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Lopez R, Singh J, Ghoraishian M, Nicholson T, Gates S, Namdari S. Anatomic factors associated with degeneration and fraying of the coracoacromial ligament. Clin Shoulder Elb 2024; 27:26-31. [PMID: 38147873 PMCID: PMC10938016 DOI: 10.5397/cise.2023.00661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/05/2023] [Accepted: 09/13/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND The coracoacromial ligament (CAL) is frequently observed to be damaged during arthroscopy and it is unclear how demographic, anatomic, and radiographic factors are related to CAL degeneration in full-thickness rotator cuff tears. METHODS A prospective study was conducted of patients at a single institution undergoing shoulder arthroscopy for first-time, full-thickness rotator cuff tears. We evaluated preoperative anteroposterior radiographs to obtain critical shoulder angle, glenoid inclination, acromial index, acromiohumeral distance, lateral acromial angle, and acromial morphology. We documented CAL quality, rotator cuff tear size and pattern during arthroscopy. Multiple logistic regression was used to identify predictive factors for encountering severe CAL fraying during arthroscopy. RESULTS Shoulders had mild CAL degeneration in 58.1% of cases, whereas severe CAL degeneration was present in 41.9% of shoulders. Patients with severe CAL attrition were significantly older (62.0 years vs. 58.0 years, P=0.042). Shoulders with severe CAL attrition had large rotator cuff tears in 54.1% of cases (P<0.001), and tears involving the infraspinatus (63.2% vs. 29.6%, P=0.003). The severe degeneration group was more likely to have a larger critical shoulder angle measurement on preoperative radiographs than those in the mild attrition group (36.1°±3.6° [range, 30°-45°] vs. 34.1°±3.8° [range, 26°-45°], P=0.037). CONCLUSIONS While the clinical impact of CAL degeneration remains uncertain, increased severity of CAL degeneration is associated with older age, larger rotator cuff tear size, presence of infraspinatus tearing, and increased preoperative critical shoulder angle. Level of evidence: III.
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Affiliation(s)
- Ryan Lopez
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Jaspal Singh
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Mohammad Ghoraishian
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Thema Nicholson
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Stephen Gates
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Surena Namdari
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
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Chuang HC, Hong CK, Hsu KL, Kuan FC, Chen Y, Yen JZ, Chiang CH, Chang HM, Su WR. Association of Coracoacromial Ligament Degeneration With Rotator Cuff Tear Patterns and Retear Rate. Orthop J Sports Med 2023; 11:23259671231175873. [PMID: 37347016 PMCID: PMC10280534 DOI: 10.1177/23259671231175873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 02/26/2023] [Indexed: 06/23/2023] Open
Abstract
Background Coracoacromial ligament (CAL) degeneration is thought to be a factor in external impingement in bursal-sided rotator cuff tears, but CAL release is associated with adverse effects. Purpose To investigate the association between CAL degeneration and the patterns of massive rotator cuff tears using multiple modalities and to assess the effect of CAL degeneration on supraspinatus tendon retear rates. Study Design Cohort study; Level of evidence, 2. Methods The authors prospectively recruited 44 patients who had undergone arthroscopic rotator cuff repair without acromioplasty or CAL release. Preoperative radiographs and magnetic resonance imaging (MRI) scans were reviewed to determine acromial morphology and CAL thickness, respectively. Rotator cuff tears were categorized as isolated supraspinatus or massive (involvement of ≥2 tendons), with massive tears categorized using the Collin classification. Acromial degeneration was analyzed using the Copeland-Levy classification. The CAL was biopsied intraoperatively and histologically analyzed using the Bonar score. At 6-month follow-up, the integrity of the repaired supraspinatus tendon was analyzed on MRI using the Sugaya classification. Finally, the associations among CAL degeneration, rotator cuff tear pattern, and arthroscopic grading were investigated. Results Patients with Collin type B rotator cuff tear had significantly higher CAL Bonar scores than those with Collin type A or isolated supraspinatus tears (10.0 vs 6.8 and 3.4; P = .03 and P < .001, respectively). Patients with a degenerative acromial undersurface of Copeland-Levy stage 2 or 3 had CALs with significantly higher Bonar scores than those with an intact acromial undersurface (8.4 and 8.2 vs 3.5; P = .034 and P = .027, respectively). The CAL Bonar scores of patients with different stages of the 6-month postoperative Sugaya classification were comparable (6.5, 7.2, 8.0, and 7.8 for stages 1, 2, 3, and 4, respectively; P = .751). Conclusion CAL degeneration was more severe in anterosuperior-type massive rotator cuff tears. Interestingly, even without acromioplasty, the severity of CAL degeneration did not affect the retear rate of the supraspinatus tendon.
