SpringerLink
Log in

Can the presence of SLAP-5 lesions be predicted by using the critical shoulder angle in traumatic anterior shoulder instability?

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

Although SLAP-5 lesions are associated with recurrent dislocations, their causes and pathomechanisms have not been fully elucidated. This study aimed to investigate the association between SLAP-5 lesions and scapular morphology in traumatic anterior shoulder instability (ASI). We hypothesized that there may be a relationship between SLAP-5 lesions and scapular morphology in traumatic ASI patients.

Materials and methods

The study included 74 patients with isolated Bankart lesions and 69 with SLAP-5 lesions who underwent arthroscopic labral repair for ASI. Critical shoulder angle (CSA) was measured on the roentgenograms, while glenoid inclination (GI) and glenoid version (GV) were measured on magnetic resonance imaging (MRI) by two observers in two separate sessions blinded to each other. Both groups were compared in terms of CSA, GI, and GV.

Results

The mean ages of Bankart and SLAP-5 patients were 28.4±9.1 and 27.9±7.7 (P=0.89), respectively; their mean CSA values were 33.1°±2.6° and 28.2°±2.4°, respectively (P<0.001). The ROC analysis’s cut-off value was 30.5°, with 75.0% sensitivity and 76.7% specificity (AUC = 0.830). SLAP-5 lesions were more common on the dominant side than isolated Bankart lesions (P=0.021), but no difference was found between the groups in terms of GI and GV (P=0.334, P=0.081, respectively).

Conclusions

In ASI, low CSA values appeared to be related to SLAP-5 lesions, and the cut-off value of CSA for SLAP lesion formation was 30.5° with 75.0% sensitivity and 76.7% specificity. Scapula morphology may be related to the SLAP-5 lesions, and CSA can be used as an additional parameter in provocative diagnostic tests and medical imaging techniques for the detection of SLAP lesions accompanying Bankart lesions.

Level of Evidence

III retrospective case-control study

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Aydin N, Unal MB, Asansu M, Tok O. Concomitant SLAP repair does not influence the surgical outcome for arthroscopic Bankart repair of traumatic shoulder dislocations. J Orthop Surg (Hong Kong). 2017;25(2):2309499017718952.

  2. Tordjman D, Vidal C, Fontès D. Mid-term results of arthroscopic Bankart repair: a review of 31 cases. Orthop Traumatol Surg Res. 2016;102(5):541–8.

    Article  CAS  PubMed  Google Scholar 

  3. Maffet MW, Gartsman GM, Moseley B. Superior labrum-biceps tendon complex lesions of the shoulder. Am J Sports Med. 1995;23(1):93–8.

    Article  CAS  PubMed  Google Scholar 

  4. Patzer T, Wimmer N, Verde PE, Hufeland M, Krauspe R, Kubo HK. The association between a low critical shoulder angle and SLAP lesions. Knee Surg Sports Traumatol Arthrosc. 2019;27(12):3944–51.

    Article  PubMed  Google Scholar 

  5. Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ. SLAP lesions of the shoulder. Arthroscopy. 1990;6(4):274–9.

    Article  CAS  PubMed  Google Scholar 

  6. Blonna D, Giani A, Bellato E, et al. Predominance of the critical shoulder angle in the pathogenesis of degenerative diseases of the shoulder. J Shoulder Elbow Surg. 2016;25(8):1328–36.

    Article  PubMed  Google Scholar 

  7. Bouaicha S, Ehrmann C, Slankamenac K, Regan WD, Moor BK. Comparison of the critical shoulder angle in radiographs and computed tomography. Skeletal Radiol. 2014;43(8):1053–6.

    Article  PubMed  Google Scholar 

  8. Moor BK, Bouaicha S, Rothenfluh DA, Sukthankar A, Gerber C. Is there an association between the individual anatomy of the scapula and the development of rotator cuff tears or osteoarthritis of the glenohumeral joint?: A radiological study of the critical shoulder angle. Bone Joint J. 2013;95-B(7):935–41.

    Article  CAS  PubMed  Google Scholar 

  9. Moor BK, Röthlisberger M, Müller DA, et al. Age, trauma and the critical shoulder angle accurately predict supraspinatus tendon tears. Orthop Traumatol Surg Res. 2014;100(5):489–94.

    Article  CAS  PubMed  Google Scholar 

  10. Tunalı O, Erşen A, Kızılkurt T, Bayram S, Sıvacıoğlu S, Atalar AC. Are critical shoulder angle and acromion index correlated to the size of a rotator cuff tear. Orthop Traumatol Surg Res. 2022;108(2):103122.

