Editorial Commentary: Arthroscopic Treatment Should No Longer Be Offered to People With Subacromial Impingement

Buchbinder, Rachelle; Karjalainen, Teemu; Gorelik, Alexandra

doi:10.1016/j.arthro.2022.03.017

Cited by 3 publications

(3 citation statements)

References 33 publications

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“…The positive AAC group also demonstrated a larger AAS, which may indicate subacromial impingement and explain the correlation between greater AAC and the presence of RCTs and their sizes in previous studies. 3,35,54 However, the clinical relevance of subacromial impingement or anterior acromioplasty remains controversial, 5,11 and the effects of AP acromial coverage on arthroscopic repair of MRCTs have not been elucidated. Burkhart 6 classified the glenohumeral kinematics of patients with MRCTs into 3 types: stable fulcrum (provided by the remaining rotator cuff attachment), captured fulcrum (provided by the inferior acromial surface), and unstable fulcrum (no mechanical fulcrum for active abduction).…”

Section: Discussionmentioning

confidence: 99%

“…The inclusion criteria were (1) involvement of the supraspinatus, infraspinatus, and subscapularis tendons (AP-MRCT) and (2) having undergone arthroscopic rotator cuff repair. Patients were excluded from the study if they (1) underwent partial rotator cuff repair; (2) underwent biceps rerouting, graft bridging, or muscle tendon transfer; (3) had a fracture of the humeral head or scapula; (4) underwent additional procedures for shoulder instability; (5) had confirmed glenohumeral osteoarthritis (Outerbridge grade 3) 66 ; (6) had a history of ipsilateral shoulder surgery; or (7) were lost to follow-up within 24 months.…”

Section: Patient Selectionmentioning

confidence: 99%

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Effect of Anterior Acromial Coverage on Functional and Radiological Outcomes After Arthroscopic Repair of Anteroposterior Massive Rotator Cuff Tears

Ye,

Qiao,

et al. 2023

Am J Sports Med

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Background: Rotator cuff tear size, fatty infiltration, and scapular morphology are correlated with tendon healing and functional outcomes after arthroscopic repair; however, the association between anteroposterior acromial coverage and the clinical outcomes of anteroposterior massive rotator cuff tears (AP-MRCTs; involving all 3 tendons) remains unclear. Purpose: To identify the association between AP acromial coverage and functional and radiological outcomes after arthroscopic repair of AP-MRCTs. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 98 patients who underwent arthroscopic repair of AP-MRCTs between January 2015 and December 2020 were included in the study and classified according to whether anterior acromial coverage (AAC) was anterior (46 patients; positive AAC group) or posterior (52 patients; negative AAC group) to the scapular line on true lateral shoulder radiographs. Demographic characteristics, surgical details, and functional outcomes were prospectively collected. Acromial morphological features, global tear extension (GTE), the global fatty infiltration index (GFII), tendon integrity after repair, proximal humeral migration, and glenohumeral abduction were measured and calculated on radiographs or magnetic resonance imaging scans preoperatively and at 2 years postoperatively. Multivariate logistic regression was performed to identify the independent risk factors of a rotator cuff retear. Results: The positive AAC group showed larger AAC, posterior acromial tilt, and anterior acromial slope as well as smaller posterior acromial coverage compared with the negative AAC group. Postoperatively, the American Shoulder and Elbow Surgeons score (82.5 ± 8.3 vs 77.2 ± 11.5, respectively; P = .013), active abduction (157.8°± 27.1° vs 142.7°± 39.6°, respectively; P = .048), and glenohumeral abduction (45.6°± 10.4° vs 39.7°± 14.9°, respectively; P = .041) in the positive AAC group were significantly higher than those in the negative AAC group, while the retear rate (23.9% vs 44.2%, respectively; P = .035) and proximal humeral migration (1.7 ± 1.0 vs 2.3 ± 1.2 mm, respectively; P = .006) were significantly lower in the positive AAC group than in the negative AAC group. Smaller AAC (odds ratio [OR], 0.93 [95% CI, 0.87-1.00]; P = .040), larger GTE (OR, 1.03 [95% CI, 1.01-1.06]; P = .017), and a higher GFII (OR, 3.49 [95% CI, 1.09-11.19]; P = .036) were associated with an increased risk of a rotator cuff retear. Conclusion: Increased AAC was associated with a lower retear rate and better functional outcomes after arthroscopic repair of AP-MRCTs. A preliminary risk evaluation integrating GTE, the GFII, and AAC is recommended to consider the necessity of additional procedures for patients in need of arthroscopic rotator cuff repair.

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Section: Discussionmentioning

confidence: 99%

Section: Patient Selectionmentioning

confidence: 99%

Effect of Anterior Acromial Coverage on Functional and Radiological Outcomes After Arthroscopic Repair of Anteroposterior Massive Rotator Cuff Tears

Ye,

Qiao,

et al. 2023

Am J Sports Med

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“…The commentary, which follows the article in the current issue, is strongly worded and adamant, as summarized by the commentary title, "Arthroscopic Treatment Should No Longer Be Offered to People With Subacromial Impingement." 5 Regarding the article and the commentary, readers can form their own opinions.…”

Section: H Ippocrasymentioning

confidence: 99%

Stop Overtreatment, Overdiagnosis, and the Medicalization of “Normal” to Improve Health Care Outcomes. Hippocrasy: The Book

Lubowitz¹,

Brand²,

Rossi³

2022

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Substantial Variation in Decision Making to Perform Subacromial Decompression Surgery for Subacromial Pain Syndrome Between Orthopaedic Shoulder Surgeons for Identical Clinical Scenarios: A Case-Vignette Study

Geurkink,

Marang-van de Mheen,

Nagels

et al. 2023

Arthroscopy, Sports Medicine, and Rehabilitation

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Editorial Commentary: Arthroscopic Treatment Should No Longer Be Offered to People With Subacromial Impingement

Cited by 3 publications

References 33 publications

Effect of Anterior Acromial Coverage on Functional and Radiological Outcomes After Arthroscopic Repair of Anteroposterior Massive Rotator Cuff Tears

Effect of Anterior Acromial Coverage on Functional and Radiological Outcomes After Arthroscopic Repair of Anteroposterior Massive Rotator Cuff Tears

Stop Overtreatment, Overdiagnosis, and the Medicalization of “Normal” to Improve Health Care Outcomes. Hippocrasy: The Book

Substantial Variation in Decision Making to Perform Subacromial Decompression Surgery for Subacromial Pain Syndrome Between Orthopaedic Shoulder Surgeons for Identical Clinical Scenarios: A Case-Vignette Study

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