Critical shoulder angle: what do radiologists need to know?

Loriaud, Amélie; Bise, Sylvain; Meyer, P.; Billaud, Anselme; Dallaudière, B.; Silvestre, Alain; Pesquer, Lionel

doi:10.1007/s00256-019-03337-3

Cited by 13 publications

(9 citation statements)

References 29 publications

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“… 19 For comparison of pre- and postoperative CSA, the exact orientation of the x-rays and the spatial orientation of the scapula should be as similar as possible. 22 Given the difficulty of obtaining SHC type A1 radiographs in daily practice and the inherent problems of standardization of Grashey views that might result in repeated or substantial ionizing radiation exposures (in the form of radiography or CT), patients for whom shoulder MRI is considered part of the diagnostic workup would better have their CSAs measured by means of the ZTE MRI sequence with anatomic cross-referencing on images from other planes.…”

Section: Discussionmentioning

confidence: 99%

Optimization of the Grashey View Radiograph for Critical Shoulder Angle Measurement: A Reliability Assessment With Zero Echo Time MRI

Yıldız

Yaraşır

Huri

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Suboptimal positioning on Grashey view radiographs may limit the prognosticating potential of the critical shoulder angle (CSA) for shoulder disorders. Purpose: To investigate whether radiography optimized according to the latest research is reliable for measuring CSA in comparison with magnetic resonance imaging (MRI) featuring 3-dimensional (3D) zero echo time (ZTE) sequencing, which accentuates the contrast between cortical bone and surrounding soft tissue with high fidelity. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients with shoulder pain were prospectively and consecutively enrolled. All patients had Grashey view radiographs as well as 3.0-T MRI scans with isotropic 3D ZTE sequencing. Acceptable positioning on the radiographs was determined using the ratio of the transverse to longitudinal (RTL) diameter of the lateral glenoid outline; radiographs with an RTL ≥0.25 were repeated. Two observers independently measured the CSA on the radiographs and the coronal oblique reformatted ZTE images, the latter including verification of measurement points by cross-referencing against images from other planes. Reliability of measurements between observers and modalities was analyzed with the intraclass correlation coefficient (ICC). The paired-samples t test was used to compare the differences between imaging modalities. Results: Enrolled were 65 patients (35 female and 30 male; mean age, 40.2 years; range, 25-49 years). Radiographs with optimal positioning (RTL < 0.25) were attained after a mean of 1.6 exposures (range, 1-4); the mean RTL was 0.09 (range, 0-0.20). Interobserver agreement of CSA was excellent for radiographs (ICC = 0.91; 95% CI, 0.84-0.94) and good for ZTE MRI scans (ICC = 0.85; 95% CI, 0.71-0.92). Intermodality agreement of CSA between radiographs and ZTE MRI scans was moderate (ICC = 0.66; 95% CI, 0.48-0.73). The CSA was significantly different between an optimal radiograph (30.7° ± 4.3°) and ZTE MRI scan (31.8° ± 3.8) ( P = .005). Subgroup analysis revealed no significant differences in CSA measurement between ZTE MRI scans and Grashey view radiographs with an RTL of <0.1 ( P = .08). Conclusion: CSA measurement on ZTE MRI scans with anatomic point cross-referencing was significantly different from that on Grashey view radiographs, even with optimal positioning, and radiography may necessitate more than 1 exposure. An RTL of <0.1 ensured reliability of radiographs when other standards of sufficient x-ray exposure were met.

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Section: Discussionmentioning

confidence: 99%

Optimization of the Grashey View Radiograph for Critical Shoulder Angle Measurement: A Reliability Assessment With Zero Echo Time MRI

Yıldız

Yaraşır

Huri

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…Recently, there has been increased interest in assessing the correlation between CSA and retear rate following arthroscopic RCR. Some studies suggest higher CSAs correlate with a higher rate of retear [9, 19, 20, 25, 26], while others have reported inconclusive results [6, 7, 11, 23]. Additionally, few studies have attempted to correlate CSA with patient‐reported outcomes (PROs) after arthroscopic RCR.…”

Section: Introductionmentioning

confidence: 99%

Critical shoulder angle does not influence retear rate after arthroscopic rotator cuff repair

