Lateral Acromioplasty has a Positive Impact on Rotator Cuff Repair in Patients with a Critical Shoulder Angle Greater than 35 Degrees.
critical shoulder angle
rotator cuff tear
shoulder
shoulder arthroscopy
Journal
Journal of clinical medicine
ISSN: 2077-0383
Titre abrégé: J Clin Med
Pays: Switzerland
ID NLM: 101606588
Informations de publication
Date de publication:
05 Dec 2020
05 Dec 2020
Historique:
received:
21
10
2020
revised:
30
11
2020
accepted:
02
12
2020
entrez:
9
12
2020
pubmed:
10
12
2020
medline:
10
12
2020
Statut:
epublish
Résumé
A Critical Shoulder Angle (CSA), evaluated on plain radiographs, greater than 35° is considered predictive of rotator cuff tears. The present prospective comparative study aimed, firstly, to develop a formula to calculate the amount of acromion that should be resected performing a lateral acromioplasty and, secondly, verify whether lateral acromioplasty to reduce the CSA associated with arthroscopic cuff repair decreased the rate of recurrence of the tears, and impacted favorably on clinical postoperative outcomes. Patients undergoing arthroscopic rotator cuff repair (RCR) for rotator cuff tears with a CSA greater than 35° were included in this study and divided into two groups, based on whether the CSA had been reduced by arthroscopic resection of the lateral portion of the acromion. A new mathematical formula was developed in order to quantify the amount of bone to be resected while performing the lateral acromioplasty. Patients with traumatic tears, previous surgery, osteoarthritis or plain radiographs, not classified as A1 according to Suter-Henninger, were excluded. Clinical and radiographic outcomes were assessed at a minimum of 2 years of follow-up considering the tear size. 289 patients were included in this study. Thirty-seven were lost to follow-up. Group A (Lateral acromioplasty) patients included: 38 small tears, 30 medium tears, 28 large tears and 22 massive tears; Group B (control group) was composed of 40 small tears, 30 medium tears, 30 large tears and 23 massive tears. The Constants Score value and retear Rate were, respectively, significant higher ( Arthroscopic lateral acromioplasty decreased the CSA within the favorable range (30°-35°) in all patients treated, resecting the amount of bone predicted by the mathematical formula. Lateral acromioplasty is a safe and reproducible technique which may prevent recurrence of rotator cuff tears in patients with small and medium lesions. II.
Sections du résumé
BACKGROUND
BACKGROUND
A Critical Shoulder Angle (CSA), evaluated on plain radiographs, greater than 35° is considered predictive of rotator cuff tears. The present prospective comparative study aimed, firstly, to develop a formula to calculate the amount of acromion that should be resected performing a lateral acromioplasty and, secondly, verify whether lateral acromioplasty to reduce the CSA associated with arthroscopic cuff repair decreased the rate of recurrence of the tears, and impacted favorably on clinical postoperative outcomes.
METHODS
METHODS
Patients undergoing arthroscopic rotator cuff repair (RCR) for rotator cuff tears with a CSA greater than 35° were included in this study and divided into two groups, based on whether the CSA had been reduced by arthroscopic resection of the lateral portion of the acromion. A new mathematical formula was developed in order to quantify the amount of bone to be resected while performing the lateral acromioplasty. Patients with traumatic tears, previous surgery, osteoarthritis or plain radiographs, not classified as A1 according to Suter-Henninger, were excluded. Clinical and radiographic outcomes were assessed at a minimum of 2 years of follow-up considering the tear size.
RESULTS
RESULTS
289 patients were included in this study. Thirty-seven were lost to follow-up. Group A (Lateral acromioplasty) patients included: 38 small tears, 30 medium tears, 28 large tears and 22 massive tears; Group B (control group) was composed of 40 small tears, 30 medium tears, 30 large tears and 23 massive tears. The Constants Score value and retear Rate were, respectively, significant higher (
CONCLUSION
CONCLUSIONS
Arthroscopic lateral acromioplasty decreased the CSA within the favorable range (30°-35°) in all patients treated, resecting the amount of bone predicted by the mathematical formula. Lateral acromioplasty is a safe and reproducible technique which may prevent recurrence of rotator cuff tears in patients with small and medium lesions.
LEVEL OF EVIDENCE
METHODS
II.
Identifiants
pubmed: 33291482
pii: jcm9123950
doi: 10.3390/jcm9123950
pmc: PMC7762128
pii:
doi:
Types de publication
Journal Article
Langues
eng
Références
J Bone Joint Surg Am. 2008 Nov;90(11):2423-31
pubmed: 18978411
J Bone Joint Surg Am. 1985 Jul;67(6):974-9
pubmed: 4019548
J Shoulder Elbow Surg. 2015 Jun;24(6):e149-58
pubmed: 25591458
Arthroscopy. 2019 Oct;35(10):2948-2949
pubmed: 31604516
Arch Orthop Trauma Surg. 2016 Jun;136(6):799-804
pubmed: 26920400
J Shoulder Elbow Surg. 2017 Feb;26(2):241-245
pubmed: 27594085
Am J Sports Med. 2017 Nov;45(13):2989-2994
pubmed: 28806093
J Shoulder Elbow Surg. 2014 Apr;23(4):536-41
pubmed: 24480324
J Orthop. 2019 Nov 27;19:21-27
pubmed: 32021030
Arthroscopy. 2016 Apr;32(4):569-75
pubmed: 26895784
Arthroscopy. 2018 Mar;34(3):771-780
pubmed: 29100767
Arthroscopy. 2019 Dec;35(12):3304-3315.e2
pubmed: 31785763
Arthroscopy. 2018 Oct;34(10):2755-2756
pubmed: 30286875
Arthroscopy. 2019 Dec;35(12):3316-3317
pubmed: 31785764
Am J Sports Med. 2018 Jul;46(8):1892-1900
pubmed: 29723034
J Shoulder Elbow Surg. 1996 Jan-Feb;5(1):1-11
pubmed: 8919436
J Orthop Res. 2014 Jul;32(7):952-7
pubmed: 24700399
Arthroscopy. 2016 Apr;32(4):576-7
pubmed: 27039680
Clin Orthop Relat Res. 1987 Jan;(214):160-4
pubmed: 3791738
J Shoulder Elbow Surg. 2015 Nov;24(11):1685-93
pubmed: 26234668
J Bone Joint Surg Am. 1983 Dec;65(9):1232-44
pubmed: 6654936
J Shoulder Elbow Surg. 2018 Jan;27(1):151-159
pubmed: 29111197
Clin Orthop Relat Res. 1994 Jul;(304):78-83
pubmed: 8020238
Arthroscopy. 2019 Nov;35(11):3135-3143.e4
pubmed: 31699267
Arthroscopy. 2005 Nov;21(11):1307-16
pubmed: 16325080
Orthop J Sports Med. 2017 Apr 18;5(4):2325967117702126
pubmed: 28451621
Bone Joint J. 2013 Jul;95-B(7):935-41
pubmed: 23814246
Acta Orthop. 2013 Apr;84(2):178-83
pubmed: 23409811
Arthroscopy. 2018 Oct;34(10):2748-2754
pubmed: 30195956