ABSTRACT
Several intrinsic and extrinsic factors have been advocated in the pathogenesis of rotator cuff tears, but it is still unclear whether the origin of the tear is related to tendon degeneration itself or induced by several morphologic changes. The purpose of this study is to determine the relationship between the acromial coverage of the humeral head and the presence of a cuff tear. We evaluated 148 shoulders, including 45 that underwent surgical rotator cuff repair (group I), 26 with documented rotator cuff tears treated conservatively (group II), and 77 with no cuff pathology as a control group (group III). The mean acromial coverage index was 0.68 in group I, 0.72 in group II, and 0.59 in group III, giving a highly significant difference (P < .0001) between the control group and both cuff tear groups. Patients with a cuff tear have a significantly higher acromial coverage index than the control group.
Subject(s)
Acromioclavicular Joint/diagnostic imaging , Acromion/diagnostic imaging , Rotator Cuff/surgery , Tendon Injuries/diagnostic imaging , Acromioclavicular Joint/injuries , Acromioclavicular Joint/surgery , Acromion/physiopathology , Adult , Age Factors , Aged , Arthroscopy , Case-Control Studies , Female , Humans , Injury Severity Score , Male , Middle Aged , Probability , Radiography , Risk Factors , Rotator Cuff Injuries , Sensitivity and Specificity , Sex Factors , Shoulder Injuries , Shoulder Joint/surgery , Tendon Injuries/surgeryABSTRACT
The importance of the preservation of the subacromial arch has been stressed recently, especially in irreparable lesions of the rotator cuff to prevent anterosuperior migration of the humeral head. The purpose of this article is to describe the surgical technique of a modified open anterior acromioplasty performed through an intra-acromial osteotomy that increases the subacromial space and preserves the insertion of the coracoacromial ligament on the undersurface of the acromion. To compare this new technique with classical acromioplasty, a prospective but nonrandomized study was performed including 20 patients undergoing open anterior acromioplasty and 22 patients undergoing a modified open anterior acromioplasty. At a mean follow-up of 18 months, no differences related to shoulder function as evaluated by the Constant score were found between these two groups. This modified acromioplasty increases the subacromial space, preserving the anatomy of the subacromial arch, and provides functional results as good as those obtained with classical open acromioplasty.
