The Effects of Arthroscopic Lateral Acromioplasty on the Critical Shoulder Angle and the Anterolateral Deltoid Origin: An Anatomic Cadaveric Study

Katthagen, J. Christoph; Marchetti, Daniel Cole; Tahal, Dimitri S.; Turnbull, Travis Lee; Millett, Peter J.

doi:10.1016/j.arthro.2015.12.019

Cited by 104 publications

(88 citation statements)

References 23 publications

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“…At the same time, a more laterally extending acromion may result in more vertically oriented deltoid muscle fibers, producing a more superiorly directed net deltoid force vector, particularly at lower degress (between 10° and 60°) of shoulder abduction. 7 A recent cadaveric study by Katthagen et al 9 reported one of the first attempts to surgically decrease the CSA by reducing the lateral extension of the acromion via lateral acromioplasty. The authors were able to decrease the overall CSA by almost 3° while safely preserving the deltoid origin.…”

Section: Discussionmentioning

confidence: 99%

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Is There an Association Between the “Critical Shoulder Angle” and Clinical Outcome After Rotator Cuff Repair?

Kirsch

Nathani

Robbins

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Variations in scapular morphology have been associated with the development of atraumatic rotator cuff tears (RCTs). The critical shoulder angle (CSA) accounts for both glenoid inclination and lateral extension of the acromion. The impact of the CSA on outcomes after rotator cuff repair (RCR) has not been investigated previously.Hypothesis:Our hypothesis was that individuals with smaller CSAs will have better patient-reported outcome scores over time compared with those with larger CSAs. Theoretically, a smaller CSA minimizes the biomechanical forces favoring superior translation of the humeral head, which may be advantageous after RCR. This is the first study to examine the relationship between the CSA and clinical outcomes after RCR.Study Design:Cohort study; Level of evidence, 2.Methods:Fifty-three patients (mean age, 61 years) with atraumatic full-thickness RCTs who underwent arthroscopic RCR were prospectively evaluated. Demographic data as well as the Western Ontario Rotator Cuff Index (WORC) score, American Shoulder and Elbow Surgeons (ASES) score, and a visual analog scale (VAS) for pain were prospectively collected at various time points up to 24 months postoperatively. Statistical analysis included longitudinal multilevel regression modeling to investigate the association between the CSA and the WORC, ASES, and VAS scores.Results:The overall clinical outcome, as measured by the WORC, ASES, and VAS, improved significantly (P < .0001). Controlling for demographic and clinical characteristics, a multilevel regression analysis demonstrated that the CSA was not a significant independent predictor for change in WORC (P = .581), ASES (P = .458), or VAS (P = .859) scores at 24 months after arthroscopic RCR. Interobserver and intraobserver reliability for CSA measurements resulted in interclass correlation coefficients of 0.986 and 0.982, respectively (P < .001), indicating excellent agreement.Conclusion:The CSA did not appear to be a significant predictor of patient-reported outcomes after arthroscopic repair of atraumatic full-thickness RCTs.

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Section: Discussionmentioning

confidence: 99%

“…The authors were able to decrease the overall CSA by almost 3° while safely preserving the deltoid origin. 9 …”

Section: Discussionmentioning

confidence: 99%

Is There an Association Between the “Critical Shoulder Angle” and Clinical Outcome After Rotator Cuff Repair?

Kirsch

Nathani

Robbins

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…In a prospective study of 49 patients (mean age 56 years, mean follow-up 30 months), it was found that reported improvements in patient-reported outcomes have no effects on the deltoid muscle origin, after arthroscopic alteration of the CSA 40. A biomechanical study has identified that with a smaller CSA, the load from the SSP is transferred to the deltoid, thus theoretically protecting the SSP and generating increased abduction power with the more effective use of the deltoid 41. It is also suggested that the risk of primary rotator cuff tears or even re-tears after rotator cuff repair can potentially be reduced when combining an arthroscopic anterolateral acromioplasty with an arthroscopic lateral acromion resection to significantly reduce the CSA, the favourable range of 30° to 35° 41.…”

Section: Discussionmentioning

confidence: 99%

“…A biomechanical study has identified that with a smaller CSA, the load from the SSP is transferred to the deltoid, thus theoretically protecting the SSP and generating increased abduction power with the more effective use of the deltoid 41. It is also suggested that the risk of primary rotator cuff tears or even re-tears after rotator cuff repair can potentially be reduced when combining an arthroscopic anterolateral acromioplasty with an arthroscopic lateral acromion resection to significantly reduce the CSA, the favourable range of 30° to 35° 41. Though there are theoretical advantages, studies investigating the use of an anterolateral acromioplasty have demonstrated that there are no differences in clinical outcomes after rotator cuff repair with or without this adjunct procedure 42 43…”

Section: Discussionmentioning

confidence: 99%

Critical shoulder angle is an effective radiographic parameter that is associated with rotator cuff tears and osteoarthritis: a systematic review

et al. 2019

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“…Some authors advocate for lateral acromioplasty in order to reduce the CSA to 30°to 35°to offload the supraspinatus. 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].…”

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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The Effects of Arthroscopic Lateral Acromioplasty on the Critical Shoulder Angle and the Anterolateral Deltoid Origin: An Anatomic Cadaveric Study

Cited by 104 publications

References 23 publications

Is There an Association Between the “Critical Shoulder Angle” and Clinical Outcome After Rotator Cuff Repair?

Is There an Association Between the “Critical Shoulder Angle” and Clinical Outcome After Rotator Cuff Repair?

Critical shoulder angle is an effective radiographic parameter that is associated with rotator cuff tears and osteoarthritis: a systematic review

Partial and Full-Thickness RCT: Modern Repair Techniques

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