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![Distribution (%) of Bigliani Types [5] of Acromion](profile/Martin-Breitenseher/publication/8061212/figure/tbl1/AS:601580193718345@1520439303991/Distribution-of-Bigliani-Types-5-of-Acromion.png)
Distribution (%) of Bigliani Types [5] of Acromion
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![TABLE 1 Distribution (%) of Bigliani Types [5] of Acromion](profile/Martin-Breitenseher/publication/8061212/figure/tbl1/AS:601580193718345@1520439303991/Distribution-of-Bigliani-Types-5-of-Acromion_Q320.jpg)
Our aim was to determine the value of different MRI planes independently and in combination for assessment of acromial shape.
Sixty-one patients with subacromial impingement syndrome who had undergone acromioplasty after failure to respond to conservative treatment were included in the study. Parasagittal T2-weighted MR images and outlet view radio...
Context in source publication
Context 1
... the 56 acromions that showed agreement between the 3D model and the intraoperative findings, 10.7% (n = 6) were classified as type 1; 82.1% (n = 46), as type 2; and 7.1% (n = 4) as type 3. Distributions of acromial shape as- sessed at different slice positions and in outlet view radiographs are listed in Table 1. From the lateral edge of the acromion to the acromi- oclavicular joint, an increase in hooked acro- mions (7.1% in S-1, 16.1% in S-2, and 37.5% in S-3) and a decrease in flat acromions (30.4% in S-1, 21.4% in S-2, and 19.6% in S-3) were noted on MR images. ...
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Background:
Patients who have shoulder pain usually have compensatory or contributory deviation of shoulder motion during arm elevation. In the traditional scapulohumeral rhythm, the share of the acromioclavicular (AC) and the sternoclavicular (SC) joint movements and also the role of AC internal rotation angle are unknown.
Objectives:
The main...
Citations
... There have been several reports assessing special views for the evaluation of potential impingement from the anterior acromion. Outlet views can be used to determine acromial shape and have been shown to be more accurate than a single-slice MRI [43]. The Rockwood and cassette tilt views are angled frontal projections that can be used to detect anterior acromial osteophytes [44]. ...
Chronic shoulder pain is an extremely common presenting complaint. Potential pain generators include the rotator cuff tendons, biceps tendon, labrum, glenohumeral articular cartilage, acromioclavicular joint, bones, suprascapular and axillary nerves, and the joint capsule/synovium. Radiographs are typically the initial imaging study obtained in patients with chronic shoulder pain. Further imaging may often be required, with modality chosen based on patient symptoms and physical examination findings, which may lead the clinician to suspect a specific pain generator. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
... Moreover, lack of standardisation of radiographs and differences due to minor changes of patient and central beam positioning were also suggested as possible factors for poor reliability 12 . Therefore, magnetic resonance imaging (MRI) was proposed as an alternative imaging modality in order to avoid these projection errors related to conventinal radiography 12,13 . Even though the appearance of acromion morphology is highly dependent on the plane of the image, we believe that MRI based evaluation of acromial shape is more reliable with standard selection of slice position and strict assessment protocol. ...
... Parasagittal MR images of T2-weighted fat-suppressed sequences, perpendicular to the supraspinatus tendon as determined with an axial localising image were used (Fig. 2). The slice position that was located just lateral to acromioclavicular joint was chosen from obtained MR images which was reported to be the most adequate slice position for acromial morphology assessment 12,14 . ...
... These results were attributed to the fact that selection of slice position would affect acromial shape seen on MRI. Mayerhoefer et al assessed reliability of MRI to determine acromial morphology with different slice positions 12 . Results of this study showed that highest reliability was obtained with MRI slice positioned just lateral to the acromioclavicular joint when a single MRI slice was used. ...
... An algorithm has been developed to confidently rule out RCTs based on conventional shoulder X-rays in patients clinically suspected of having a RCT [18]. The deep learning algorithm was trained with only three views (true anteroposterior, caudal 30 • tilt, and supraspinatus outlet) which are known to play a helpful role in predicting RCT [19][20][21][22]. The ML model showed a sensitivity of 97.3%, a negative likelihood of 0.06 and a NPV of 96.6%, higher in patients with age < 60 years [18]. ...
