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The critical shoulder angle is associated with rotator cuff tears and shoulder osteoarthritis and is better assessed with radiographs over MRI

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to determine whether there is an association between the critical shoulder angle (CSA) and rotator cuff tears (RCT) as well as osteoarthritis (OA), and to compare the reproducibility and accuracy of CSA values as measured with radiograph and MRI.

Methods

Based on a pre hoc power analysis, three independent reviewers measured CSAs for three groups of 10 age-matched patients each (RCT group, OA group, and non-RCT/non-OA group) using radiographs and MRIs. Inter- and intra-observer agreements of CSAs were determined with intraclass correlation coefficients. ANOVA analysis was performed.

Results

Interobserver and intra-observer agreements on radiographs were 0.87 (95 % CI 0.78–0.93) and 0.91 (95 % CI 0.82–0.96), respectively. Significant differences in mean CSAs by radiographs were found between the groups (RCT 37.3° ± 2.6°; OA 28.7° ± 2.2°; non-RCT/non-OA 32.7° ± 2.5°; p < 0.001). CSAs obtained from MRI scans had interobserver agreement of 0.62 (95 % CI 0.43–0.78) and intra-observer agreement of 0.68 (95 % CI 0.50–0.80). There was a significant correlation between the patients’ pathologies and CSAs measured by radiographs (r = 0.44; p = 0.02) and MRI (r = 0.50; p = 0.01). A significant difference in mean CSAs measured on radiograph versus MRI was seen in the OA group (28.7° ± 2.2° vs. 31.3° ± 4.4°; p = 0.01).

Conclusion

CSA measurements obtained from radiographs demonstrated excellent interobserver agreement with less variability than CSAs from MRI, especially in OA patients. This study confirms an association between the CSA and RCTs as well as OA pathology. Assessing the CSA may be helpful during diagnostic evaluation of patients with shoulder pain and can help predict pathology.

Level of evidence

Retrospective cohort study, Level IV.

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References

  1. Ames JB, Horan MP, Van der Meijden OA, Leake MJ, Millett PJ (2012) Association between acromial index and outcomes following arthroscopic repair of full-thickness rotator cuff tears. J Bone Joint Surg Am 94:1862–1869

    Article  PubMed  Google Scholar 

  2. Bhatia S, Hsu A, Lin EC, Chalmers P, Ellman M, Cole BJ, Verma NN (2012) Surgical treatment options for the young and active middle-aged patient with glenohumeral arthritis. Adv Orthop 2012:1–8

    Article  Google Scholar 

  3. Bigliani LU, Ticker JB, Flatow EL, Soslowsky LJ, Mow VC (1991) The relationship of acromial architecture to rotator cuff disease. Clin Sports Med 10:823–838

    CAS  PubMed  Google Scholar 

  4. Davidson PA, Elattrache NS, Jobe CM, Jobe FW (1995) Rotator cuff and posterior-superior glenoid labrum injury associated with increased glenohumeral motion: a new site of im**ement. J Shoulder Elbow Surg 4:384–390

    Article  CAS  PubMed  Google Scholar 

  5. DeOrio JK, Cofield RH (1984) Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joint Surg Am 66:563–567

    CAS  PubMed  Google Scholar 

  6. Drӧge W (2003) Oxidative stress and aging. Adv Exp Med Biol 543:191–200

    Article  Google Scholar 

  7. Funakoshi T, Iwasaki N, Kamishima T, Nishida M, Ito Y, Kondo M, Minami A (2010) In vivo visualization of vascular patterns of rotator cuff tears using contrast-enhanced ultrasound. Am J Sports Med 38:2464–2471

    Article  PubMed  Google Scholar 

  8. Gerber C, Rahm SA, Catanzaro S, Farshad M, Moor BK (2013) Latissimus dorsi tendon transfer for treatment of irreparable posterosuperior rotator cuff tears: long-term results at a minimum follow-up of 10 years. J Bone Joint Surg Am 95:1920–1926