Como

Hughes

Lesniak

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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PurposeThe critical shoulder angle (CSA) has been implicated as a potential risk factor for failure following arthroscopic rotator cuff repair (RCR). However, there is conflicting evidence regarding the clinical usefulness of this measurement. Given these discrepancies and limited comparisons to clinical outcomes, the aim of the current study was to determine whether higher CSAs correlated with an increased retear rate after arthroscopic rotator cuff repair and to determine if any association between CSA and patient‐reported outcomes (PROs) exists. It was hypothesized that there would be no correlation between CSA and retear rate or PROs after arthroscopic rotator cuff repair. MethodsA total of 164 patients who underwent arthroscopic RCR were retrospectively reviewed. CSA was measured for each patient. Patients were then divided into a retear group of 18 patients and a non‐retear group of 146 patients. Patient‐reported outcomes (PROs), including PROMIS 10 score, American Shoulder and Elbow Surgeons (ASES) score, Brophy score, and visual analog pain scores (VAS) were recorded post‐operatively. ResultsThe average CSA was 31.2 ± 4.5° for the retear group and 32.2 ± 4.7° for the non‐retear group (n.s.). No correlations were found between CSA and PROMIS score (n.s.), ASES score (n.s.), Brophy score (n.s.), or VAS (n.s.). ConclusionCritical shoulder angle had no correlation to retear rate or patient‐reported outcomes. CSA should not be used as a clinical predictor to assess rotator cuff retear risk after arthroscopic RCR. Level of evidenceLevel III.

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“…1. "Critical Shoulder Angle (CSA)" and Rotator Cuff Tears CSA is a radiological parameter widely used among orthopedic surgeons for analyzing pathological changes in the shoulder cuff [13]. Initially introduced by Moor et al in 2013 [4], it combines the acromion index and the inclination of the glenoid to enhance the sensitivity and accuracy of this parameter for shoulder joint diseases.…”

Section: Discussionmentioning

confidence: 99%

Clinical effect of modified anterolateral acromioarthroplasty during arthroscopic rotator cuff repair

Zhou,

He,

Kang

et al. 2023

Preprint

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Background: To compare the clinical effect of modified anterolateral acromioplasty and traditional acromioplasty in arthroscopicrotator cuff repair. Methods: The clinical data of 92 patients with total rotator cuff tears admitted to the Department of Joint Surgery of Jinhua Central Hospital from January 2016 to December 2019 were retrospectively analyzed. Among them,42 patients underwent traditional acromioplasty during arthroscopic rotator cuff repair, and 50 patients underwent modified anterolateral acromioplasty. Patients were evaluated for preoperative and postoperative shoulder function, pain and critical shoulder angle, and incidence of rotator cuff retear at 12 months postoperatively. Results: There was no statistical difference between the preoperative general data of the patients in the traditional acromioplasty and modified anterolateral acromioplasty groups (P>0.05), and they were comparable. The UCLA score, ASES score and Constant score of the shoulder joint in both groups were significantly improved and the VAS score was significantly decreased compared with those before surgery at 12 months after surgery, and the differences were statistically significant (P≤0.05). There was no statistically significant difference in shoulder function and pain scores between the two groups at 12 months postoperatively (P>0.05). There was no significant difference in CSA between the preoperative and postoperative 12 months in the traditional acromioplasty group (P>0.05), and the postoperative 12 months CSA in the modified anterolateral acromioplasty group was significantly smaller than the preoperative CSA, with a statistically significant difference (P≤0.05). At 12 months postoperatively, the rates of rotator cuff retears were 16.67% (7/42) and 4% (2/50) in the two groups, respectively, with statistically significant differences (P≤0.05). Conclusions: Both traditional acromioplasty and modified anterolateral acromioplasty performed during the treatment of total rotator cuff tears using arthroscopic rotator cuff repair significantly improved the function of the shoulder joint in patients, but modified anterolateral acromioplasty significantly reduced the CSA value and decreased the incidence of rotator cuff retears.

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Critical shoulder angle: what do radiologists need to know?

Cited by 13 publications

References 29 publications

Optimization of the Grashey View Radiograph for Critical Shoulder Angle Measurement: A Reliability Assessment With Zero Echo Time MRI

Optimization of the Grashey View Radiograph for Critical Shoulder Angle Measurement: A Reliability Assessment With Zero Echo Time MRI

Critical shoulder angle does not influence retear rate after arthroscopic rotator cuff repair

Clinical effect of modified anterolateral acromioarthroplasty during arthroscopic rotator cuff repair

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