El-Hadara University Hospital, Department of Orthopaedic Surgery, Alexandria University, Egypt.
Department of Orthopaedic Surgery, University of Cincinnati Medical Center, 200 Albert Sabin Way, Cincinnati, OH 45220, USA.
J ISAKOS. 2024 Oct;9(5):100300. doi: 10.1016/j.jisako.2024.07.008. Epub 2024 Aug 3.
Critical shoulder angle (CSA) and acromial index (AI) are two radiographic signs that can influence the risk of rotator cuff tears and the outcomes of repair. The purpose of this study was to determine the influence of CSA and AI on massive cuff tears and on the functional outcomes after repair. The hypothesis was that CSA and AI would be higher in posterosuperior compared to anterosuperior tears.
CSA and AI were retrospectively measured on radiographs of patients who underwent repair of two rotator cuff tendons. Functional outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) score and Simple Shoulder Test (SST) at least six months postoperatively. Patients were divided according to the tendons repaired into anterosuperior group and posterosuperior group. Radiographic measurements and functional outcomes were compared. Patients in the posterosuperior group were subdivided into low or high CSA (cut-off value = 39), and into low or high AI (cut-off value = 0.75). All available preoperative magnetic resonance images were reviewed and graded according to Goutallier classification. Multivariate analysis was used to determine the influence of CSA, AI and Goutallier grade on functional outcomes.
Eighty six patients were included. Both CSA and AI were statistically significantly higher in the posterosuperior group (p = 0.0143 and 0.0052, respectively). After a mean follow-up of 33 months, ASES and SST were significantly better in patients with Goutallier grades 0-1 than grades>1 (multivariate p = 0.03 and 0.009, respectively). No statistically significant differences were found between low and high CSA and AI groups in terms of functional outcomes of the posterosuperior group after repair (multivariate p = 0.9).
Higher CSA and AI seem to increase the risk of posterosuperior more than anterosuperior rotator cuff tears. Neither of these radiographic parameters influenced the functional outcomes of massive posterosuperior tears after repair.
Level III.
临界肩角（CSA）和肩峰指数（AI）是两种影像学标志，可能会影响肩袖撕裂的风险和修复的结果。本研究的目的是确定 CSA 和 AI 对巨大肩袖撕裂以及修复后的功能结果的影响。假设是 CSA 和 AI 在肩袖后上方撕裂中比肩袖前上方撕裂更高。
回顾性测量了接受双肌腱肩袖修复的患者的 X 线片上的 CSA 和 AI。术后至少 6 个月，使用美国肩肘外科医师（ASES）评分和简易肩部测试（SST）评估功能结果。根据修复的肌腱将患者分为肩袖前上方组和肩袖后上方组。比较影像学测量和功能结果。将肩袖后上方组患者分为 CSA 低或高（临界值=39）和 AI 低或高（临界值=0.75）组。回顾了所有可用的术前磁共振图像，并根据 Goutallier 分级进行了分级。使用多变量分析确定 CSA、AI 和 Goutallier 分级对功能结果的影响。
共纳入 86 例患者。肩袖后上方组的 CSA 和 AI 均显著更高（p=0.0143 和 0.0052）。平均随访 33 个月后，Goutallier 分级 0-1 级患者的 ASES 和 SST 明显优于分级>1 级患者（多变量 p=0.03 和 0.009）。在肩袖后上方修复后，低 CSA 和 AI 组与高 CSA 和 AI 组之间在功能结果方面无统计学差异（多变量 p=0.9）。
较高的 CSA 和 AI 似乎增加了肩袖后上方撕裂的风险，而不是肩袖前上方撕裂。这两个影像学参数都不影响巨大肩袖后上方撕裂修复后的功能结果。
III 级。
