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Critical shoulder angle does not influence retear rate after arthroscopic rotator cuff repair

  • SHOULDER
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The critical shoulder angle (CSA) has been implicated as a potential risk factor for failure following arthroscopic rotator cuff repair (RCR). However, there is conflicting evidence regarding the clinical usefulness of this measurement. Given these discrepancies and limited comparisons to clinical outcomes, the aim of the current study was to determine whether higher CSAs correlated with an increased retear rate after arthroscopic rotator cuff repair and to determine if any association between CSA and patient-reported outcomes (PROs) exists. It was hypothesized that there would be no correlation between CSA and retear rate or PROs after arthroscopic rotator cuff repair.

Methods

A total of 164 patients who underwent arthroscopic RCR were retrospectively reviewed. CSA was measured for each patient. Patients were then divided into a retear group of 18 patients and a non-retear group of 146 patients. Patient-reported outcomes (PROs), including PROMIS 10 score, American Shoulder and Elbow Surgeons (ASES) score, Brophy score, and visual analog pain scores (VAS) were recorded post-operatively.

Results

The average CSA was 31.2 ± 4.5° for the retear group and 32.2 ± 4.7° for the non-retear group (n.s.). No correlations were found between CSA and PROMIS score (n.s.), ASES score (n.s.), Brophy score (n.s.), or VAS (n.s.).

Conclusion

Critical shoulder angle had no correlation to retear rate or patient-reported outcomes. CSA should not be used as a clinical predictor to assess rotator cuff retear risk after arthroscopic RCR.

Level of evidence

Level III.

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References

  1. Andrade R, Correia AL, Nunes J, Xará-Leite F, Calvo E, Espregueira-Mendes J, Sevivas N (2019) Is bony morphology and morphometry associated with degenerative full-thickness rotator cuff tears? A systematic review and meta-analysis. Arthroscopy 35:3304-3315.e2

    Article  Google Scholar 

  2. Bishop J, Klepps S, Lo IK, Bird J, Gladstone JN, Flatow EL (2006) Cuff integrity after arthroscopic versus open rotator cuff repair: a prospective study. J Shoulder Elbow Surg 15:290–299

    Article  Google Scholar 

  3. Bjarnison AO, Sørensen TJ, Kallemose T, Barfod KW (2017) The critical shoulder angle is associated with osteoarthritis in the shoulder but not rotator cuff tears: a retrospective case–control study. J Shoulder Elbow Surg 26:2097–2102

    Article  Google Scholar 

  4. Björnsson Hallgren HC, Adolfsson L (2021) Neither critical shoulder angle nor acromion index were related with specific pathology 20 years later! Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-021-06602-y

    Article  PubMed  PubMed Central  Google Scholar 

  5. 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 475:1608–1617

    Article  Google Scholar 

  6. Degen RM (2018) Editorial commentary: critical shoulder angle: perhaps not so “critical” for clinical outcomes following rotator cuff repair. Arthroscopy 34:2755–2756

    Article  Google Scholar 

  7. Docter S, Khan M, Ekhtiari S, Veillette C, Paul R, Henry P, Leroux T (2019) The relationship between the critical shoulder angle and the incidence of chronic, full-thickness rotator cuff tears and outcomes after rotator cuff repair: a systematic review. Arthroscopy 35:3135-3143.e4

    Article  Google Scholar 

  8. Fehringer EV, Sun J, VanOeveren LS, Keller BK, Matsen FA (2008) Full-thickness rotator cuff tear prevalence and correlation with function and co-morbidities in patients sixty-five years and older. J Shoulder Elbow Surg 17:881–885

    Article  Google Scholar 

  9. Garcia GH, Liu JN, Degen RM, Johnson CC, Wong A, Dines DM, Gulotta LV, Dines JS (2017) Higher critical shoulder angle increases the risk of retear after rotator cuff repair. J Shoulder Elbow Surg 26:241–245

    Article  Google Scholar 

  10. Gerber C, Snedeker JG, Baumgartner D, Viehöfer AF (2014) Supraspinatus tendon load during abduction is dependent on the size of the critical shoulder angle: a biomechanical analysis. J Orthop Res 32:952–957

    Article  Google Scholar 

  11. Gürpınar T, Polat B, Çarkçı E, Eren M, Polat AE, Öztürkmen Y (2019) The effect of critical shoulder angle on clinical scores and retear risk after rotator cuff tendon repair at short-term follow up. Sci Rep 9:12315

    Article  Google Scholar 

  12. İncesoy MA, Yıldız Kİ, Türk Öİ, Akıncı Ş, Turgut E, Aycan OE, Bayhan IA (2020) The critical shoulder angle, the acromial index, the glenoid version angle and the acromial angulation are associated with rotator cuff tears. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-06145-8

    Article  PubMed  Google Scholar 

  13. Kim J-H, Min Y-K, Gwak H-C, Kim C-W, Lee C-R, Lee S-J (2019) Rotator cuff tear incidence association with critical shoulder angle and subacromial osteophytes. J Shoulder Elbow Surg 28:470–475

    Article  Google Scholar 

  14. 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 Sports Med 5:2325967117702126