    Article  PubMed  Google Scholar 

  11. Hardy V, Rony L, Bächler J, Favard L, Hubert L. Does isolated arthroscopic anterior acromioplasty modify critical shoulder angle? Orthop Traumatol Surg Res. 2022;108(2):103040.

    Article  PubMed  Google Scholar 

  12. Girard M, Colombi R, Azoulay V, et al. Does anterior acromioplasty reduce critical shoulder angle? Orthop Traumatol Surg Res. 2020;106(6):1101–6.

    Article  PubMed  Google Scholar 

  13. Cherchi L, Ciornohac JF, Godet J, Clavert P, Kempf JF. Critical shoulder angle: measurement reproducibility and correlation with rotator cuff tendon tears. Orthop Traumatol Surg Res. 2016;102(5):559–62.

    Article  CAS  PubMed  Google Scholar 

  14. Cho HL, Lee CK, Hwang TH, Suh KT, Park JW. Arthroscopic repair of combined Bankart and SLAP lesions: operative techniques and clinical results. Clin Orthop Surg. 2010;2(1):39–46.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Garofalo R, Mocci A, Moretti B, et al. Arthroscopic treatment of anterior shoulder instability using knotless suture anchors. Arthroscopy. 2005;21(11):1283–9.

    Article  PubMed  Google Scholar 

  16. Hantes ME, Venouziou AI, Liantsis AK, Dailiana ZH, Malizos KN. Arthroscopic repair for chronic anterior shoulder instability: a comparative study between patients with Bankart lesions and patients with combined Bankart and superior labral anterior posterior lesions. Am J Sports Med. 2009;37(6):1093–8.

    Article  PubMed  Google Scholar 

  17. Gutierrez V, Monckeberg JE, Pinedo M, Radice F. Arthroscopically determined degree of injury after shoulder dislocation relates to recurrence rate. Clin Orthop Relat Res. 2012;470(4):961–4.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kim DS, Yi CH, Kwon KY, Oh JR. Relationship between the extent of labral lesions and the frequency of glenohumeral dislocation in shoulder instability. Knee Surg Sports Traumatol Arthrosc. 2013;21(2):430–7.

    Article  PubMed  Google Scholar 

  19. Burkhart SS, Lo IK, Brady PC. Burkhart’s view of the shoulder: a cowboy’s guide to advanced shoulder arthroscopy; 2006.

    Google Scholar 

  20. Seo J, Heo K, Kwon S, Yoo J. Critical shoulder angle and greater tuberosity angle according to the partial thickness rotator cuff tear patterns. Orthop Traumatol Surg Res. 2019;105(8):1543–8.

    Article  PubMed  Google Scholar 

  21. Cunningham G, Cocor C, Smith MM, Young AA, Cass B, Moor BK. Implication of bone morphology in degenerative rotator cuff lesions: a prospective comparative study between greater tuberosity angle and critical shoulder angle. Orthop Traumatol Surg Res. 2022;108(2):103046.

    Article  PubMed  Google Scholar 

  22. Tétreault P, Krueger A, Zurakowski D, Gerber C. Glenoid version and rotator cuff tears. J Orthop Res. 2004;22(1):202–7.

    Article  PubMed  Google Scholar 

  23. Scheyerer MJ, Brunner FE, Gerber C. The acromiohumeral distance and the subacromial clearance are correlated to the glenoid version. Orthop Traumatol Surg Res. 2016;102(3):305–9.

    Article  CAS  PubMed  Google Scholar 

  24. Maurer A, Fucentese SF, Pfirrmann CW, et al. Assessment of glenoid inclination on routine clinical radiographs and computed tomography examinations of the shoulder. J Shoulder Elbow Surg. 2012;21(8):1096–103.

    Article  PubMed  Google Scholar 

  25. Miswan MF, Saman MS, Hui TS, Al-Fayyadh MZ, Ali MR, Min NW. Correlation between anatomy of the scapula and the incidence of rotator cuff tear and glenohumeral osteoarthritis via radiological study. J Orthop Surg (Hong Kong). 2017;25(1):2309499017690317.

    Article  PubMed  Google Scholar 

  26. Kandeel AA. Type V superior labral anterior-posterior (SLAP) lesion in recurrent anterior glenohumeral instability. J Shoulder Elbow Surg. 2020;29(1):95–103.

    Article  PubMed  Google Scholar 

  27. Benhenneda R, Brouard T, Dordain F, et al. Can artificial intelligence help decision-making in arthroscopy? Part 1: Use of a standardized analysis protocol improves inter-observer agreement of arthroscopic diagnostic assessments of the long head of biceps tendon in small rotator cuff tears [published online ahead of print, 2023 Jun 24]. Orthop Traumatol Surg Res. 2023;103648.

