Chuang Hao-Chun, Hong Chih-Kai, Hsu Kai-Lan, Kuan Fa-Chuan, Chen Yueh, Yen Joe-Zhi, Chiang Chen-Hao, Chang Hao-Ming, Su Wei-Ren
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.
Orthop J Sports Med. 2023 Jun 7;11(6):23259671231175873. doi: 10.1177/23259671231175873. eCollection 2023 Jun.
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.
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.
Cohort study; Level of evidence, 2.
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.
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; = .03 and < .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; = .034 and = .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; = .751).
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.
喙肩韧带（CAL）退变被认为是滑囊侧肩袖撕裂时外部撞击的一个因素，但CAL松解会带来不良影响。
使用多种方式研究CAL退变与巨大肩袖撕裂模式之间的关联，并评估CAL退变对冈上肌腱再撕裂率的影响。
队列研究；证据等级，2级。
作者前瞻性招募了44例行关节镜下肩袖修复且未行肩峰成形术或CAL松解的患者。分别回顾术前X线片和磁共振成像（MRI）扫描，以确定肩峰形态和CAL厚度。肩袖撕裂分为孤立性冈上肌撕裂或巨大撕裂（累及≥2条肌腱），巨大撕裂采用科林分类法进行分类。肩峰退变采用科普兰-利维分类法进行分析。术中对CAL进行活检，并使用博纳尔评分进行组织学分析。在6个月随访时，使用菅谷分类法在MRI上分析修复的冈上肌腱的完整性。最后，研究CAL退变、肩袖撕裂模式和关节镜分级之间的关联。
科林B型肩袖撕裂患者的CAL博纳尔评分显著高于科林A型或孤立性冈上肌撕裂患者（分别为10.0对6.8和3.4；P = 0.03和P < 0.001）。科普兰-利维2期或3期肩峰下表面退变的患者的CAL博纳尔评分显著高于肩峰下表面完整的患者（分别为8.4和8.2对3.5；P = 0.034和P = 0.027）。术后6个月菅谷分类不同阶段患者的CAL博纳尔评分具有可比性（1、2、3和4期分别为6.5、7.2、8.0和7.8；P = 0.751）。
前上型巨大肩袖撕裂中CAL退变更严重。有趣的是，即使未行肩峰成形术，CAL退变的严重程度也不影响冈上肌腱的再撕裂率。
