGHO, and COR can be used on radiographs and have a high inter-observer agreement. In contrast with the CSA and LGHO, we found a correlation between clinical failure and revision surgery in case of a deviation of the COR greater than 5 mm.Trial registrationInstitutional review board, number: ACLU 2016.0054, Ethical Committee number: CBP M1330348. Registered 7 November 2006.

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Section: Discussionmentioning

confidence: 99%

Overstuffing in resurfacing hemiarthroplasty is a potential risk for failure

et al. 2019

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“…Additionally, in a subset of patients with cuff tear arthropathy (n 5 100), the mean CSA was 35.2°6 2.8°. Mantell et al 27 , using the receiver operating characteristic (ROC) curve, showed that a CSA of .35°was 90% specific and 52% sensitive for a full-thickness cuff tear in the setting of osteoarthritis. Contrary to the above findings, Chalmers et al 21 found that the mean CSA was 34°6 4°in patients with cuff tears, compared with 32°6 4°in patients with normal rotator cuffs, and concluded that the difference was small enough that it could have been influenced by measurement error.…”

Section: Critical Shoulder Anglementioning

confidence: 99%

Relationship Between the Critical Shoulder Angle and Shoulder Disease

Olszewski

Abdul-Rassoul

et al. 2018

JBJS Rev

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» In this review, we describe the history of the Critical Shoulder Angle (CSA), the utility of the CSA in identifying rotator cuff tears and glenohumeral osteoarthritis, and the association between the CSA and patient-reported outcomes. Additionally, we address some of the controversies surrounding the CSA with an updated literature review. » The CSA is the angle between the plane of the glenoid fossa (the line from the inferior edge of the glenoid to the superior edge of the glenoid) and a line drawn from the inferior edge of the glenoid to the lateral edge of the acromion on a true anteroposterior (Grashey) shoulder radiograph. » An increased CSA (.35°) is thought to alter deltoid vectors, which results in increased superior shear forces on the rotator cuff muscles. This increased loading of the rotator cuff may be a risk factor for the development of rotator cuff tears. » A decreased CSA (,30°) is associated with glenohumeral arthritis due to the increased compressive forces across the glenohumeral joint. » Reports in the literature have both supported and refuted the associations between the CSA, shoulder disease, and clinical treatment outcomes. These conflicting findings may be attributable to the lack of standardized radiographic methods for measuring CSA and/or to measurement errors. » Prospective longitudinal cohort studies involving a standard and reproducible method of CSA measurement are needed to elucidate the true relationship between the CSA and shoulder disease. Disclosure: No external funding was used for this study. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked "yes" to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work and "yes" to indicate that the author had other relationships or activities that could be perceived to influence, or have the potential to influence, what was written in this work (http://links.lww.com/JBJSREV/A359).

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“… 2 , 3 , 5 , 9 , 17 , 20 While genetics, 16 , 17 , 19 age, 16 , 17 , 19 and overuse 8 , 22 have all been suggested, osseous morphology may also play a role. 1 , 3 , 5 , 7 , 10 , 11 , 12 Recently, this research has focused on glenoid and acromial morphology including Bigliani type, acromial slope, acromiohumeral distance, lateral acromial angle, acromion index, critical shoulder angle, and glenoid inclication. 1 , 3 , 5 , 7 , 10 , 11 , 12 However, humeral morphology, specifically the morphology of the greater tuberosity may also play a role.…”

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confidence: 99%

Footprint size matters: wider coronal greater tuberosity width is associated with increased rates of healing after rotator cuff repair

et al. 2021

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Background The purpose of this study was to determine whether greater tuberosity morphology (1) could be measured reliably on magnetic resonance imaging (MRI), (2) differed between patients with rotator cuff tears (RCTs) compared with those without tears or glenohumeral osteoarthritis, or (3) differed between patients with rotator cuff repairs (RCR) who healed and those that did not. Methods This is a retrospective comparative study. (1) We measured greater tuberosity width (coronal and sagittal), lateral offset, and angle on MRI corrected into the plane of the humerus. To determine reliability, these measurements were made by two observers and intraclass correlation coefficients were calculated. (2) We compared these measurements between patients with a full-thickness RCT and patients aged >50 years without evidence of a RCT or glenohumeral osteoarthritis. (3) We then compared these measurements between those patients with healed RCRs and those with evidence of retear on MRI. In this portion, we only included patients with both a preoperative and postoperative MRI at least 1 year from RCR. Postoperative MRIs were obtained to assess healing rates, not because of concern for failure. Those without tendon defects were considered healed. Results (1) In a validation cohort of 50 patients with MRI, all inter-rater intraclass correlation coefficients were greater than 0.75. (2) There were no differences between our RCT group of 110 patients and our comparison group of 100 patients in tuberosity coronal width, sagittal width, or lateral offset. The RCT group had a significantly smaller greater tuberosity angle (63 ± 4° vs 65 ± 5°, P = .003). (3) In our group of 110 RCRs, postoperative MRI scans were obtained at a mean follow-up of 23.6 ± 15.7 months showing 84 (76%) patients had healed RCRs. Larger coronal tuberosity width was associated with healing (1.3 ± 0.2 vs 1.2 ± 0.2 cm, P = .032), as was smaller tear width ( P < .001), and retraction ( P < .001). When coronal width was dichotomized, there was a significantly higher healing rate with a width over 1.2 cm (85 vs 66%, P = .02). No other greater tuberosity morphological characteristics were associated with RCR or postoperative healing. Conclusion RCTs do not appear to be associated with greater tuberosity morphology. Postoperative rotator cuff healing based on MRI is 76%. Higher rates of healing occur with a wider coronal tuberosity width (ie, rotator cuff tendon footprint). Consideration could be given to widening the footprint intraoperatively in an effort to improve healing rates although this remains to be validated.

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Critical shoulder angle is associated with full-thickness rotator cuff tears in patients with glenohumeral osteoarthritis

Cited by 46 publications

References 28 publications

Overstuffing in resurfacing hemiarthroplasty is a potential risk for failure

Overstuffing in resurfacing hemiarthroplasty is a potential risk for failure

Relationship Between the Critical Shoulder Angle and Shoulder Disease

Footprint size matters: wider coronal greater tuberosity width is associated with increased rates of healing after rotator cuff repair

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