Technological innovation is a key component of orthopedic surgery. Artificial intelligence (AI), which describes the ability of computers to process massive data and “learn” from it to produce outputs that mirror human cognition and problem solving, may become an important tool for orthopedic surgeons in the future. AI may be able to improve decision making, both clinically and surgically, via integrating additional data-driven problem solving into practice. The aim of this article will be to review the current applications of AI in the management of rotator cuff tears. The article will discuss various stages of the clinical course: predictive models and prognosis, diagnosis, intraoperative applications, and postoperative care and rehabilitation. Throughout the article, which is a review in terms of study design, we will introduce the concept of AI in rotator cuff tears and provide examples of how these tools can impact clinical practice and patient care. Though many advancements in AI have been made regarding evaluating rotator cuff tears—particularly in the realm of diagnostic imaging—further advancements are required before they become a regular facet of daily clinical practice.
... Moreover, lack of standardisation of radiographs and differences due to minor changes of patient and central beam positioning were also suggested as possible factors for poor reliability 12 . Therefore, magnetic resonance imaging (MRI) was proposed as an alternative imaging modality in order to avoid these projection errors related to conventinal radiography 12,13 . Even though the appearance of acromion morphology is highly dependent on the plane of the image, we believe that MRI based evaluation of acromial shape is more reliable with standard selection of slice position and strict assessment protocol. ...
... Parasagittal MR images of T2-weighted fat-suppressed sequences, perpendicular to the supraspinatus tendon as determined with an axial localising image were used (Fig. 2). The slice position that was located just lateral to acromioclavicular joint was chosen from obtained MR images which was reported to be the most adequate slice position for acromial morphology assessment 12,14 . ...
... These results were attributed to the fact that selection of slice position would affect acromial shape seen on MRI. Mayerhoefer et al assessed reliability of MRI to determine acromial morphology with different slice positions 12 . Results of this study showed that highest reliability was obtained with MRI slice positioned just lateral to the acromioclavicular joint when a single MRI slice was used. ...
INTRODUCTION: Bigliani classification is used for determination of acromial morphology, but poor inter- observer reliability has been reported on conventional radiographs. This study aims to assess inter- and intra- observer reliability using magnetic resonance imaging (MRI).
MATERIALS AND METHODS: Forty consecutive patients diagnosed with subacromial impingement syndrome were included to study. All subjects underwent standard shoulder MRI scan and acromial shape was evaluated by nine observers of different level of expertise (three attending surgeons, three senior orthopaedic residents and three radiologists). A second set of evaluation was performed in order to assess intra-observer reproducibility. Kappa (κ) coefficient analyses both for interobserver reliability and intra-observer reproducibility were then performed.
RESULTS: Overall inter-observer agreement among nine observers was fair (κ=0.323). κ values for all 4 individual types ranged from 0.234 to 0.720 with highest agreement for type 4 and lowest agreement for type 3. Second evaluation did not result with an increase of inter-observer agreement (κ=0.338, fair). The κ coefficients for intra-observer reproducibility of nine observers ranged from 0.496 to 0.867. Overall intra-observer reproducibility was substantial. Comparison of inter- and intra-observer reliability among three groups showed no significant difference (p=0.92 and 0.22, respectively).
CONCLUSION: Results showed that MRI did not show superior reliability compared to conventional radiographs. Moreover, inter- and intra-observer agreement did not differ between observers of different level of expertise. Findings of present study suggest that despite a sophisticated imaging modality like MRI, Bigliani’s classification apparently lacks accuracy and additional criteria, or different assessment methods are required to assess acromial morphology for clinical guidance.
... Other studies have shown that elderly patients undergoing hook plate surgery have a higher risk of SIS, which may be related to shoulder tissue degeneration [7,17]. Macdonald [18] believed that SIS after clavicular hook plate surgery was related to the acromial type, and curved and hooked acromions were more likely to cause SIS than flat acromions. Additionally, the hook portion of the hook plate was fixed under the acromion without screws, and there was fretting in the horizontal direction, which could rub the soft tissue under the acromion to aggravate inflammatory response of the tissue and cause pain, resulting in SIS [19]. ...
Background
Distal clavicular fracture is a shoulder joint injury that is common in clinical settings and is generally surgically treated using the clavicular hook plate technique with a confirmed curative effect. However, symptoms, such as shoulder abduction limitation, shoulder discomfort, and postoperative joint pain, may occur in some patients. To overcome these problems, after a previous study we developed an acromial height-measuring device and a new type of clavicular hook plate. This study aimed to investigate whether an acromial height-measuring device combined with an improved new-type clavicular hook plate can better reduce the incidence of complications and improve postoperative function. To provide patients with better treatment effects, an acromion gauge and clavicular hook plate are used.
Methods
A retrospective analysis was performed on 81 patients with distal clavicular fractures admitted to our hospital. They were divided into experimental and control groups according to different plates, and the Constant–Murley score, visual analogue scale score, incidence of acromion osteolysis, and incidence of subacromial impingement syndrome were compared.
