São João University Hospital, Porto, Portugal.
São João University Hospital, Porto, Portugal; Unit of Anatomy, Department of Biomedicine, Porto Medical School, Porto University, Center for Health Technology and Services Research (CINTESIS), Porto, Portugal; Porto Medical School, Porto University, Porto, Portugal.
J Shoulder Elbow Surg. 2020 Sep;29(9):1804-1810. doi: 10.1016/j.jse.2020.01.074. Epub 2020 Apr 16.
The pathophysiology of subscapularis (SS) lesions is still relatively unknown despite recent interest in predictive factors for SS tears. Our goal was to determine the influence of the coracoid morphology and humeral version on SS tears.
This was a retrospective, controlled, single-blinded study. We analyzed 232 shoulders with SS lesions confirmed by magnetic resonance imaging. The coracoid proximal length, coracoid distal length (CLD), and coracoid total length were measured. The coracoid length ratio, coracoid angle (CA), and humeral version were also evaluated.
We found that greater humeral retroversion was progressively related to more serious SS injuries, with values of -28.6° ± 19.5° and -51.0° ± 11.1° in the normal SS group and tear group, respectively (P < .001). The same tendency was shown for the CA, with values of 123.8° ± 11.1° in the control group vs. 97.4° ± 10.1° in the tear group (P < .001). Greater CLD, coracoid total length, and coracoid length ratio were also associated with an increased risk of SS tears (P < .001). The CA and CLD represented the best predictors of SS tears, presenting areas under the receiver operating characteristic curve of 90.0% and 89.0%, respectively.
This article is the first to study the influence of different parameters of the coracoid process morphology and humeral version on SS tears. We proved that humeral version and coracoid morphology were important risk factors for SS pathology and could accurately predict these lesions. Finally, our study was the first to create a classification system to divide coracoids according to their morphology and relative risk of associated SS tears.
尽管人们对肩袖下肌（SS）撕裂的预测因素越来越感兴趣，但 SS 损伤的发病机制仍知之甚少。我们的目标是确定喙突形态和肱骨头倾斜度对 SS 撕裂的影响。
这是一项回顾性、对照、单盲研究。我们分析了 232 例经磁共振成像证实的 SS 病变的肩关节。测量了喙突近端长度、喙突远端长度（CLD）和喙突总长度。还评估了喙突长度比、喙突角（CA）和肱骨头倾斜度。
我们发现，更大的肱骨头后倾与更严重的 SS 损伤呈渐进性相关，在正常 SS 组和撕裂组中分别为-28.6°±19.5°和-51.0°±11.1°（P<0.001）。CA 也表现出相同的趋势，对照组为 123.8°±11.1°，撕裂组为 97.4°±10.1°（P<0.001）。更大的 CLD、喙突总长度和喙突长度比也与 SS 撕裂的风险增加相关（P<0.001）。CA 和 CLD 是 SS 撕裂的最佳预测指标，其受试者工作特征曲线下面积分别为 90.0%和 89.0%。
本文首次研究了喙突形态和肱骨头倾斜度的不同参数对 SS 撕裂的影响。我们证明了肱骨头倾斜度和喙突形态是 SS 病理的重要危险因素，可以准确预测这些病变。最后，我们的研究首次创建了一个分类系统，根据喙突的形态及其与 SS 撕裂的相对风险对喙突进行分类。