    Article  Google Scholar 

  15. Knudsen HB, Gelineck J, Søjbjerg JO, Olsen BS, Johannsen HV, Sneppen O (1999) Functional and magnetic resonance imaging evaluation after single-tendon rotator cuff reconstruction. J Shoulder Elbow Surg 8:242–246

    Article  CAS  Google Scholar 

  16. Lädermann A (2020) The law of use and disuse: critical shoulder angle and rotator cuff tears-association does not imply causation. Arthroscopy 36:2342–2343

    Article  Google Scholar 

  17. 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 45:2989–2994

    Article  Google Scholar 

  18. Lee YS, Jeong JY, Park C-D, Kang SG, Yoo JC (2017) Evaluation of the risk factors for a rotator cuff retear after repair surgery. Am J Sports Med 45:1755–1761

    Article  Google Scholar 

  19. Li H, Chen Y, Chen J, Hua Y, Chen S (2018) Large critical shoulder angle has higher risk of tendon retear after arthroscopic rotator cuff repair. Am J Sports Med 46:1892–1900

    Article  Google Scholar 

  20. Loriaud A, Bise S, Meyer P, Billaud A, Dallaudiere B, Silvestre A, Pesquer L (2020) Critical shoulder angle: what do radiologists need to know? Skeletal Radiol 49:515–520

    Article  Google Scholar 

  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? Bone Joint J 95:935–941

    Article  Google Scholar 

  22. Moor BK, Kuster R, Osterhoff G, Baumgartner D, Werner CML, Zumstein MA, Bouaicha S (2016) Inclination-dependent changes of the critical shoulder angle significantly influence superior glenohumeral joint stability. Clin Biomech 32:268–273

    Article  CAS  Google Scholar 

  23. Opsomer G-J, Verstuyft L, Muermans S (2020) Long-term follow-up of patients with a high critical shoulder angle and acromion index: is there an increased retear risk after arthroscopic supraspinatus tendon repair? JSES Int 4:882–887

    Article  Google Scholar 

  24. Rose-Reneau Z, Moorefield AK, Schirmer D, Ismailov E, Downing R, Wright BW (2020) The critical shoulder angle as a diagnostic measure for osteoarthritis and rotator cuff pathology. Cureus 12:e11447

    PubMed  PubMed Central  Google Scholar 

  25. Scheiderer B, Imhoff FB, Johnson JD, Aglio J, Cote MP, Beitzel K, Imhoff AB, Arciero RA, Mazzocca AD, Morikawa D (2018) Higher critical shoulder angle and acromion index are associated with increased retear risk after isolated supraspinatus tendon repair at short-term follow up. Arthroscopy 34:2748–2754

    Article  Google Scholar 

  26. Sheean AJ, de Sa D, Woolnough T, Cognetti DJ, Kay J, Burkhart SS (2019) Does an increased critical shoulder angle affect re-tear rates and clinical outcomes following primary rotator cuff repair? A systematic review. Arthroscopy 35:2938-2947.e1

    Article  Google Scholar 

  27. Smith GCS, Liu V, Lam PH (2020) The critical shoulder angle shows a reciprocal change in magnitude when evaluating symptomatic full-thickness rotator cuff tears versus primary glenohumeral osteoarthritis as compared with control subjects: a systematic review and meta-analysis. Arthroscopy 36:566–575

    Article  Google Scholar 

  28. Tang Y, Hou J, Li Q, Li F, Zhang C, Li W, Yang R (2019) The effectiveness of using the critical shoulder angle and acromion index for predicting rotator cuff tears: accurate diagnosis based on standard and nonstandard anteroposterior radiographs. Arthroscopy 35:2553–2561

    Article  Google Scholar 

  29. Tashjian RZ, Hollins AM, Kim H-M, Teefey SA, Middleton WD, Steger-May K, Galatz LM, Yamaguchi K (2010) Factors affecting healing rates after arthroscopic double-row rotator cuff repair. Am J Sports Med 38:2435–2442

    Article  Google Scholar 

  30. Zaid MB, Young NM, Pedoia V, Feeley BT, Ma CB, Lansdown DA (2019) Anatomic shoulder parameters and their relationship to the presence of degenerative rotator cuff tears and glenohumeral osteoarthritis: a systematic review and meta-analysis. J Shoulder Elbow Surg 28:2457–2466

    Article  Google Scholar 

  31. Zhao J, Luo M, Pan J, Liang G, Feng W, Zeng L, Yang W, Liu J (2021) Risk factors affecting rotator cuff re-tear after arthroscopic repair: a meta-analysis and systematic review. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2021.05.010

    Article  PubMed  Google Scholar 

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Acknowledgements

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The authors received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. School of Medicine, University of Pittsburgh, 456 South Graham St, Pittsburgh, PA, 15232, USA

    C. J. Como

  2. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3200 South Water Street, Pittsburgh, PA, 15203, USA

    J. D. Hughes, B. P. Lesniak & A. Lin

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  1. C. J. Como
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Correspondence to C. J. Como.

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Como, C.J., Hughes, J.D., Lesniak, B.P. et al. Critical shoulder angle does not influence retear rate after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 29, 3951–3955 (2021). https://doi.org/10.1007/s00167-021-06652-2

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