  28. Nourissat G, Tribot-Laspiere Q, Aim F, Radier C. Contribution of MRI and CT arthrography to the diagnosis of intra-articular tendinopathy of the long head of the biceps. Orthop Traumatol Surg Res. 2014;100(8 Suppl):S391–4.

    Article  CAS  PubMed  Google Scholar 

  29. Bents RT, Skeete KD. The correlation of the Buford complex and SLAP lesions. J Shoulder Elbow Surg. 2005;14(6):565–9.

    Article  PubMed  Google Scholar 

  30. Cook C, Beaty S, Kissenberth MJ, Siffri P, Pill SG, Hawkins RJ. Diagnostic accuracy of five orthopedic clinical tests for diagnosis of superior labrum anterior posterior (SLAP) lesions [published correction appears in J Shoulder Elbow Surg. 2012 May;21(5):707]. J Shoulder Elbow Surg. 2012;21(1):13-22.

  31. Morgan CD, Burkhart SS, Palmeri M, Gillespie M. Type II SLAP lesions: three subtypes and their relationships to superior instability and rotator cuff tears. Arthroscopy. 1998;14(6):553–65.

    Article  CAS  PubMed  Google Scholar 

  32. Parentis MA, Glousman RE, Mohr KS, Yocum LA. An evaluation of the provocative tests for superior labral anterior posterior lesions. Am J Sports Med. 2006;34(2):265–8.

    Article  PubMed  Google Scholar 

  33. Rao AG, Kim TK, Chronopoulos E, McFarland EG. Anatomical variants in the anterosuperior aspect of the glenoid labrum: a statistical analysis of seventy-three cases. J Bone Joint Surg Am. 2003;85(4):653–9.

    Article  PubMed  Google Scholar 

  34. Somerville LE, Willits K, Johnson AM, et al. Clinical assessment of physical examination maneuvers for superior labral anterior to posterior lesions. Surg J (N Y). 2017;3(4):e154–62.

    Article  PubMed  Google Scholar 

  35. Van Spanning SH, Lafosse T, Verweij LPE, van Rijn SK, Lafosse L, Buijze GA. Predictive value of Gagey’s hyperabduction test in identifying inferior glenohumeral ligament lesions. Orthop Traumatol Surg Res. 2023;109(4):103500.

    Article  PubMed  Google Scholar 

  36. Ajuied A, McGarvey CP, Harb Z, Smith CC, Houghton RP, Corbett SA. Diagnosis of glenoid labral tears using 3-tesla MRI vs. 3-tesla MRA: a systematic review and meta-analysis. Arch Orthop Trauma Surg. 2018;138(5):699–709.

    Article  PubMed  Google Scholar 

  37. Altmann S, Jungmann F, Emrich T, Jezycki T, Kreitner KF. ABER position in direct MR arthrography of the shoulder: useful adjunct or waste of imaging time?. Die ABER-Position bei der direkten MR-Arthrografie der Schulter: Sinnvolle Ergänzung oder Verschwendung von Messzeit? Rofo. 2023;195(7):586–96.

    Article  PubMed  Google Scholar 

  38. Karahan N, Yılmaz B, Öztermeli A, Kaya M, Duman S, Çiçek ED. Evaluation of critical shoulder angle and acromion index in patients with anterior shoulder instability and rotator cuff tear. Acta Orthop Traumatol Turc. 2021;55(3):220–6.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics & Traumatology, School of Medicine, Necmettin Erbakan University, Konya, Turkey

    Haluk Yaka & Mustafa Özer

  2. Department of Orthopaedics & Traumatology, Pazarcık State Hospital, Kahraman Maraş, Turkey

    Turgut Emre Erdem

  3. Department of Orthopaedics & Traumatology, Gazi University School of Medicine, Ankara, Turkey

    Ulunay Kanatli

Authors
  1. Haluk Yaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Turgut Emre Erdem
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mustafa Özer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ulunay Kanatli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Haluk Yaka.

Ethics declarations

Ethical approval

Ethical approval was obtained from “Necmettin Erbakan University Ethical Committee” (Ref no: 2023/4111).

Informed consent

Informed consent was obtained from all patients that their radiological images would be used for scientific purposes in accordance with the decision of the university ethics committee.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yaka, H., Erdem, T.E., Özer, M. et al. Can the presence of SLAP-5 lesions be predicted by using the critical shoulder angle in traumatic anterior shoulder instability?. Skeletal Radiol (2024). https://doi.org/10.1007/s00256-024-04708-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00256-024-04708-1

Keywords

Search

Navigation