    Article  PubMed  Google Scholar 

  9. Hamid N, Omid R, Yamaguchi K, Steger-May K, Stobbs G, Keener JD (2012) Relationship of radiographic acromial characteristics and rotator cuff disease: a prospective investigation of clinical, radiographic, and sonographic findings. J Shoulder Elbow Surg 10:1289–1298

    Article  Google Scholar 

  10. Hashimoto T, Nobuhara K, Hamada T (2003) Pathologic evidence of degeneration as a primary cause of rotator cuff tear. Clin Orthop Relat Res 415:111–120

    Article  PubMed  Google Scholar 

  11. Hughes RE, Bryant CR, Hall JM, Wening J, Huston LJ, Kuhn JE, Carpenter JE, Blasier RB (2003) Glenoid inclination is associated with full-thickness rotator cuff tears. Clin Orthop Relat Res 407:86–91

    Article  PubMed  Google Scholar 

  12. Kim JR, Ryu KJ, Hong IT, Kim BK, Kim JH (2012) Can a high acromion index predict rotator cuff tears? Int Orthop 36:1019–1024

    Article  PubMed  PubMed Central  Google Scholar 

  13. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  14. Lenza M, Buchbinder R, Takwoingi Y, Johnston RV, Hanchard NC, Faloppa F (2013) Magnetic resonance imaging, magnetic resonance arthrography. Cochrane Database Syst Rev 24(9):CD009020

    Google Scholar 

  15. Miyazaki AN, Itoi E, Sano H, Fregoneze M, Santos PD, da Silva LA, Sella Gdo V, Martel EM, Debom LG, Andrade ML, Checchia SL (2011) Comparison between the acromion index and rotator cuff tears in the Brazilian and Japanese populations. J Shoulder Elbow Surg 20:1082–1086

    Article  PubMed  Google Scholar 

  16. Moor BK, Bouaicha S, Rothenfluh DA, Sukthankar A, Gerber C (2013) 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 95-B:935–941

    Article  CAS  PubMed  Google Scholar 

  17. Neer CS 2nd (1972) Anterior acromioplasty for the chronic im**ement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am 54:41–50

    PubMed  Google Scholar 

  18. Nove-Josserand L, Edwards TB, O’Connor DP, Walch G (2005) The acromiohumeral and coracohumeral intervals are abnormal in rotator cuff tears with muscular fatty degeneration. Clin Orthop Relat Res 433:90–96

    Article  PubMed  Google Scholar 

  19. Nyffeler RW, Werner CM, Sukthankar A, Schmid MR, Gerber C (2006) Association of a large lateral extension of the acromion with rotator cuff tears. J Bone Joint Surg Am 88:800–805

    Article  PubMed  Google Scholar 

  20. Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg Br 43-B:752–757

    CAS  PubMed  Google Scholar 

  21. Patte D (1990) Classification of rotator cuff lesions. Clin Orthop Relat Res 254:81–86

    PubMed  Google Scholar 

  22. Steinbach LS (2008) MRI of shoulder instability. Eur J Radiol 68:57–71

    Article  PubMed  Google Scholar 

  23. Zumstein MA, Jost B, Hempel J, Hodler J, Gerber C (2008) The clinical and structural long-term results of open repair of massive tears of the rotator cuff. J Bone Joint Surg Am 90:2423–2431

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO, 81657, USA

    Ulrich J. Spiegl, Marilee P. Horan, Sean W. Smith, Charles P. Ho & Peter J. Millett

  2. The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA

    Charles P. Ho & Peter J. Millett

Authors
  1. Ulrich J. Spiegl
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  2. Marilee P. Horan
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  3. Sean W. Smith
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  4. Charles P. Ho
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  5. Peter J. Millett
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Correspondence to Peter J. Millett.

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Spiegl, U.J., Horan, M.P., Smith, S.W. et al. The critical shoulder angle is associated with rotator cuff tears and shoulder osteoarthritis and is better assessed with radiographs over MRI. Knee Surg Sports Traumatol Arthrosc 24, 2244–2251 (2016). https://doi.org/10.1007/s00167-015-3587-7

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  • DOI: https://doi.org/10.1007/s00167-015-3587-7

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