Department of Orthopedic Surgery, Suncheon Jungang Hospital, 5 Jangmeong-ro, Suncheon, Jeollanam-do, 57956, Republic of Korea.
Division of Musculoskeletal Radiology, Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea.
Knee Surg Sports Traumatol Arthrosc. 2019 Jan;27(1):289-298. doi: 10.1007/s00167-018-5247-1. Epub 2018 Oct 26.
Previous studies have reported that a high critical shoulder angle (CSA) is associated with rotator cuff tears (RCTs). However, the available evidence concerning the strength of the association of these parameters with the pathogenesis of RCTs is conflicting. The aim in the present meta-analysis was to assess the diagnostic performance of CSA for detecting RCTs.
The PubMed and EMBASE databases were searched for diagnostic accuracy studies of CSA for detecting RCT. Quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. We calculated the pooled diagnostic accuracy of CSA, including diagnostic odd ratios (DORs) with 95% confidence intervals (CIs). Bivariate random-effect modeling with forest plots and hierarchical summary receiver operating characteristic curves was performed to evaluate the pooled sensitivity and specificity of CSA. For heterogeneity exploration, we performed meta-regression analyses.
Eight studies including 902 patients (460 patients with RCT and 442 control patients) were included. According to DOR, CSA was an informative feature for RCT (DOR 8; 95% CI 4-16). The overall diagnostic performance of CSA for RCT was good (sensitivity 71% [95% CI 61-80%]; specificity, 77% [95% CI 65-86%]). Meta-regression analyses revealed that the sensitivity of CSA could be higher for differentiating full-thickness RCTs and normal patients. Furthermore, the specificity of CSA could be higher using a cut-off value of 35°.
CSA on plain radiographs has good diagnostic performance for RCTs. A cut-off value of 35° is recommended for more accurate diagnosis of full-thickness RCTs. Measuring CSA on plain radiographs may provide clinicians with a readily available and reliable method for detecting RCT in daily practice.
Diagnostic studies, Level III.
先前的研究报告称，较高的临界肩角（CSA）与肩袖撕裂（RCT）有关。然而，关于这些参数与 RCT 发病机制之间关联强度的证据存在争议。本荟萃分析旨在评估 CSA 检测 RCT 的诊断性能。
检索了 PubMed 和 EMBASE 数据库中关于 CSA 检测 RCT 的诊断准确性研究。使用诊断准确性研究质量评估工具-2 评估纳入研究的质量。我们计算了 CSA 的汇总诊断准确性，包括诊断比值比（DOR）及其 95%置信区间（CI）。使用森林图和分层综合受试者工作特征曲线进行二元随机效应模型分析，以评估 CSA 的汇总敏感性和特异性。为了探索异质性，我们进行了荟萃回归分析。
共纳入 8 项研究，包括 902 例患者（460 例 RCT 患者和 442 例对照患者）。根据 DOR，CSA 是 RCT 的一个信息特征（DOR 8；95%CI 4-16）。CSA 对 RCT 的总体诊断性能良好（敏感性 71%[95%CI 61-80%]；特异性，77%[95%CI 65-86%]）。荟萃回归分析表明，CSA 对全层 RCT 和正常患者的鉴别灵敏度可能更高。此外，使用 35°的截断值，CSA 的特异性可能更高。
平片 CSA 对 RCT 具有良好的诊断性能。建议使用 35°的截断值以更准确地诊断全层 RCT。在平片上测量 CSA 可能为临床医生提供一种在日常实践中易于获得且可靠的方法来检测 RCT。
诊断研究，III 级。
