The acromiohumeral distance in the MRI should not be used as a decision criterion to assess subacromial space width in shoulders with an intact rotator cuff

Hufeland, Martin; Brusis, Christina; Kubo, Hannes; Grassmann, Jan-Peter; Latz, David; Patzer, Thilo

doi:10.1007/s00167-020-06090-6

Cited by 12 publications

(22 citation statements)

References 23 publications

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“…The AHI is the shortest distance between the inferior cortex of the acromion and the top of the humeral head, the normal AHI is 7-14 mm. [3,4] Patients with an AHI ≤ 7 mm suggests a large rotator cuff tear. [2][3][4] Gruber et al measured AHI on standard AP radiographs and found that the AHI measurement was reliable and reproducible.…”

Section: Discussionmentioning

confidence: 99%

“…[3,4] Patients with an AHI ≤ 7 mm suggests a large rotator cuff tear. [2][3][4] Gruber et al measured AHI on standard AP radiographs and found that the AHI measurement was reliable and reproducible. [7] This study also found that the AHI measurements, in either supine or upright radiographs and MRIs, were reliable and reproducible.…”

Section: Discussionmentioning

confidence: 99%

“…The AHI of the shoulder radiographs was measured by using the distance between the dense cortical bone at the inferior aspect of the acromion and the subchondral lamina of the humeral head. [3] The shortest distance was measured. The same measurement was performed by reviewers on sagittal oblique T1-weighted MRI.…”

Section: Measurement Of Acromiohumeral Intervalmentioning

confidence: 99%

“…(7-14 mm.). [3,4] While the AHI ≤ 7 mm. measured on an anteroposterior radiograph suggests subacromial space narrowing and is indicative of large rotator cuff tears and the likelihood of successful outcomes after the repair is reduced.…”

Section: Introductionmentioning

confidence: 99%

“…measured on an anteroposterior radiograph suggests subacromial space narrowing and is indicative of large rotator cuff tears and the likelihood of successful outcomes after the repair is reduced. [2][3][4] The AHI value may be increased by the gravity during upright arm position and has the possibility to get the false negative result in detecting rotator cuff tears. Measurement of the AHI from supine MRIs is lower than measurement in upright shoulder radiographs [5] but plain radiographs are still the most initial investigation for rotator cuff-related patients.…”

Section: Introductionmentioning

confidence: 99%

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The Differences of the Acromiohumeral Interval Between Supine and Upright Radiographs of the Shoulder

Sanguanjit

Apivatgaroon

Boonsun

et al. 2021

Preprint

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Background: Acromiohumeral interval (AHI) is a measurement method to determine the superior migration of the humeral head in patients with rotator cuff tears.Hypothesis/Purpose: The purpose of this study was to compare the AHI measurement in supine shoulder and upright shoulder radiographs, as well as magnetic resonance imaging (MRI), as well as to report the sensitivity, specificity, and accuracy in detecting full thickness rotator cuff tears.Study Design: Diagnostic study.Methods: From July 2020 to May 2021, evaluation of 86 shoulder radiographs in both supine & upright Grashey views compared with the MRI of the affected shoulder. Measurements of the AHI obtained from both radiographs and MRIs was determined by two independent orthopaedic surgeons. The intraclass correlation of the AHI measurement was tested. The difference between the AHI in each view was determined.Result: The 86 shoulders were divided into 3 groups that included; 1) non-full thickness tear (50%), 2) full thickness (FT) tear 3 cm (33.7%), and 3) FT tear > 3 cm (16.3%). The mean difference of AHI noted was significantly lower in the supine radiographs than with the upright (1.34-1.37 mm.). The mean difference of the AHI was significantly lower in the MRI than the upright (1.62-1.87 mm.). AHI obtained from the supine radiographs and MRI had no significant differences. The area under the curve (AUC) of the upright and supine AHI in the diagnosis of the FT tears were at 0.649 and 0.642 accuracy. Upright AHI 7.09 mm. had 27.9% sensitivity and 100% specificity in diagnosing FT tears with 64% accuracy (p<0.001). The upright AHI cut off value of 9.52 mm. had 60.5% sensitivity, 67.4% specificity, and 64% accuracy (p=0.01). The supine AHI 6.56 mm. had 32.6% sensitivity, 100.0% specificity, and 66.3% accuracy (p<0.01). Supine AHI cut off value of 7.42 mm. had 41.9% sensitivity, 86.0% specificity, and 64.0% accuracy (p=0.004). The inter- and intra-rater reliability of AHI measurement in 3 views were of substantial to almost perfect agreement (0.668-0.824).Conclusion: The AHI in supine radiographs were significantly lower than upright shoulder radiographs in all groups as divided by severity of the rotator cuff tear and was comparable with the MRI. For AHI ≤ 7 mm. in upright shoulder radiographs remains as a good diagnostic test of full thickness rotator cuff tears, while this value was not relevant for use as the cut point in the supine radiographs and MRI shoulders.Level of evidence: Level III; Diagnostic studyClinical Relevance: The AHI measurement in supine and upright radiographs are reliable and reproducible. The AHI ≤ 7 mm. in upright shoulder radiographs remains as a good diagnostic test of full thickness rotator cuff tears, while this value was not relevant for use as the cut point in the supine radiographs and MRI shoulders.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Measurement Of Acromiohumeral Intervalmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Differences of the Acromiohumeral Interval Between Supine and Upright Radiographs of the Shoulder

