The Relationship of Acromial Architecture to Rotator Cuff Disease
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Acromion
Rotator cuff injury
Etiology
Objectives: Acromioplasty has been one of the most common techniques amongst orthopedic surgeries in the past decade. However, its efficacy in arthroscopic surgeries of rotator cuff repair is still debatable. The purpose of this study is to compare the arthroscopic rotator cuff repair with or without acromioplasty in patients with complete rotator cuff tear.Methods: In this prospective cohort study, patients with complete rotator cuff tear (acromion type II or III Bigliani) and a history of failure to the conservative treatment for at least 6 months were evaluated for eligibility. Patients, based on the time interval, were placed in one of two groups: arthroscopic rotator cuff repair with (RCR-A group) and without acromioplasty (RCR group). Patients were assessed for two years in term of pain intensity by VAS criteria and shoulder functional status by Quick-DASH, Constant score and simple shoulder test criteria.Results: In the baseline assessment, RCR-A group (34 patients) and RCR group (33 patients) were similar. Comparing patients in two groups in relation to SST, Quick-DASH and VAS scores preoperatively showed there is no significant difference between the two groups. The SST, Quick-DASH and VAS scores improved significantly in both groups at both the 6-month and 2-year follow-ups (all P < 0.001). The extent of progress in the functional scores was similar in both groups (P > 0.05).Conclusion: Arthroscopic rotator cuff repair without acromioplasty may be as reliable and useful as conventional rotator cuff repair with acromioplasty. Thus, acromioplasty cannot be recommended as a routine technique in every rotator cuff repair.
Acromioplasty
Rotator cuff injury
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Acromion
Rotator cuff injury
Etiology
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Citations (398)
We evaluated the available English literature for cases of acromion non-union and rotator cuff tear, looking at surgical methods of treatment as well as at functional results. As expected, the literature regarding rotator cuff pathology was found to be abundant, and a good number of articles were found regarding acromion non-union, but articles concerning the association of the two were scarce. Treatment recommendations varied, and were made on a case-to-case fashion. The accepted treatment methods for acromion non-union consist of non-surgical management, open or arthroscopic fragment removal, open or arthroscopic reduction and fixation (bone grafting may be used), while the rotator cuff witll be reinserted with anchors. In this rare occurence, a large rotator cuff tear with retracted tendons combined with an acromion non-union are usually repaired by an open technique in an one-stage surgery, with good results. In order to chose the right treatment option scapular kinematics must be taken into consideration especially when acromial fractures are associated with rotator cuff tears.
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Background: Shoulder pain is frequently caused by subacromial impingement or rotator cuff injuries and forms the major indications for presurgical evaluation using MRI. Rotator cuff tears are caused by either internal degenerative changes or extrinsic compression of the acromion on the rotator cuff tendons. Reduction in subacromial space and abnormal acromial morphologies contribute to rotator cuff damage. Hence identifying these acromial abnormalities forms an essential part of evaluation since these forms the main indication for corrective acromioplasty. Methods: This institution-based MRI study was evaluated in three groups as follows: Group1-15 patients with rotator cuff tear; Group 2-15 patients with subacromial impingement; Group 3-10 controls without subacromial impingement pathology and rotator cuff tear and assessed for type of acromion, Lateral Acromial Angle (LAA), Acromion Index (AI), and Acromio-humeral Interval. Results: The type II Acromion showed significant association with rotator cuff tear and subacromial impingement followed by Type III and Type I respectively in our study. However, Type II acromion is relatively commoner in the control study and showed 26.92%, subacromial impingement showed 30.7% and rotator cuff tear showed 42.31%. The distribution of Lateral Acromial Angles differed significantly between the three groups. In comparison to controls, patients with low lateral acromial angle had significant association with subacromial impingement and rotator cuff tears. The age distribution of the Acromial Index differed significantly between the three groups with higher predilection to rotator cuff tear and impingement as age advanced and higher acromial index. Between the three groups, the subjects with low acromio-humeral distance had significant association with rotator cuff tears and impingement. Conclusions: Low lateral acromial angle, larger acromial index, and smaller acromio-humeral interval are related with a higher incidence of subacromial impingement and rotator cuff tears on MRI assessment of the shoulder.
