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Critical shoulder angle formed by a line joining the inferior (point A) and superior (point B) border of the glenoid fossa and another line joining the inferior border of the glenoid (point A) with the inferior lateral boarder of the acromion (point C). https://doi.org/10.1371/journal.pone.0253282.g001
Source publication
Critical shoulder angle (CSA) is the angle between the superior and inferior bone margins of the glenoid and the most lateral border of the acromion and is potentially affected during a rotator cuff tear (RCT). Acromioplasty is generally performed to rectify the anatomy of the acromion during RCT repair surgery. However, limited information is avai...
Context in source publication
Context 1
... the radiographic images did not overlap and during rotation along the edges of the glenoid cavity, image quality remained sufficient to evaluate these parameters. Fig 1 summarizes the CSA measurements. The angle was measured from a line connecting superior and inferior bone margins of the glenoid and a line from the inferior bony margin of the glenoid to the most lateral border of the acromion. ...
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Background
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Citations
... Anterolateral acromioplasty was described in 2 studies. Lin et al. [25] reported that 337 participants presented with a mean CSA of 38.4° ± 6.0° before surgery, which significantly decreased to 35.8° ± 5.9° after anterolateral acromioplasty (p < 0.05). Katthagen et al. [17] reported that anterolateral acromioplasty decreased the CSA by a mean of 1.4° (95% CI 0.8°, 1.9°). ...
Background
Rotator cuff tears are one of the most common shoulder injuries in the older population. This study aimed to determine whether acromioplasty reliably decreases the critical shoulder angle (CSA) and describe any associated complications.
Methods
A systematic literature review was performed according to PRISMA guidelines using PubMed, EMBASE, Web of Science, and Cochrane Library Database. Two reviewers independently screened the titles and abstracts using prespecified criteria. Studies where the acromioplasty was performed as a surgical procedure were included. Patient characteristics and degree of CSA reduction were collected from each individual study. All statistical analyses were performed using Review Manager (RevMan) 5.4.1 software. A random-effects model was used for meta-analysis.
Results
A total of 9 studies involving 1236 patients were included in the meta-analysis. The age of patients ranged from 23 to 82 years. The follow-up period ranged from 12 to 30 months. Of the 9 studies, 8 (88.9%) were retrospective, 1 (11.1%) was prospective, 5 were comparative, and 4 were case series. The mean CSA was significantly reduced from 36.1° ± 4.6° to 33.7° ± 4.2 ( p < 0.05). The meta-analysis showed an overall best estimate of the mean difference in pre- and postoperative CSA equal to 2.63° (95% confidence interval: 2.15, 3.11] ( p < 0.00001).
Conclusions
Acromioplasty can significantly reduce CSA, notably in cases of high preoperative CSA. In addition, the effect of lateral acromioplasty on the CSA was more significant compared to anterolateral acromioplasty. Acromioplasty was not associated with complications during the short-term follow-up.
Objective
The pathogenesis of rotator cuff tears (RCTs) is multifactorial. Critical shoulder angle (CSA), which represents the lateral extension of the acromion over the cuff, has been proposed as an extrinsic risk factor. The aim of the present systematic review and meta-analysis was to analyze the available literature regarding the correlation between RCT and CSA.
Methods
A review was carried out in accordance with the “Preferred Reporting Items for Systematic reviews and Meta-Analyses” guidelines on July 17, 2023, using the following databases: PubMed, Ovid, and Cochrane Reviews. The following keywords were used: “critical shoulder angle,” “rotator cuff tears,” and “rotator cuff lesions.” The methodological quality of the studies was assessed with the MINORS SCORE.
Results
Twenty-eight studies were included. The average CSA among the 2110 patients with full-thickness RCT was 36.7 degrees, whereas the same value among the 2972 controls was 33.1 degrees. The average CSA in the 348 patients with partial-thickness RCT was 34.6 degrees, whereas it was 38.1 degrees in the 132 patients with massive RCT. The average MINORS score was 15.6.
Conclusions
CSA values were significantly higher in patients with RCT compared with the asymptomatic population. In addition, it appears that CSA values increase with the severity of rotator cuff involvement.