Results
Compared with the standard clavicular hook plate, the acromial height-measuring device combined with the new-type clavicular hook plate in the treatment of distal clavicle fractures has a lower incidence of subacromial impingement syndrome with better postoperative functional recovery and quality of life.
Conclusions
We considered the acromial height-measuring device combined with the new clavicular hook plate to be a safe and promising alternative to distal clavicular fractures.
... The type of acromion was evaluated according to Bigliani [16]. The analysis of acromion type was performed according to the classic criteria described in previous studies [15,16]. Cohen's kappa was used to calculate the degree of agreement in the type of acromion between two observers, and the final decision was made by consensus. ...
... According to previous studies, radiography had a fair agreement in ACJ evaluation and was superior to any single MRI image. However, a combination of two MRI images showed better agreement than radiography [15]. ...
Purpose
Visualization of a structure in orthogonal planes is essential for correct radiological assessment. The aim was to assess the utility of the standard MRI protocol for the shoulder in the assessment of the acromioclavicular joint (ACJ).
Methods
A total of 204 MRI scans of the shoulder were re-reviewed. Visibility of the ACJ in orthogonal planes was assessed, and the type of acromion and the angle between the ACJ and the glenoid cavity were assessed by two observers.
Results
Agreement in the assessment of ACJ visibility was moderate to substantial. The ACJ was visible in the three anatomical views in 48% (confidence interval [CI] 95% = [41–54%]) of the examinations, and no significant difference regarding gender or age was noticed. The mean angle between the ACJ and the glenoid cavity was 41.12 deg. CI95% = (39.72, 42.53) in the axial plane, 33.39 deg. CI95% = (31.33, 35.45) in the coronal plane and 52.49 deg. CI95% = (50.10, 54.86) in the sagittal plane. When the ACJ was visible in the sagittal and axial planes, significant differences were noticed in the remaining planes (p < .05).
Conclusion
Anatomical variations of the ACJ influence its visibility in the standard MRI protocol for examining the shoulder, making this protocol insufficient for ACJ assessment in the examined population.
... If this angle was more than 20, then the angle between the posterior third and the anterior two thirds was furtherly measured. If this latter angle was 10 or less, type III acromion was defined and if more than 10 this would be type IV acromial shape ( Fig. 2) (4) . Acromial thickness was also measured at the widest portion of the acromion on the perpendicular plane to the long axis of the acromion on the sagittal oblique plane just lateral to the acromioclavicular joint (5) . ...
... Some scholars believed that the difference in shoulder anatomy was one of the important etiological factors of subacromial impingement syndrome. [10] Elmaraghy et al [11] analyzed the influence of the hook end under the acromion in the subacromial space by a cadaver simulated surgery. They believed that the presence of the hook end increased the risk of SIS. ...
... According to relevant literature reports [9][10][11]16] and the clinical experience of the research team, we included 16 potential, influential factors in our study: age, gender, body-mass index (BMI), smoking status, alcohol consumption, type of injury, Rockwood Classification, site of injury, operation time, the time of injury-to-surgery, DBA, DHT, DHH, AHP, acromial shape, and DAH (Table 1). The operation time of the two groups was 45.671 ± 8.882 min and 43.126 ± 9.546 min, and this was significantly different (P = .027). ...
... The most consistent opinion was that its occurrence was often associated with the shape of the acromion and matching of the clavicle hook plate. [9,10,11] Elmaraghy et al [11] placed the clavicular hook plate on fresh cadaveric specimens to study the position of the hook end of the plate under the acromion. They found that the radian of the hook was located above the head of the humerus. ...
Subacromial impingement syndrome (SIS) after hook plate fixation for acromioclavicular joint (AC) dislocation was the most common complication. However, the researches on its’ influential factors were rare. The purpose of this study was to identify the risk factors by analyzing the influencing factors of postoperative SIS and minimize the incidence of SIS in clinical surgery.
We retrospectively analyzed the prospectively collected data from 330 consecutive patients with AC joint dislocation between August 2014 and August 2017 at our institute. The SIS was presented as the dependent variable at the last follow-up when the internal fixation was removed. The independent variables included age, gender, body-mass index (BMI), smoking status, alcohol consumption, type of injury, Rockwood Classification, site of injury, operation time, injury-to-surgery, the distance between the hook body and the acromion (DBA), the depth of hook tip (DHT), the distance between the hook plate and the humeral head (DHH), the distance between the acromion and the humeral head (DAH), the hook plate angle (AHP) and acromial shape. Logistic regression analysis was performed to identify independent influential factors of SIS.
