Toro Felipe, De la Paz Joaquín, De la Maza Francisca, Ruiz Francisco, Moraga Claudio, Mardones Paula
Department of Traumatology, Clinica Alemana, Santiago, Chile.
School of Medicine, Universidad del Desarrollo, Santiago, Chile.
JSES Int. 2024 May 28;8(5):1023-1028. doi: 10.1016/j.jseint.2024.05.009. eCollection 2024 Sep.
Rotator cuff tears are highly prevalent, and their association with critical shoulder angle (CSA) has been reported. There is controversy regarding whether the morphology of the acromion influences its incidence, as well as whether acromioplasty would impact the results of a rotator cuff repair. Lateral acromioplasty does not play a decompressive role; rather, it aims to correct the deltoid vector. According to some publications, this would achieve less loading on the repaired rotator cuff, a lower retear rate, and better function. CSA correction with lateral acromioplasty can be planned with radiography (2-dimensional [2D]), but its predictability has not been fully studied. The primary objective of this study is to evaluate the predictability of 2D planning with radiography in CSA correction in patients with rotator cuff repair. The secondary objective is to analyze the association between the correction of the CSA and the functional outcomes.
This single-center, prospective, observational, analytical study included candidates for arthroscopic repair of a rotator cuff tear with a CSA > 35°. Lateral acromioplasty was performed as planned with preoperative radiography (2D) to achieve a CSA of 35°. The degrees to be corrected were calculated. CSA was recalculated with a postoperative radiography; and the error in the planned grades to be corrected was calculated. At the end of follow-up, Visual Analog Scale, Subjective Shoulder Value (SSV), and Quick-Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) scores were evaluated.
Forty one cases were included, 43.9% were men, and the mean age was 55.5 ± 8.6 years. The mean preoperative and postoperative CSA were 39.6° ± 1.9° and 35.7° ± 2.3°, respectively; 41.5% achieved a postoperative CSA ≤ 35°. The mean CSA planned correction error was 45.7 ± 28.8%. At the end of the follow-up, 33 (78.6%) had a functional evaluation, with an average follow-up of 41 ± 6.8 months. The mean Visual Analog Scale, Quick-DASH, and SSV were 0.9 ± 1.6, 5.3 ± 7.5, and 92.7 ± 10.6, respectively. There was a significant difference in Quick-DASH ( = .01) and SSV ( = .02) according to whether a postoperative CSA ≤ 35° was achieved.
In lateral acromioplasty, planning of CSA correction with radiography (2D) is imprecise. Reaching a CSA ≤ 35° positively influences functional results.
肩袖撕裂非常普遍，且已有报道称其与临界肩角（CSA）有关。关于肩峰形态是否会影响其发病率，以及肩峰成形术是否会影响肩袖修复的结果，目前存在争议。外侧肩峰成形术并不起减压作用；相反，其目的是纠正三角肌向量。根据一些出版物，这将减少修复后的肩袖上的负荷，降低再撕裂率，并改善功能。可以通过放射摄影（二维[2D]）来规划外侧肩峰成形术对CSA的矫正，但尚未充分研究其可预测性。本研究的主要目的是评估放射摄影二维规划在肩袖修复患者CSA矫正中的可预测性。次要目的是分析CSA矫正与功能结果之间的关联。
这项单中心、前瞻性、观察性、分析性研究纳入了CSA>35°的肩袖撕裂关节镜修复候选患者。根据术前放射摄影（2D）计划进行外侧肩峰成形术，以实现35°的CSA。计算需要矫正的度数。术后通过放射摄影重新计算CSA；并计算计划矫正度数的误差。在随访结束时，评估视觉模拟量表、主观肩关节评分（SSV）和手臂、肩部和手部快速残疾评定量表（Quick-DASH）评分。
纳入41例患者，男性占43.9%，平均年龄为55.5±8.6岁。术前和术后CSA的平均值分别为39.6°±1.9°和35.7°±2.3°；41.5%的患者术后CSA≤35°。计划的CSA矫正误差平均值为45.7±28.8%。在随访结束时，33例（78.6%）患者进行了功能评估，平均随访时间为41±6.8个月。视觉模拟量表、Quick-DASH和SSV的平均值分别为0.9±1.6、5.3±7.5和92.7±10.6。根据术后CSA是否≤35°，Quick-DASH（P = 0.01）和SSV（P = 0.02）存在显著差异。
在外侧肩峰成形术中，通过放射摄影（2D）规划CSA矫正不准确。达到CSA≤35°对功能结果有积极影响。