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Affiliation(s)
- Hao-Chun Chuang
- Department of Orthopaedic Surgery,
National Cheng Kung University Hospital, College of Medicine, National Cheng Kung
University, Tainan
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery,
National Cheng Kung University Hospital, College of Medicine, National Cheng Kung
University, Tainan
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery,
National Cheng Kung University Hospital, College of Medicine, National Cheng Kung
University, Tainan
- Department of Biomedical Engineering,
National Cheng Kung University, Tainan
| | - Fa-Chuan Kuan
- Department of Orthopaedic Surgery,
National Cheng Kung University Hospital, College of Medicine, National Cheng Kung
University, Tainan
- Department of Biomedical Engineering,
National Cheng Kung University, Tainan
| | - Yueh Chen
- Department of Orthopaedic Surgery, Sin
Lau Christian Hospital, Tainan
- Institute of Allied Health Sciences,
College of Medicine, National Cheng Kung University, Tainan
| | - Joe-Zhi Yen
- Department of Orthopaedic Surgery,
National Cheng Kung University Hospital, College of Medicine, National Cheng Kung
University, Tainan
| | - Chen-Hao Chiang
- Department of Biomedical Engineering,
National Cheng Kung University, Tainan
- Department of Orthopaedics, Ditmanson
Medical Foundation Chia-Yi Christian Hospital, Chiayi
| | - Hao-Ming Chang
- Tainan Municipal Hospital (managed by
Show Chwan Medical Care Corporation), Tainan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery,
National Cheng Kung University Hospital, College of Medicine, National Cheng Kung
University, Tainan
- Medical Device R&D Core Laboratory,
National Cheng Kung University Hospital, Tainan
- Musculoskeletal Research Center,
Innovation Headquarter, National Cheng Kung University, Tainan
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Consensus Statement for Shoulder Impingement: To Operate or Not? Who to Ask for the Consensus Panel. Arthroscopy 2022; 38:1385-1387. [PMID: 35501003 DOI: 10.1016/j.arthro.2022.01.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/25/2022] [Indexed: 02/02/2023]
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Reliable interobserver and intraobserver agreement of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification system of rotator cuff tears. J ISAKOS 2021; 7:56-61. [DOI: 10.1016/j.jisako.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/12/2021] [Indexed: 11/18/2022]
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Park JY, Lee JH, Oh KS, Chung SW, Choi Y, Yoon WY, Kim DW. Rotator cuff retear after repair surgery: comparison between experienced and inexperienced surgeons. Clin Shoulder Elb 2021; 24:135-140. [PMID: 34488293 PMCID: PMC8423529 DOI: 10.5397/cise.2021.00073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/07/2021] [Indexed: 12/19/2022] Open
Abstract
Background We hypothesized in this study that the characteristics of retear cases vary according to surgeon volume and that surgical outcomes differ between primary and revision arthroscopic rotator cuff repair (revisional ARCR). Methods Surgeons performing more than 12 rotator cuff repairs (RCRs) per year were defined as high-volume surgeons, and those performing fewer than 12 RCRs were considered low-volume surgeons. Of the 47 patients who underwent revisional ARCR at our clinic enrolled in this study, 21 cases were treated by high-volume surgeons and 26 cases by low-volume surgeons. In all cases, the interval between primary surgery and revisional ARCR, degree of “acromial scuffing,” number of anchors, RCR technique, retear pattern, fatty infiltration, retear size, operating time, and clinical outcome were recorded. Results During primary surgery, significantly more lateral anchors (p=0.004) were used, and the rate of use of the double-row repair technique was significantly higher (p<0.001) in the high- versus low-volume surgeon group. Moreover, the “cut-through pattern” was observed significantly more frequently among the cases treated by high- versus low-volume surgeons (p=0.008). The clinical outcomes after revisional ARCR were not different between the two groups. Conclusions Double-row repair during primary surgery and the cut-through pattern during revisional ARCR were more frequent in the high- versus low-volume surgeon groups. However, no differences in retear site or size, fatty infiltration grade, or outcomes were observed between the groups.
