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Archives of Orthopaedic and Trauma Surgery

, Volume 139, Issue 8, pp 1125–1132 | Cite as

Does the critical shoulder angle decrease after anterior acromioplasty?

  • Anselme BillaudEmail author
  • Eduardo Cruz-Ferreira
  • Lionel Pesquer
  • Pierre Abadie
  • Yacine Carlier
  • Pierre-Henri Flurin
Arthroscopy and Sports Medicine
  • 70 Downloads

Abstract

Introduction

No clinical studies to date have analyzed the critical shoulder angle (CSA) following anterior acromioplasty. Our study’s main objective was to measure the change in the CSA after acromioplasty.

Materials and methods

Ninety patients were included in this retrospective series. The CSA and the type of acromion were evaluated before and after surgery.

Results

The average CSA for patients before surgery was 35.9° (± 3.7, 26.2, 44.2) and 33° after the acromioplasty (± 3.5, 24.8, 41.4). The decrease was significant and 2.9° on average (± 2.2, − 2.2, 11.9, p = 0.000). Preoperatively, 58% of patients had a CSA ≥ 35° (n = 52) and 24% postoperatively (n = 22, p = 0.000).

Conclusions

Standardized anterior acromioplasty allows for a significant decrease in the CSA without lateral resection of the acromion. This study confirms the tight link between the CSA and the anterior acromion as well as the interest of this angle to quantify acromioplasty whether anterior or lateral.

Level of evidence

Level IV, Case Series, Retrospective design.

Keywords

Acromioplasty Critical shoulder angle Rotator cuff tear Rotator cuff repair 

Notes

Compliance with ethical standards

Conflict of interest

AB, EC, LP, PA, YC, and P-H F declare that they have no conflict of interest.

