RESUMO
PURPOSE: To evaluate the effect of several shoulder anatomical parameters in the development of rotator cuff tear (RCT). METHODS: Between 2014 and 2018, all consecutive patients who underwent arthroscopic rotator cuff repair due to full-thickness rotator cuff tear with a minimum 2-year follow-up were identified. Inclusion criteria were (1) age>18 years, (2) patients with degenerative RCT, (3) full-thickness RCTs, (4) patients underwent arthroscopic RCR due to unresponsive conservative treatment, (5) minimum 2-year follow-up period. Exclusion criteria were traumatic RCT, history of previous shoulder surgery, shoulder deformity, neurologic or neuromuscular dysfunction, glenohumeral and/or acromioclavicular joint arthritis, cuff-tear arthropathy, history of fracture around shoulder and inadequate or low-quality magnetic resonance images (MRI). Acromion index (AI), Critical shoulder angle (CSA), Coracoacromial ligament (CAL) thickness, Subacromial space (SS) width, Acromiohumeral distance (AHD), CAL/SS ratio, Lateral acromial angle (LAA) and glenoid version angle (GVA) parameters were measured on MRI. Intra- and interobserver reliability were measured. Regression analysis was used to evaluate the association between anatomical parameters and RCT development. Receiver operating curves (ROC) were created for independent risk factors. The correlation between measurement parameters were evaluated. RESULTS: There were 1029 patients met the inclusion criteria. After exclusions, 437 patients were included. Age- and sex matched 437 patients without any shoulder pathologies were selected as control group. There was almost perfect intra- (ICC>0.85) and interobserver (ICC> 0.81) reliability regarding all measurement parameters. There was significant difference between RCT group and control group regarding AI (0.67±0.07 vs. 0.61±0.08, p<0.001), CSA (33.58±3.93 vs. 31.50±4.01, p<0.001), CAL thickness (1.81±0.64 vs. 1.53±0.50, p<0.001), CAL/SS ratio (0.29±0.14 vs. 0.23±0.10, p<0.001) and GVA (-16.69±6.69 vs. -15.37±5.95, p=0.002) parameters. AI (OR: 1.998, P<0.001), CAL thickness (OR: 2.801, p<0.000) and CSA (OR: 3.055, p<0.001) were found to be independently associated with the increased risk of RCT development. Area under curve (AUC) of the AI, CSA, and CAL thickness were 71.4%, 71.3%, and 70.2%, respectively. Cut-off values for AI, CSA, and CAL thickness were 0.62, 36.4° and 1.47 mm, respectively. There was significantly positive strong correlation between AI and CSA (p<0.001, r=0.814). CONCLUSION: Higher AI, CSA and CAL thickness independently associated with full-thickness RCT development. In clinical practice, these parameters may be useful in the prediction of rotator cuff rupture.
RESUMO
PURPOSE: To compare the critical shoulder angle (CSA), acromion index (AI), acromion angulation (AA) and glenoid version angle (GVA) between patients with full-thickness rotator cuff tears (RCTs) and patients with intact rotator cuffs. METHODS: Between 2014 and 2018, the CSA, AI, AA and GVA were measured in consecutively included patients aged > 40 years who underwent shoulder arthroscopy for full-thickness RCTs. A total of 437 patients with RCTs and a mean age of 51.2 years (± 5.8) were included, 35.7% of whom were male. In the control group, there were n = 433 patients (36.3% male) with an intact rotator cuff, and the mean age was 50.7 years (± 5.3). RESULTS: The mean AI for the RCT group was 0.7 ± 0.1, which was significantly higher than the mean AI for the control group (0.6 ± 0.1, p < 0.001). The mean CSA for the RCT group was 33.6° ± 3.9°, which was significantly higher than the mean CSA for the control group (31.5° ± 4°, p < 0.001). The mean AA for the RCT group was 13.9° ± 9°, which was significantly higher than the mean AA for the control group (12.4 ± 8.6, p = 0.012). The mean GVA for the RCT group was - 3.5° ± 4.6° and significantly retroverted compared with the mean GVA for the control group (- 2.2° ± 4.6°, p < 0.001). The cutoff values determined by the ROC curve analyses were as follows: 0.6 for AI, 31.4° for CSA, 9.6° for AA and - 2.6° for GVA. CONCLUSION: The CSA, AI, GVA and AA values measured by MRI were determined to be significantly related to full-thickness rotator cuff ruptures. The AI, CSA, AA and GVA may be considered risk factors for degenerative rotator cuff tears. Assessing the CSA, AI, GVA and AA can be helpful for diagnostic evaluation of patients with full-thickness RCTs. LEVEL OF EVIDENCE: III.
