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Lateral acromioplasty cannot sufficiently reduce the critical shoulder angle if preoperatively measured over 40°

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To investigate whether arthroscopic lateral acromion resection can sufficiently reduce the critical shoulder angle (CSA) without damaging deltoid muscle insertion.

Methods

Ninety patients who underwent arthroscopic rotator cuff (RC) repair were retrospectively analysed. According to the preoperative CSA, patients were categorized as Group I (CSA < 35°) and Group II (CSA ≥ 35°). Additional arthroscopic lateral acromion resection was performed in Group II. The CSA was measured 1 week postoperatively, while RC integrity and the deltoid attachment were assessed at 3, 6 and 12 months via ultrasound. Deltoid function was evaluated using the Akimbo test, in which patients place their hands on the iliac crest with abduction in the coronal plane and internal rotation of the shoulder joint while simultaneously flexing the elbow joint and pronating the forearm.

Results

Large and massive RC tears were more prevalent in Group II (p = 0.017). In both groups, the CSA reduction was statistically significant (Group I = 1°: range 0°–3°, Group II = 3.7°: range 1°–8°; p < 0.001). When the preoperative CSA was > 40°, the respective postoperative CSA remained > 35° in 83.3% of cases (p < 0.001). Final shoulder strength was correlated with the amount of CSA reduction (rho = 0.41, p = 0.002). The postoperative CSA was higher, but not significantly different (n.s.), in patients with re-torn (36°, range 32°–40°) than with healed RC (33°, range 26°–38°). No clinical detachment or hypotrophy of the deltoid was observed with the Akimbo test and ultrasound evaluation.

Conclusions

Arthroscopic lateral acromion resection is a safe procedure without affecting deltoid muscle origin or function, and it is effective in significantly reducing the CSA. However, the CSA cannot always be reduced to < 35°, especially in patients with preoperative CSA values > 40°.

Level of evidence

III.

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Abbreviations

CSA:

Critical shoulder angle

ALAR:

Arthroscopic lateral acromioplasty

RC:

Rotator cuff

RCT:

Rotator cuff tear

SSP:

Supraspinatus

Sscap:

Subscapularis

DCR:

Distal clavicle resection

BMI:

Body mass index

ROM:

Range of motion

VAS:

Visual analogue scale

SST:

Simple shoulder test

SSV:

Subjective shoulder value

ASES:

American Shoulder and Elbow Score

CS:

Constant Score

US:

Ultrasound

CAP:

Critical acromial point

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No benefits and no funds in any form have been received or will be received from a commercial party related directly or indirectly to the subject of the article.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Centre Osteoarticulaire Des Cèdres, Parc Sud Galaxie, 5 Rue Des Tropiques, Echirolles, 38130, Grenoble, France

    Manuel Ignacio Olmos, John Swan, Philippe Delsol & Johannes Barth

  2. Department of Orthopedic Surgery, 401 Military Hospital of Athens, Athens, Greece

    Achilleas Boutsiadis

  3. Department of Orthopedic Surgery, Centre Hospitalier Universitaire de Poitiers, Poitiers, France

    Paul Brossard

  4. Department of Radiology, Clinique du Mail, Grenoble, France

    Renaud Barthelemy

Authors
  1. Manuel Ignacio Olmos
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  2. Achilleas Boutsiadis
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  5. Renaud Barthelemy
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  7. Johannes Barth
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Correspondence to Johannes Barth.

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The Scientific Council of our clinic “Clinique des Cèdres, Grenoble, France” has approved the above project and its publication (COAC IRB #2018-05).

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Olmos, M.I., Boutsiadis, A., Swan, J. et al. Lateral acromioplasty cannot sufficiently reduce the critical shoulder angle if preoperatively measured over 40°. Knee Surg Sports Traumatol Arthrosc 29, 240–249 (2021). https://doi.org/10.1007/s00167-020-05951-4

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