References

  1. 1.
    Balke M, Liem D, Greshake O, Hoeher J, Bouillon B, Banerjee M (2016) Differences in acromial morphology of shoulders in patients with degenerative and traumatic supraspinatus tendon tears. Knee Surg Sports Traumatol Arthrosc 24(7):2200–2205.  https://doi.org/10.1007/s00167-014-3499-y CrossRefGoogle Scholar
  2. 2.
    Balke M, Schmidt C, Dedy N, Banerjee M, Bouillon B, Liem D (2013) Correlation of acromial morphology with impingement syndrome and rotator cuff tears. Acta Orthop 84(2):178–183.  https://doi.org/10.3109/17453674.2013.773413 CrossRefGoogle Scholar
  3. 3.
    Armstrong JR (1949) Excision of the acromion in treatment of the supraspinatus syndrome; report of 95 excisions. J Bone Joint Surg Br 31B(3):436–442CrossRefGoogle Scholar
  4. 4.
    Neer CS (1972) Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am 54(1):41–50CrossRefGoogle Scholar
  5. 5.
    Bigliani LU, Morrison DS, April DW (1986) The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans 10:216Google Scholar
  6. 6.
    Epstein RE, Schweitzer ME, Frieman BG, Fenlin JM, Mitchell DG (1993) Hooked acromion: prevalence on MR images of painful shoulders. Radiology 187(2):479–481.  https://doi.org/10.1148/radiology.187.2.8475294 CrossRefGoogle Scholar
  7. 7.
    MacGillivray JD, Fealy S, Potter HG, O’Brien SJ (1998) Multiplanar analysis of acromion morphology. Am J Sports Med 26(6):836–840.  https://doi.org/10.1177/03635465980260061701 CrossRefGoogle Scholar
  8. 8.
    Toivonen DA, Tuite MJ, Orwin JF (1995) Acromial structure and tears of the rotator cuff. J Shoulder Elb Surg 4(5):376–383CrossRefGoogle Scholar
  9. 9.
    Worland RL, Lee D, Orozco CG, SozaRex F, Keenan J (2003) Correlation of age, acromial morphology, and rotator cuff tear pathology diagnosed by ultrasound in asymptomatic patients. J South Orthop Assoc 12(1):23–26Google Scholar
  10. 10.
    Bright AS, Torpey B, Magid D, Codd T, McFarland EG (1997) Reliability of radiographic evaluation for acromial morphology. Skeletal Radiol 26(12):718–721CrossRefGoogle Scholar
  11. 11.
    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 Elb Surg 21(10):1289–1298.  https://doi.org/10.1016/j.jse.2011.09.028 CrossRefGoogle Scholar
  12. 12.
    Nyffeler RW, Werner CML, Sukthankar A, Schmid MR, Gerber C (2006) Association of a large lateral extension of the acromion with rotator cuff tears. J Bone Jt Surg Am 88(4):800–805.  https://doi.org/10.2106/JBJS.D.03042 Google Scholar
  13. 13.
    Stehle J, Moore SM, Alaseirlis DA, Debski RE, McMahon PJ (2015) A reliable method for classifying acromial shape. Int Biomech 2(1):36–42.  https://doi.org/10.1080/23335432.2015.1014847 CrossRefGoogle Scholar
  14. 14.
    Zuckerman JD, Kummer FJ, Cuomo F, Greller M (1997) Interobserver reliability of acromial morphology classification: an anatomic study. J Shoulder Elb Surg 6(3):286–287CrossRefGoogle Scholar
  15. 15.
    Gill TJ, McIrvin E, Kocher MS, Homa K, Mair SD, Hawkins RJ (2002) The relative importance of acromial morphology and age with respect to rotator cuff pathology. J Shoulder Elb Surg 11(4):327–330.  https://doi.org/10.1067/mse.2002.124425 CrossRefGoogle Scholar
  16. 16.
    Mayerhoefer ME, Breitenseher MJ, Wurnig C, Roposch A (2009) Shoulder impingement: relationship of clinical symptoms and imaging criteria. Clin J Sport Med 19(2):83–89.  https://doi.org/10.1097/JSM.0b013e318198e2e3 CrossRefGoogle Scholar
  17. 17.
    Moor BK, Wieser K, Slankamenac K, Gerber C, Bouaicha S (2014) Relationship of individual scapular anatomy and degenerative rotator cuff tears. J Shoulder Elb Surg 23(4):536–541.  https://doi.org/10.1016/j.jse.2013.11.008 CrossRefGoogle Scholar
  18. 18.
    Stehle J, Moore SM, Alaseirlis DA, Debski RE, McMahon PJ (2007) Acromial morphology: effects of suboptimal radiographs. J Shoulder Elb Surg 16(2):135–142.  https://doi.org/10.1016/j.jse.2006.05.004 5doiCrossRefGoogle Scholar
  19. 19.
    Li X, Xu W, Hu N, Liang X, Huang W, Jiang D et al (2017) Relationship between acromial morphological variation and subacromial impingement: a three-dimensional analysis. PLoS One 12(4):e0176193.  https://doi.org/10.1371/journal.pone.0176193 CrossRefGoogle Scholar
  20. 20.
    Pandey V, Vijayan D, Tapashetti S, Agarwal L, Kamath A, Acharya K et al (2016) Does scapular morphology affect the integrity of the rotator cuff? J Shoulder Elb Surg 25(3):413–421.  https://doi.org/10.1016/j.jse.2015.09.016 CrossRefGoogle Scholar
  21. 21.
    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(7):935–941.  https://doi.org/10.1302/0301-620X.95B7.31028 CrossRefGoogle Scholar