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Affiliation(s)
- Jin-Young Park
- Center for Shoulder, Elbow and Sports, Neon Orthopaedic Clinic, Seoul, Korea
| | - Jae-Hyung Lee
- Center for Shoulder, Elbow and Sports, Neon Orthopaedic Clinic, Seoul, Korea
| | - Kyung-Soo Oh
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Yunseong Choi
- Center for Shoulder, Elbow and Sports, Neon Orthopaedic Clinic, Seoul, Korea
| | - Won-Yong Yoon
- Center for Shoulder, Elbow and Sports, Neon Orthopaedic Clinic, Seoul, Korea
| | - Dong-Wook Kim
- Center for Shoulder, Elbow and Sports, Neon Orthopaedic Clinic, Seoul, Korea
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Lädermann A, Chagué S, Preissmann D, Kolo FC, Zbinden O, Kevelham B, Bothorel H, Charbonnier C. Acromioplasty during repair of rotator cuff tears removes only half of the impinging acromial bone. JSES Int 2020; 4:592-600. [PMID: 32939492 PMCID: PMC7479029 DOI: 10.1016/j.jseint.2020.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background To date, there is no consensus on when and how to perform acromioplasty during rotator cuff repair (RCR). We aimed to determine the volume of impinging bone removed during acromioplasty and whether it influences postoperative range of motion (ROM) and clinical scores after RCR. Methods Preoperative and postoperative computed tomography scans of 57 shoulders that underwent RCR were used to reconstruct scapula models to simulate volumes of impinging acromial bone preoperatively and then compare them to the volumes of bone resected postoperatively to calculate the proportions of desired (ideal) vs. unnecessary (excess) resections. All patients were evaluated preoperatively and at 6 months to assess ROM and functional scores. Results The volume of impinging bone identified was 3.5 ± 2.3 cm3, of which 1.6 ± 1.2 cm3 (50% ± 27%) was removed during acromioplasty. The volume of impinging bone identified was not correlated with preoperative critical shoulder angle (r = 0.025, P = .853), nor with glenoid inclination (r = -0.024, P = .857). The volume of bone removed was 3.7 ± 2.2 cm3, of which 2.1 ± 1.6 cm3 (53% ± 24%) were unnecessary resections. Multivariable analyses revealed that more extensive removal of impinging bone significantly improved internal rotation with the arm at 90° of abduction (beta, 27.5, P = .048) but did not affect other shoulder movements or clinical scores. Conclusions Acromioplasty removed only 50% of the estimated volume of impinging acromial bone. More extensive removal of impinging bone significantly improved internal rotation with the arm at 90° of abduction.
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Affiliation(s)
- Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Sylvain Chagué
- Medical Research Department, Artanim Foundation, Meyrin, Switzerland
| | - Delphine Preissmann
- Center for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | | | - Olivia Zbinden
- Service of Orthopedics and Traumatology, Lausanne University Hospital, Lausanne, Switzerland
| | - Bart Kevelham
- Medical Research Department, Artanim Foundation, Meyrin, Switzerland
| | | | - Caecilia Charbonnier
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Medical Research Department, Artanim Foundation, Meyrin, Switzerland
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Consigliere P, Haddo O, Levy O, Sforza G. Subacromial impingement syndrome: management challenges. Orthop Res Rev 2018; 10:83-91. [PMID: 30774463 PMCID: PMC6376459 DOI: 10.2147/orr.s157864] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The painful shoulder is the most common condition seen in specialist shoulder clinics. It is often associated with lack of range of motion and reduced shoulder function. Lack of sleep and difficulties in performing basic daily life activities are common findings. Subacromial Impingement Syndrome (SAIS) has been considered as the most common cause of shoulder pain since it was described in 1852. Charles Neer, in 1972, described the presence of a "proliferative spur and ridge" on the undersurface of the acromion, which needs to be removed to improve the symptoms (acromioplasty). Neer's "impingement" hegemony was undisputed for at least 30 years. A more extensive knowledge of the pathogenesis of SAIS, however, has led authors to challenge the role of "impingement" in the shoulder pain and the role of surgical intervention. The aim of this review was to understand if there is still a role for surgical decompression in patients with SAIS. A literature review was performed in PubMed, PEDro, Embase, and the Cochrane Central Register of Controlled Trials using impingement, subacromial space, rotator cuff tears, tendinopathy, and tendinitis as key words. Randomized clinical trials (RCTs) with long-term follow-up comparing surgical intervention and conservative treatments in SAIS were preferred; however, prospective articles studying the outcome of surgical decompression and physiotherapy were also included. The majority of the studies showed no difference in the outcome between patients randomized to surgical decompression or conservative management. However, some studies reported better results after surgery, especially in the long term. Interpretation of the results is very difficult as most of the studies are of poor quality and have short follow-up. In our opinion, the type of subacromial lesion needs to be considered; this may offer an explanation to the difference in severity of symptoms and to the varying degrees of response to certain treatments, including surgery. Further studies are mandatory to better understand the role of surgery in SAIS.
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Affiliation(s)
- Paolo Consigliere
- The Reading Shoulder Unit, Berkshire Independent Hospital Coley Park, Swallows Croft, Reading, Berkshire, UK,
| | - Omar Haddo
- The Whittington Hospital NHS FT, London, UK
| | - Ofer Levy
- The Reading Shoulder Unit, Berkshire Independent Hospital Coley Park, Swallows Croft, Reading, Berkshire, UK, .,The Reading Shoulder Unit, Royal Berkshire NHS Foundation Trust, Reading, Berkshire, UK
| | - Giuseppe Sforza
- The Reading Shoulder Unit, Berkshire Independent Hospital Coley Park, Swallows Croft, Reading, Berkshire, UK,
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