Impact of Arthroscopic Lateral Acromioplasty on the Mechanical and Structural Integrity of the Lateral Deltoid Origin: A Cadaveric Study

Marchetti, Daniel Cole; Katthagen, J. Christoph; Mikula, Jacob D.; Montgomery, Scott R.; Tahal, Dimitri S.; Dahl, Kimi D.; Turnbull, Travis Lee; Millett, Peter J.

doi:10.1016/j.arthro.2016.08.015

Cited by 40 publications

(31 citation statements)

References 34 publications

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“…Although it has not yet been clarified which sub-component (glenoid inclination, lateral acromial roof extension, acromial height) has the greatest impact, arthroscopic lateral acromioplasty is already performed. [8][9][10][11][12][13] Our data could support lateral acromioplasty. But nevertheless, an assessment about the effectiveness and necessity of lateral acromioplasty cannot be investigated by this study.…”

Section: Discussionsupporting

confidence: 58%

“…There is a great interest to change the radiological CSA towards to “normal” values and thereby reducing an overload of the rotator cuff. Although it has not yet been clarified which sub‐component (glenoid inclination, lateral acromial roof extension, acromial height) has the greatest impact, arthroscopic lateral acromioplasty is already performed . Our data could support lateral acromioplasty.…”

Section: Discussionmentioning

confidence: 60%

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Critical shoulder angle: Acromial coverage is more relevant than glenoid inclination

Beeler

Hasler

Götschi

et al. 2019

Journal Orthopaedic Research

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It is still unknown whether glenoid inclination or lateral acromial roof extension is a more important determinant for development of rotator cuff tears (RCT) or osteoarthritis (OA) of the shoulder. It was the purpose of this study, to evaluate whether there is a potential predominance of one of these factors in pathogenesis of RCT or concentric OA. We analyzed 70 shoulders with advanced degenerative RCT and 54 shoulders with concentric OA undergoing primary shoulder arthroplasty (anatomical or reverse) using antero-posterior radiography and multiplanar computed tomography. The two groups were compared in relation to glenoid inclination, lateral acromion roof extension, acromial height and critical shoulder angle (CSA). All measured parameters were highly significantly different between RCT and concentric OA (p < 0.001). Based on Cohen's d effect size, group differences were most distinct in lateral acromial roof extension (1.36 , 0.92 ) compared with acromial height (1.06 , 0.73 ) and glenoid inclination (0.60 , 0.61 ). However, no single factor showed an effect size which was as high as that of the CSA (1.63 ). Interestingly, a ratio of lateral acromion roof extension and acromial height could enhance the effect size (1.60 , 1.16 ) near to values of the CSA (1.63 ). In summary, lateral acromial roof extension has a greater influence in pathogenesis of degenerative RCT and concentric OA than acromial height or glenoid inclination. This article is protected by copyright. All rights reserved.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 60%

Critical shoulder angle: Acromial coverage is more relevant than glenoid inclination

Beeler

Hasler

Götschi

et al. 2019

Journal Orthopaedic Research

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“…Katthagen et al performed a cadaveric study showing that 5 mm lateral acromion resection reduced the CSA by nearly 3°without damaging the deltoid origin [32]. Marchetti et al then showed that both 5 and 10 mm lateral acromial resection did not significantly reduce the mechanical or structural integrity of the lateral deltoid origin when loaded to failure [33]. More research is necessary as there are currently no outcomes published for lateral acromioplasty in combination with RCR.…”

Section: Critical Shoulder Anglementioning

confidence: 99%

Partial and Full-Thickness RCT: Modern Repair Techniques

Nathani

Smith

Wang

2018

Curr Rev Musculoskelet Med

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Purpose of Review The purpose of this article is to review the recent literature concerning modern repair techniques related to partial-and full-thickness rotator cuff tears. Recent Findings The understanding of rotator cuff pathology and healing continues to evolve, beginning with emerging descriptions of the anatomic footprint and natural history of rotator cuff tears. Significant controversy remains in treatment indications for partial-thickness rotator cuff lesions as well as optimal surgical repair techniques for both partial-and full-thickness tears. Techniques such as margin convergence and reduction of the so-called "comma" tissue have improved the ability to anatomically reduce large and retracted tears. Repair strength and contact pressures are improved with double-row repairs and transosseusequivalent techniques compared to traditional single-row repairs. Future work is directed towards obtaining reliable radiographic healing and demonstrating clinical superiority and cost-effectiveness of a single technique. Summary Much recent work regarding rotator cuff anatomy and pathology has been reported. Newer techniques improve repair strength. Despite these advances, significant questions remain concerning surgical indications and clinical outcomes.

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“…Shortening the lateral aspect of the acromion to modify the CSA with LA is a technically feasible, effective, and safe procedure to reduce an unfavorably large CSA, although its clinical usefulness and effectiveness have not yet been widely demonstrated. [1][2][3][4] We applaud Gerber, Catanzaro, Betz, and Ernstbrunner for their work "Arthroscopic Correction of the Critical Shoulder Angle Through Lateral Acromioplasty: A Safe Adjunct to Rotator Cuff Repair." 5 The authors report on a clinical series of 49 patients with a mean follow-up of 30 months after LA, with an average of 6 mm lateral bone resection in patients with arthroscopic rotator cuff repair (RCR) and a preoperative CSA of 34 or more.…”

mentioning

confidence: 99%

“…1 In a subsequent ex vivo cadaveric study, we showed that both 5-and 10-mm (2 widths of a burr) LAs did not weaken the acromion or the deltoid origin when compared to intact specimens. 2 Now, Gerber et al demonstrate that the reduction of an unfavorably large CSA by LA as an adjunct to RCR has beneficial clinical effects, without causing additional complications compared with RCR without LA. Gerber's group found the postoperative CSA to be significantly larger in failed than in healed RCR and that patients with a healed RCR and a CSA corrected to 33 had 25% more abduction strength than patients with a healed cuff and a CSA corrected to 35 .…”

mentioning

confidence: 99%

Editorial Commentary: Lateral Acromioplasty Is Clinically Safe and Has the Potential to Reduce the Risk for Rotator Cuff Re-tears

Katthagen

Millett²

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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The critical shoulder angle and lateral acromioplasty are areas of controversy that are being studied in association with rotator cuff tears both as potential pathogenic variables and as surgically modifiable variables that could improve clinical outcomes. Current clinical evidence regarding the effectiveness and potential benefit of lateral acromioplasty support the hypothesis that modification of the bony anatomy may influence the integrity of the rotator cuff.

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Impact of Arthroscopic Lateral Acromioplasty on the Mechanical and Structural Integrity of the Lateral Deltoid Origin: A Cadaveric Study

Cited by 40 publications

References 34 publications

Critical shoulder angle: Acromial coverage is more relevant than glenoid inclination

Critical shoulder angle: Acromial coverage is more relevant than glenoid inclination

Partial and Full-Thickness RCT: Modern Repair Techniques

Editorial Commentary: Lateral Acromioplasty Is Clinically Safe and Has the Potential to Reduce the Risk for Rotator Cuff Re-tears

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