  22. 22.
    Chalmers PN, Salazar D, Steger-May K, Chamberlain AM, Yamaguchi K, Keener JD (2017) Does the critical shoulder angle correlate with rotator cuff tear progression? Clin Orthop Relat Res 475(6):1608–1617.  https://doi.org/10.1007/s11999-017-5249-1 CrossRefGoogle Scholar
  23. 23.
    Kirsch JM, Nathani A, Robbins CB, Gagnier JJ, Bedi A, Miller BS (2017) Is there an association between the “critical shoulder angle” and clinical outcome after rotator cuff repair? Orthop J Sport Med 5(4):2325967117702126.  https://doi.org/10.1177/2325967117702126 CrossRefGoogle Scholar
  24. 24.
    Lee M, Chen JY, Liow MHL, Chong HC, Chang P, Lie D (2017) Critical shoulder angle and acromial index do not influence 24-month functional outcome after arthroscopic rotator cuff repair. Am J Sports Med 45(13):2989–2994.  https://doi.org/10.1177/0363546517717947 CrossRefGoogle Scholar
  25. 25.
    Blonna D, Giani A, Bellato E, Mattei L, Caló M, Rossi R et al (2016) Predominance of the critical shoulder angle in the pathogenesis of degenerative diseases of the shoulder. J Shoulder Elb Surg 25(8):1328–1336.  https://doi.org/10.1016/j.jse.2015.11.059 CrossRefGoogle Scholar
  26. 26.
    Cherchi L, Ciornohac JF, Godet J, Clavert P, Kempf J-F (2016) Critical shoulder angle: measurement reproducibility and correlation with rotator cuff tendon tears. Orthop Traumatol Surg Res 102(5):559–562.  https://doi.org/10.1016/j.otsr.2016.03.017 CrossRefGoogle Scholar
  27. 27.
    Daggett M, Werner B, Collin P, Gauci M-O, Chaoui J, Walch G (2015) Correlation between glenoid inclination and critical shoulder angle: a radiographic and computed tomography study. J Shoulder Elb Surg 24(12):1948–1953.  https://doi.org/10.1016/j.jse.2015.07.013 CrossRefGoogle Scholar
  28. 28.
    Dietrich TJ, Moor BK, Puskas GJ, Pfirrmann CWA, Hodler J, Peterson CK (2015) Is the lateral extension of the acromion related to the outcome of shoulder injections? Eur Radiol 25(1):267–273.  https://doi.org/10.1007/s00330-014-3403-7 CrossRefGoogle Scholar
  29. 29.
    Heuberer PR, Plachel F, Willinger L, Moroder P, Laky B, Pauzenberger L et al (2017) Critical shoulder angle combined with age predict five shoulder pathologies: a retrospective analysis of 1000 cases. BMC Musculoskelet Disord 18(1):259.  https://doi.org/10.1186/s12891-017-1559-4 CrossRefGoogle Scholar
  30. 30.
    Mantell MT, Nelson R, Lowe JT, Endrizzi DP, Jawa A (2017) Critical shoulder angle is associated with full-thickness rotator cuff tears in patients with glenohumeral osteoarthritis. J Shoulder Elb Surg 26(12):e376–e381.  https://doi.org/10.1016/j.jse.2017.05.020 CrossRefGoogle Scholar
  31. 31.
    Spiegl UJ, Horan MP, Smith SW, Ho CP, Millett PJ (2016) 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(7):2244–2251.  https://doi.org/10.1007/s00167-015-3587-7 CrossRefGoogle Scholar
  32. 32.
    Garcia GH, Liu JN, Degen RM, Johnson CC, Wong AC, Dines DM et al (2017) Higher critical shoulder angle increases the risk of retear after rotator cuff repair. J Shoulder Elb Surg 26(2):241–245.  https://doi.org/10.1016/j.jse.2016.07.009 CrossRefGoogle Scholar
  33. 33.
    Li H, Chen Y, Chen J, Hua Y, Chen S (2018) Large critical shoulder angle has higher risk of tendon retair after arthroscopic rotator cuff repair. Am J Sports Med 46(8):1892–1900.  https://doi.org/10.1177/0363546518767634 CrossRefGoogle Scholar
  34. 34.
    Gerber C, Catanzaro S, Betz M, Ernstbrunner L (2018) Arthroscopic correction of the critical shoulder angle through lateral acromioplasty: a safe adjunct to rotator cuff repair. Arthroscopy 34(3):771–780.  https://doi.org/10.1016/j.arthro.2017.08.255 CrossRefGoogle Scholar
  35. 35.
    Abrams GD, Gupta AK, Hussey KE, Tetteh ES, Karas V, Bach BR et al (2014) Arthroscopic repair of full-thickness rotator cuff tears with and without acromioplasty: randomized prospective trial with 2-year follow-up. Am J Sports Med 42(6):1296–1303.  https://doi.org/10.1177/0363546514529091 CrossRefGoogle Scholar
  36. 36.
    Beard DJ, Rees JL, Cook JA, Rombach I, Cooper C, Merritt N et al (2017) Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. Lancet 391(10118):329–338.  https://doi.org/10.1016/S0140-6736(17)32457-1 CrossRefGoogle Scholar
  37. 37.
    Bond EC, Maher A, Hunt L, Leigh W, Brick M, Young SW et al (2017) The role of acromioplasty when repairing rotator cuff tears-no difference in pain or functional outcome at 24 months in a cohort of 2,441 patients. NZ Med J 130(1458):13–20Google Scholar
