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Which radiological parameters of the coracoid process influence the diagnosis of atraumatic subscapularis tears? Systematic review and meta-analysis.

作者信息

Arias Pérez Rubén Dario, Jaramillo Quiceno Alejandro, Mejia Bustamante Alejandro

机构信息

Pontifical Bolivarian University, Medellín, Colombia.

Salud Sura, Medellín, Colombia.

出版信息

Eur J Orthop Surg Traumatol. 2025 Sep 6;35(1):383. doi: 10.1007/s00590-025-04475-2.


DOI:10.1007/s00590-025-04475-2
PMID:40914771
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12414054/
Abstract

INTRODUCTION: Accurate diagnosis of subscapularis tears remains challenging due to the limitations of physical examinations and imaging techniques. Therefore, specific radiological parameters have been proposed as predictors of atraumatic subscapularis tears to improve diagnostic sensitivity and accuracy. These parameters include coracohumeral distance (CHD), coracoglenoid angle (CGA), coracoid angle (CA), coracoid overlap (CO), and coracohumeral angle (CHA). However, well-accepted cutoff values are still lacking, and there is no consensus on its clinical usefulness. MATERIALS AND METHODS: The PubMed, Scopus, and Cochrane Library databases were queried in July 2024. Inclusion criteria focused on studies that reported MRI-based radiological measurements of the coracoid process in patients with subscapularis tears versus controls. A meta-analysis was performed to evaluate outcomes, with data reported as raw mean difference (MD) and 95% confidence interval (CI). RESULTS: Fourteen studies involving 1,692 patients with subscapularis tears and 1,648 controls were included. Significant findings include a smaller axial CHD in the subscapularis tear group compared to controls (MD, - 1.67; 95% CI, - 2.61 to - 0.72; P = 0.002). The sagittal CHD was also reduced in the tear group (MD, - 1.43; 95% CI, - 1.89 to - 0.98; P < 0.0001). The CGA was (MD, - 1.15; 95% CI, - 2.20 to - 0.10; P = 0.032), and the CA was also reduced (MD, - 18.63; 95% CI, - 35.60 to - 1.66; P = 0.042). The CO showed no significant difference between the tear and control groups (MD, 1.68; 95% CI, - 1.27 to 4.62; P = 0.21). In contrast, the CHA was increased in the tear group (MD, 3.71; 95% CI, 2.32-5.11; P < 0.01). CONCLUSION: Several radiological parameters, including CA, CHA, CGA, and axial and sagittal CHD, demonstrated statistically significant differences between patients with and without atraumatic subscapularis tears. Among them, CHA appears to be the most promising due to its consistent association and low heterogeneity. However, substantial variability across studies and limited data for certain parameters underscore the need for further prospective research to validate their diagnostic value and establish standardized imaging protocols. STUDY DESIGN: Systematic review and meta-analysis; Level of evidence, III.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/830e/12414054/3df51a8d22da/590_2025_4475_Fig8_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/830e/12414054/06acf15b59ed/590_2025_4475_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/830e/12414054/73524a04f178/590_2025_4475_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/830e/12414054/f712d8665ac4/590_2025_4475_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/830e/12414054/44de29cb1e71/590_2025_4475_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/830e/12414054/e3480d61b1ab/590_2025_4475_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/830e/12414054/188cded8cfb9/590_2025_4475_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/830e/12414054/1527fd0811cf/590_2025_4475_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/830e/12414054/3df51a8d22da/590_2025_4475_Fig8_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/830e/12414054/06acf15b59ed/590_2025_4475_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/830e/12414054/73524a04f178/590_2025_4475_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/830e/12414054/f712d8665ac4/590_2025_4475_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/830e/12414054/44de29cb1e71/590_2025_4475_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/830e/12414054/e3480d61b1ab/590_2025_4475_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/830e/12414054/188cded8cfb9/590_2025_4475_Fig6_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/830e/12414054/1527fd0811cf/590_2025_4475_Fig7_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/830e/12414054/3df51a8d22da/590_2025_4475_Fig8_HTML.jpg

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本文引用的文献

[1]
Clinical Benefits of Cartilage Repair in High Tibial Osteotomy Can Only Be Expected in Patients with Successfully Regenerated Cartilage.

Clin Orthop Surg. 2025-8

[2]
Anatomic Morphometry of the Coracoid Process and Lateral Clavicle for Management of Glenoid Bone Loss: A 3-Dimensional Analysis in a Korean Population.

Clin Orthop Surg. 2025-8

[3]
Magnetic resonance imaging based coracoid process morphology and its associations with isolated subscapularis tendon tears in Chinese patients.

Jt Dis Relat Surg. 2024-4-26

[4]
Subscapularis tendon tear detection using axial internal rotation MRI: semiquantitative and quantitative analysis.

Quant Imaging Med Surg. 2023-12-1

[5]
Both Radiologists and Surgeons Miss a Substantial Number of Subscapularis Tears on Magnetic Resonance Imaging Examination Prior to Shoulder Arthroscopy.

Arthrosc Sports Med Rehabil. 2023-11-30

[6]
Higher Upper Subscapularis Goutallier Grade and Coracohumeral Distance Narrowing Are Predictive of Subscapularis Tears in Patients Undergoing Arthroscopic Rotator Cuff Repair.

Arthroscopy. 2024-5

[7]
Clinical Approach to Inconclusive Subscapularis Tear Diagnosis: a Meta-analysis.

Int J Sports Med. 2024-2

[8]
Evaluation of Preoperative Magnetic Resonance Imaging Parameters with Arthroscopic Validation of Subscapularis Tendon Abnormalities in 187 Patients at a Single Center in Turkey.

Med Sci Monit. 2023-5-1

[9]
Is it the subcoracoid impingement or the subacromial impingement that tears the subscapularis tendon? A comparison of the MRI findings of the operated and healthy shoulders of the patients.

Turk J Med Sci. 2023-2

[10]
Development of nomograms predictive of anastomotic leakage in patients before minimally invasive McKeown esophagectomy.

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