Acromion
Subacromial impingement
Acromioplasty
Shoulder Impingement Syndrome
Rotator cuff injury
Impingement syndrome
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One hundred consecutive magnetic resonance imaging (MRI) studies of the shoulder obtained for the purpose of evaluating rotator cuff symptoms were retrospectively reviewed to assess the relationship between acromion morphologic appearance and rotator cuff disease. The studies were reviewed simultaneously by two authors. Each cuff was assigned a tendon grade and an overall cuff score with MRI criteria previously described in the literature. A newly described "lateral acromion angle" was measured from a specified oblique coronal cut on each MRI study and was correlated with the corresponding MRI-determined rotator cuff score and supraspinatus tendon grade. Observed correlations were analyzed by using statistical methods. The average measured lateral acromion angle was 78°, with a range from 64° to 99°. Eight shoulders had angles less than or equal to 70°, and all eight of these patients were found to have full-thickness rotator cuff tears. As the lateral acromion angle decreased, a statistically significant increase in rotator cuff disease was noted (p<0.0001). A significant correlation between increasing age and rotator cuff disease was also observed (p<0.0001). Multiple regression analysis confirmed that both the lateral acromion angle and the age of the patient were independent predictors of rotator cuff score. Finally, although a trend was noted suggesting a correlation between acromion type (I-flat, II-curved, and III-hooked) and MRI-determined rotator cuff disease, this trend did not reach statistical significance (p=0.12). Surgical correlation with MRI rotator cuff findings in 35 patients showed an MRI sensitivity of 100% and specificity of 83%. A statistically significant correlation between the lateral acromion angle and MRI-determined rotator cuff disease has been noted. The described angle may be a useful adjuvant in the evaluation and management of rotator cuff disease. One hundred consecutive magnetic resonance imaging (MRI) studies of the shoulder obtained for the purpose of evaluating rotator cuff symptoms were retrospectively reviewed to assess the relationship between acromion morphologic appearance and rotator cuff disease. The studies were reviewed simultaneously by two authors. Each cuff was assigned a tendon grade and an overall cuff score with MRI criteria previously described in the literature. A newly described "lateral acromion angle" was measured from a specified oblique coronal cut on each MRI study and was correlated with the corresponding MRI-determined rotator cuff score and supraspinatus tendon grade. Observed correlations were analyzed by using statistical methods. The average measured lateral acromion angle was 78°, with a range from 64° to 99°. Eight shoulders had angles less than or equal to 70°, and all eight of these patients were found to have full-thickness rotator cuff tears. As the lateral acromion angle decreased, a statistically significant increase in rotator cuff disease was noted (p<0.0001). A significant correlation between increasing age and rotator cuff disease was also observed (p<0.0001). Multiple regression analysis confirmed that both the lateral acromion angle and the age of the patient were independent predictors of rotator cuff score. Finally, although a trend was noted suggesting a correlation between acromion type (I-flat, II-curved, and III-hooked) and MRI-determined rotator cuff disease, this trend did not reach statistical significance (p=0.12). Surgical correlation with MRI rotator cuff findings in 35 patients showed an MRI sensitivity of 100% and specificity of 83%. A statistically significant correlation between the lateral acromion angle and MRI-determined rotator cuff disease has been noted. The described angle may be a useful adjuvant in the evaluation and management of rotator cuff disease.
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Acromion
Acromioplasty
Cuff
Rotator cuff injury
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Acromion
Rotator cuff injury
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Rotator cuff tears usually cause a grinding facet in the undersurface of the acromion, called facies articularis acromialis, which is observable in dried scapulas. Some authors have related the pathogenesis of rotator cuff tears to an intrinsic degeneration of the cuff, while others have indicated that this pathology would be due to subacromial impingement. Some of the latter suggest that rotator cuff tears are associated with a narrowing of the subacromial space, mainly related to variations in the anatomy of the acromion. In order to obtain more information about the pathogenesis of rotator cuff tears we studied several anatomical parameters related to the architecture of the subacromial space in 112 human scapulas, divided into a healthy group and a pathological group depending on the lack or presence of a facies articularis acromialis in the undersurface of the acromion. The results obtained have not allowed us to identify significant differences in the different parameters studied in the two groups, not even in those related to the anatomy of the acromion. Our results, however, do allow us to suggest that rotator cuff tears seem to be more related to a primary degeneration of the cuff itself rather than to the anatomical characteristics of the subacromial space.
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Background Anatomic parameters, such as the critical shoulder angle and acromion index, have emerged as methods to quantify scapular anatomy and may contribute to rotator cuff pathology. The purpose of this paper is to investigate the published literature on influences of scapular morphology on the development of re-tears and patient-reported outcomes following rotator cuff repair. Methods A systematic review of the Embase and PubMed databases was performed to identify published studies on the potential influence of scapular bony morphology and re-tear rates and patient-reported outcomes after rotator cuff repair. Studies were reviewed by two authors. Results A total of 615 unique titles and 49 potentially relevant abstracts were reviewed, with eight published manuscripts identified for inclusion. Two of three papers reported no relationship between these acromion index and rotator cuff re-tear rate, while one paper found an increased re-tear rate. All three studies on critical shoulder angle found a significant association between critical shoulder angle and cuff re-tear rate. There was no clear relationship between any bony morphologic measurement and patient-reported outcomes after rotator cuff repair. Conclusions Rotator cuff re-tear rate appears to be significantly associated with the critical shoulder angle and glenoid inclination, while not clearly associated with acromial morphologic measurements.
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Rotator cuff injury
Cuff
Acromioplasty
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Full-thickness rotator cuff tear and rotator cuff injury are frequently occurring diseases and widely exist in the social population. Surgical repair is the most effective treatment for rotator cuff tears and injuries. With the continuous development of arthroscopy, more and more surgeons choose arthroscopic acromioplasty plus rotator cuff repair for the treatment of rotator cuff injury. However, previously published systematic reviews or meta-analyses still cast doubt on the efficacy of such concomitant procedures for postoperative patient function and pain recovery. In this study, we analyzed the effects of parameters such as shoulder function and acromion morphology on aged patients with full-thickness rotator cuff tear combined with rotator cuff injury treated with arthroscopic acromion plasty and rotator cuff repair. The results showed that arthroscopic acromion plasty and rotator cuff repair helped to promote the joint function recovery of the aged patients with full-thickness rotator cuff tear combined with rotator cuff injury and alleviate the pain of the patients. Compared with simple rotator cuff repair, this technique can increase the postoperative AT and reduce the ACEA and to some extent reduce the risk of postoperative rotator cuff reinjury, which is worthy of promotion.
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