Center of Excellence in Upper Extremity Reconstruction and Sports Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Department of Orthopaedics, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand.
Department of Orthopaedics, Nopparat Rajathanee Hospital, Bangkok, Thailand.
Clin Orthop Surg. 2024 Aug;16(4):578-585. doi: 10.4055/cios23381. Epub 2024 May 28.
Morphological differences among various ethnicities can significantly impact the reliability of acromiohumeral interval (AHI) measurements in diagnosing massive rotator cuff tears. This variation raises questions about the generalizability of AHI studies conducted in Western populations to the Asian population. Consequently, the primary objective of this study was to develop a novel parameter that can enhance the diagnosis of massive rotator cuff tears, irrespective of morphometric disparities between individuals of different ethnic backgrounds.
A 10-year retrospective analysis of shoulder arthroscopic surgery patients was conducted, categorizing them into 3 groups based on intraoperative findings: those without rotator cuff tears, those with non-massive tears, and those with massive tears. AHI-glenoid ratio (AHIGR) was measured by individuals with varying academic backgrounds, and its diagnostic performance was compared to AHI. Sensitivity, specificity, accuracy, and intra- and inter-rater reliability were evaluated.
AHIGR exhibited significantly improved sensitivity, specificity, and accuracy as a diagnostic tool for massive rotator cuff tears, compared to AHI. A proposed cut-off point of AHIGR ≤ 0.2 yielded comparable results to AHI < 7 mm. Intra- and inter-rater reliability was excellent among different observers.
AHIGR emerges as a promising diagnostic tool for massive rotator cuff tears, offering improved sensitivity and specificity compared to AHI. Its reproducibility among diverse observers underscores its potential clinical utility. While further research with larger and more diverse patient cohorts is necessary, AHIGR offers significant potential as a reference for enhancing the assessment of massive rotator cuff tears.
不同种族之间的形态差异会显著影响肩峰下间隙（AHI）测量在诊断巨大肩袖撕裂中的可靠性。这种差异引发了关于在西方人群中进行的 AHI 研究是否可以推广到亚洲人群的问题。因此，本研究的主要目的是开发一种新的参数，无论不同种族背景个体的形态差异如何，都可以增强对巨大肩袖撕裂的诊断。
对 10 年的肩关节镜手术患者进行回顾性分析，根据术中发现将其分为 3 组：无肩袖撕裂组、非巨大撕裂组和巨大撕裂组。由具有不同学术背景的个体测量 AHI-肩胛盂比率（AHIGR），并比较其与 AHI 的诊断性能。评估了敏感性、特异性、准确性以及组内和组间的可靠性。
与 AHI 相比，AHIGR 作为诊断巨大肩袖撕裂的工具，具有显著提高的敏感性、特异性和准确性。提出的 AHIGR ≤ 0.2 的截断值与 AHI < 7 mm 得出的结果相当。不同观察者之间的组内和组间可靠性均非常好。
AHIGR 是一种有前途的巨大肩袖撕裂诊断工具，与 AHI 相比，其敏感性和特异性更高。不同观察者之间的可重复性突出了其潜在的临床应用价值。虽然需要进一步研究更大和更多样化的患者队列，但 AHIGR 作为增强巨大肩袖撕裂评估的参考具有重要意义。