A total of 312 cases were included and 18 cases were lost. The follow-up rate was 94.5%. In without SIS group, there were 225 cases (123 males and 102 females). In with SIS group, a total of 87 cases were included (56 males and 31 females). The incidence of SIS was 27.8%. DHT (OR = 9.385, 95% CI = 4.883 to 18.040, P < .001) and DBA (OR = 2.444, 95% CI = 1.591 to 3.755, P < .001) were the significant independent risk factor for SIS of AC dislocation treat with hook plate. DAH (OR = 0.597, 95% CI = 0.396 to 0.900, P = .014) and acromial shape with flat and straight (OR = 0.325, 95% CI = 0.135 to 0.785, P = .012) were also independent factors of SIS, but they were all protective.
The SIS had a high incidence in fixation of clavicular hook plate for AC dislocation. DHT and DBA were two independent risk factors, DAH and acromial shape with flat and straight were two independent protective factors for SIS. In clinical surgery, we should avoid risk factors to reduce the incidence of SIS.
... Therefore, researchers have continued to explore the causes of SIS after clavicular hook plate surgery. Macdonald et al. [10] thought that the occurrence of SIS after the clavicular hook plate surgery was related to the acromion shape and curved and hooked acromion were more likely to cause SIS than straight acromion. Several studies [2,9,11] have shown that older patients who underwent hook plate surgery have increased risk of SIS, which may be related to shoulder tissue degeneration. ...
Background
Acromioclavicular joint dislocation is a shoulder joint injury common in the clinical setting and is generally surgically treated with clavicular hook plate technique with confirmed curative effect. However, symptoms such as shoulder abduction limitation, shoulder discomfort and joint pain postoperatively may occur in some patients. Therefore, this study aimed to explore whether the existing clavicular hook plate can be reasonably selected to reduce the incidence of subacromial impingement syndrome (SIS) and provide a reference for clinical diagnosis and treatment.
Materials and methods
Patients with SIS admitted from March 2018 to June 2020 were selected as the experimental group and asymptomatic patients postoperatively, as the control group. The hook end depth and acromial height of the hook plate used in patients were recorded, and the difference between them was calculated.
Results
The difference between the hook plate depth and acromial height was 7.500±1.912 mm and 6.563±1.537 mm in the experimental and control groups, respectively, with statistically significant difference ( t =3.021, P =0.006). A difference of >0.6 mm as a grouping index is required to perform a single factor analysis, with statistically significant difference ( t =3.908, P =0.048).
Conclusions
The occurrence of SIS after placing the clavicular hook plate may be related to the difference between its depth and the acromial height. A difference of >6 mm may be a factor affecting the occurrence of SIS. Pre-imaging measurement of the acromial height can provide suggestions for selecting the type of hook plate intraoperatively.
... People have never stopped exploring the causes of SIS after clavicular hook plate operation. Macdonald et al. [10] thought that the appearance of SIS after clavicular hook plate was related to the shape of acromion, and curved and hooked acromion were more likely to cause SIS than straight acromion. A number of studies [11][12][13] have shown that older patients after hook plate surgery may increase the risk of SIS, which may be related to shoulder tissue degeneration.Macdonald et al. [14] found that the placement of clavicular hook plate would inevitably narrow the subacromial clearance, which may be related to the appearance of SIS. ...
Purpose:To explore whether the existing clavicular hook plate can be reasonably selected to reduce the incidence of Subacromial impingement syndrome （SIS） and provide reference for clinical diagnosis and treatment.
Methods and methods The patients with SIS admitted from March 2019 to March 2020 were selected as the experimental group, and the asymptomatic patients after operation as the control group. The hook end depth and acromion height of the hook plate used by the patients were recorded, and the difference between them was calculated.
Results The difference between the depth of hook plate and the height of acromion in the experimental group was (8.06±1.15mm). In the control group, the difference between the depth of hook plate and the height of acromion was (6.78±1.82mm), and the difference was statistically significant（t=2.721，P=0.009）. The difference is greater than 0.6 mm as a grouping index to do a single factor analysis）.The difference was statistically significant（t=5.711 P=0.017）.
Conclusions The occurrence of SIS after clavicular hook plate may be related to the difference between the depth of hook plate and the height of acromion. When the difference is greater than 6mm, it may be a factor affecting the occurrence of SIS. Pre-imaging measurement of acromion height can provide suggestions for selecting the type of hook plate during operation.