  38. 38.
    Chahal J, Mall N, MacDonald PB, Van Thiel G, Cole BJ, Romeo AA et al (2012) The role of subacromial decompression in patients undergoing arthroscopic repair of full-thickness tears of the rotator cuff: a systematic review and meta-analysis. Arthroscopy 28(5):720–727.  https://doi.org/10.1016/j.arthro.2011.11.022 CrossRefGoogle Scholar
  39. 39.
    Henkus HE, de Witte PB, Nelissen RGHH, Brand R, van Arkel ERA (2009) Bursectomy compared with acromioplasty in the management of subacromial impingement syndrome: a prospective randomised study. J Bone Jt Surg Br 91(4):504–510.  https://doi.org/10.1302/0301-620X.91B4.21442 CrossRefGoogle Scholar
  40. 40.
    Ketola S, Lehtinen J, Arnala I, Nissinen M, Westenius H, Sintonen H et al (2009) Does arthroscopic acromioplasty provide any additional value in the treatment of shoulder impingement syndrome? A two-year randomised controlled trial. J Bone Jt Surg Br 91(10):1326–1334.  https://doi.org/10.1302/0301-620X.91B10.22094 CrossRefGoogle Scholar
  41. 41.
    Kolk A, Thomassen BJW, Hund H, de Witte PB, Henkus H-E, Wassenaar WG et al (2017) Does acromioplasty result in favorable clinical and radiologic outcomes in the management of chronic subacromial pain syndrome? A double-blinded randomized clinical trial with 9 to 14 years’ follow-up. J Shoulder Elb Surg 26(8):1407–1415.  https://doi.org/10.1016/j.jse.2017.03.021 CrossRefGoogle Scholar
  42. 42.
    Katthagen JC, Marchetti DC, Tahal DS, Turnbull TL, Millett PJ (2016) The effects of arthroscopic lateral acromioplasty on the critical shoulder angle and the anterolateral deltoid origin: an anatomic cadaveric study. Arthroscopy 32(4):569–575.  https://doi.org/10.1016/j.arthro.2015.12.019 CrossRefGoogle Scholar
  43. 43.
    Marchetti DC, Katthagen JC, Mikula JD, Montgomery SR, Tahal DS, Dahl KD et al (2017) Impact of arthroscopic lateral acromioplasty on the mechanical and structural integrity of the lateral deltoid origin: a cadaveric study. Arthroscopy 33(3):511–517.  https://doi.org/10.1016/j.arthro.2016.08.015 CrossRefGoogle Scholar
  44. 44.
    Suter T, Gerber Popp A, Zhang Y, Zhang C, Tashjian RZ, Henninger HB (2015) The influence of radiographic viewing perspective and demographics on the critical shoulder angle. J Shoulder Elb Surg 24(6):e149–e158.  https://doi.org/10.1016/j.jse.2014.10.021 CrossRefGoogle Scholar
  45. 45.
    Karns MR, Jacxsens M, Uffmann WJ, Todd DC, Henninger HB, Burks RT (2018) The critical acromial point: the anatomic location of the lateral acromion in the critical shoulder angle. J Shoulder Elb Surg 27(1):151–159.  https://doi.org/10.1016/j.jse.2017.08.025 CrossRefGoogle Scholar
  46. 46.
    Familiari F, Gonzalez-Zapata A, Iannò B, Galasso O, Gasparini G, McFarland EG (2015) Is acromioplasty necessary in the setting of full-thickness rotator cuff tears? A systematic review. J Orthop Traumatol 16(3):167–174.  https://doi.org/10.1007/s10195-015-0353-z CrossRefGoogle Scholar
  47. 47.
    Altintas B, Kääb M, Greiner S (2016) Arthroscopic lateral acromion resection (ALAR) optimizes rotator cuff tear relevant scapula parameters. Arch Orthop Trauma Surg 136(6):799–804.  https://doi.org/10.1007/s00402-016-2431-y CrossRefGoogle Scholar
  48. 48.
    Song L, Miao L, Zhang P, Wang W-L (2016) Does concomitant acromioplasty facilitate arthroscopic repair of full-thickness rotator cuff tears? A meta-analysis with trial sequential analysis of randomized controlled trials. Springerplus 5(1):685.  https://doi.org/10.1186/s40064-016-2311-5 CrossRefGoogle Scholar
  49. 49.
    Soyer J, Vaz S, Pries P, Clarac JP (2003) The relationship between clinical outcomes and the amount of arthroscopic acromial resection. Arthroscopy 19(1):34–39.  https://doi.org/10.1053/jars.2003.50005 CrossRefGoogle Scholar
  50. 50.
    Lunsjö K, Bengtsson M, Nordqvist A, Abu-Zidan FM (2011) Patients with shoulder impingement remain satisfied 6 years after arthroscopic subacromial decompression: a prospective study of 46 patients. Acta Orthop 82(6):711–713.  https://doi.org/10.3109/17453674.2011.623571 CrossRefGoogle Scholar
  51. 51.
    Strauss EJ, Salata MJ, Kercher J, Barker JU, McGill K, Bach BR et al (2011) Multimedia article. The arthroscopic management of partial-thickness rotator cuff tears: a systematic review of the literature. Arthroscopy 27(4):568–580.  https://doi.org/10.1016/j.arthro.2010.09.019 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Clinique du Sport-CCOSMérignacFrance

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