Sanguanjit

Apivatgaroon

Boonsun

et al. 2021

Preprint

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Capsular remnant in the rotator cuff footprint is a novel arthroscopic finding may indicate the etiology of the tear

Ayanoğlu

Çiçeklidağ²,

Kaya

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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PurposeThe aim of the study was that the capsule remnant is a common indicator of sub‐acromial impingement syndrome and bursal side onset rotator cuff tears. MethodsSixty‐three patients with capsule remnants in the rotator cuff footprint (Study group) were detected, while the 53 patients did not have any remnant on the tendon footprint (Control group) between 2015 and 2020 were included. Demographic data of patients, such as age, gender, and operated side information were obtained from the archive files. Acromion type, presence of osteophytes in the acromioclavicular joint, Acromiohumeral Distance (AHD), Acromial Index (AI), Critical Shoulder Angle (CSA), and Coracoacromial Ligament (CAL) degeneration values were evaluated from preoperative MRI, radiographic images, and arthroscopic video recordings. ResultsSevere stages of CAL degeneration were observed in 82.5% of the patients who had capsule remnant (p: 0.001). While type 2 acromion was found in 61.9%, and also acromioclavicular joint osteophyte was found in 58.7% of the patients in the study group. The mean AHD was 8.22 ± 1.56 mm in the study group and 9.2 ± 1.3 mm in the control group. The mean CSA was 43.3 ± 4.9 in the study group and 40.8 ± 4.2 in the control group. The AI was measured as 0.8 ± 0.1 in the study group and 0.8 ± 0.01 in the control group. As a result of these measurements, a statistical difference was found between the two groups in terms of type 2 acromion ratio (p < 0.001), presence of osteophytes in the acromioclavicular joint (p < 0.001), mean acromio‐humeral distance (p < 0.001), critical shoulder angle (p = 0.004), and acromial index values (p < 0.001). ConclusionThe findings of sub‐acromial impingement syndrome were found to be more prominent in patients with full‐thickness degenerative tear and findings of capsular remnant in the footprint. If the presence of the current finding is detected during glenohumeral arthroscopy, sub‐acromial impingement syndrome should be examined in more detail to reveal the underlying cause and prevent a recurrence.

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Higher coracoacromial ligament thickness, critical shoulder angle and acromion index are associated with rotator cuff tears in patients who undergo arthroscopic rotator cuff repair

Incesoy¹,

Kulduk²,

Yıldız³

et al. 2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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The acromiohumeral distance in the MRI should not be used as a decision criterion to assess subacromial space width in shoulders with an intact rotator cuff

Cited by 12 publications

References 23 publications

The Differences of the Acromiohumeral Interval Between Supine and Upright Radiographs of the Shoulder

The Differences of the Acromiohumeral Interval Between Supine and Upright Radiographs of the Shoulder

Capsular remnant in the rotator cuff footprint is a novel arthroscopic finding may indicate the etiology of the tear

Higher coracoacromial ligament thickness, critical shoulder angle and acromion index are associated with rotator cuff tears in patients who undergo arthroscopic rotator cuff repair

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