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

Overview

Journal Orthop J Sports Med

Specialty Orthopedics

Date 2017 Apr 29

PMID 28451621

Citations 18

Authors

Jacob M Kirsch

Amit Nathani

Christopher B Robbins

Joel J Gagnier

Asheesh Bedi

Bruce S Miller

Affiliations

Soon will be listed here.

Abstract

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 ( < .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 ( = .581), ASES ( = .458), or VAS ( = .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 ( < .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.

Citing Articles

The impact of acromial morphology on the localization and size of calcific tendonitis in the rotator cuff.

Birsel O, Caliskan E, Eren I, Yuruk B, Ozben H, Demirhan M Acta Orthop Traumatol Turc. 2024; 58(5):263-268.

PMID: 39560675 PMC: 11583934. DOI: 10.5152/j.aott.2024.24035.

The effect of reduced acromiohumeral distance and increased acromial thickness on the risk of rotator cuff tear.

Kilic E, Bingol O, Ozdemir G, Keskin O, Deveci A Acta Orthop Traumatol Turc. 2024; 57(6):348-351.

PMID: 38454214 PMC: 10837597. DOI: 10.5152/j.aott.2023.23033.

A prospective study of 100 patients with rotator cuff tendinopathy showed no correlation between subacromial bursitis and the efficacy of ultrasound-guided corticosteroid injection.

Metayer B, Fouasson-Chailloux A, Le Goff B, Darrieutort-Laffite C Eur Radiol. 2023; 34(1):300-307.

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Relationship Between Diagnostic Anatomic Shoulder Parameters and Degenerative Rotator Cuff Tears: An MRI Study.

Gulcu A, Aslan A, Dincer R, Ozmanevra R, Huri G Orthop J Sports Med. 2022; 10(11):23259671221130692.

PMID: 36425011 PMC: 9679614. DOI: 10.1177/23259671221130692.

Does the critical shoulder angle influence retear and functional outcome after arthroscopic rotator cuff repair? A systematic review and meta-analysis.

Liu T, Zhang M, Yang Z, Zhang B, Jiang J, Yun X Arch Orthop Trauma Surg. 2022; 143(5):2653-2663.

PMID: 36194254 DOI: 10.1007/s00402-022-04640-w.

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