Figure - available from: Archives of Orthopaedic and Trauma Surgery
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Source publication
Purpose
This systematic review and meta-analysis aimed to evaluate the correlation between increased critical shoulder angle (CSA) and higher retear rates and functional outcomes after arthroscopic rotator cuff repair (ARCR).
Methods
PubMed, Embase, Web of Science, and Cochrane Library databases published before January 2022 were comprehensively s...
Citations
... In addition, there was no progression in CSA over time nor was there an association between CSA and progression of RCTs. These results, in addition to other recent works [33][34][35][36][37] , call into question whether CSA truly has a clinically relevant association with RCTs 32 . Nonetheless, this radiographic measure may still have clinical implications in the setting of surgical planning and counseling as the literature supports increased retear risk after RCR in patients with an increased CSA [33][34][35][36][37] . ...
... These results, in addition to other recent works [33][34][35][36][37] , call into question whether CSA truly has a clinically relevant association with RCTs 32 . Nonetheless, this radiographic measure may still have clinical implications in the setting of surgical planning and counseling as the literature supports increased retear risk after RCR in patients with an increased CSA [33][34][35][36][37] . ...
» The acromion is a well-studied region of the scapula that has demonstrated substantial relationships to various shoulder pathologies.
» Abnormal acromial morphology is associated with rotator cuff pathology, and our understanding of this risk factor inspired acromioplasty as an adjunctive treatment for rotator cuff tears.
» The acromion is linked closely to shoulder kinematics and biomechanics, as it serves as the origin for the deltoid muscle.
» In degenerative shoulder disease, eccentric glenohumeral osteoarthritis has been associated with a higher, flatter acromial roof.
» Increasing literature is emerging connecting morphology of the acromion with shoulder instability.
... Aside from that, a higher rate of retear may be seen in a high-risk group prone to retear, regardless of the repair modality. 9,25,26,45 A further consideration is that surgical repair of large full-size tears is often performed at a late stage, where undesirable quality and remarkable retraction of the tendon may not allow the surgeon to perform the repair using a DR repair technique. As a result, the only viable option in this case is SR repair, partially covering the impression, which was shown to lead to a noticeably higher tear rate in the current review. ...
Background
There is no clinical gold standard for the indications for single-row (SR) versus double-row (DR) repair according to small, large, or massive rotator cuff tear size.
Purpose
To conduct a meta-analysis to compare the clinical outcomes and retear rates after arthroscopic SR and DR repair for rotator cuff injuries with different tear sizes.
Study Design
Systematic review; Level of evidence, 3.
Methods
On the basis of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria, the PubMed, Embase, Cochrane Library databases, Web of Science, China National Knowledge Infrastructure, and China BioMedical Literature database were searched for relevant studies published before November 1, 2021, using the following search terms: “Rotator Cuff Injuries,” “Rotator Cuff Tears,” “Arthroscopy,” “Arthroscopic Surgery,” “single-row,” and “double-row”; a total of 489 articles were retrieved. Quality evaluation was conducted for all the studies that met the inclusion criteria. This study evaluated the Constant-Murley score, American Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) score, and range of motion (ROM) as well as retear rate. A fixed-effects or random-effects model was adopted to calculate the results and assess risk.
Results
A total of 10 clinical studies were included, with 404 cases of DR and 387 cases of SR. Regarding overall results, DR had better forward elevation ROM (mean difference [MD] = -4.03° [95% CI, -6.00° to -2.06°]; P < .0001; I ² = 46%) and a lower retear rate (MD = 2.39 [95% CI, 1.40 to 4.08]; P = .001; I ² = 0%) compared with SR repair. With regard to small tears (<3 cm), there was no noticeable difference on any of the 3 outcome scores between SR and DR. For large rotator cuff tears (≥3 cm), DR repair showed significantly better ASES scores (MD = -3.09 [95% CI, -6.19 to 0.02]; P = .05; I ² = 73%) and UCLA scores (MD = -1.47 [95% CI, -2.21 to -0.72]; P = .0001; I ² = 31%) compared with SR repair.
Conclusion
Our meta-analysis revealed that DR had better UCLA scores, ASES scores, and ROM in forward elevation and lower retear rates. In rotator cuff tears <3 cm, there were no statistical differences in clinical outcome between SR and DR.
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.
Objective:
To investigate the synergistic interaction between the deltoid muscle and the rotator cuff muscle group in patients with rotator cuff tears (RCT), as well as the impact of the critical shoulder angle (CSA) on deltoid muscle strength.
Methods:
A retrospective analysis was conducted on clinical data from 42 RCT patients who met the selection criteria and were treated between March 2022 and March 2023. There were 13 males and 29 females, with an age range of 42-77 years (mean, 60.5 years). Preoperative visual analogue scale (VAS) score was 6.0±1.6. CSA measurements were obtained from standard anteroposterior X-ray films before operation, and patients were divided into two groups based on CSA measurements: CSA>35° group (group A) and CSA≤35° group (group B). Handheld dynamometry was used to measure the muscle strength of various muscle group in the shoulder (including the supraspinatus, infraspinatus, subscapularis, and anterior, middle, and posterior bundles of the deltoid). The muscle strength of the unaffected side was compared to the affected side, and muscle imbalance indices were calculated. Muscle imbalance indices between male and female patients, dominant and non-dominant sides, and groups A and B were compared. Pearson correlation analysis was used to examine the relationship between muscle imbalance indices and CSA as well as VAS scores.
Results:
Muscle strength in all muscle groups on the affected side was significantly lower than on the unaffected side ( P<0.05). The muscle imbalance indices for the supraspinatus, subscapularis, infraspinatus, and anterior, middle, and posterior bundles of the deltoid were 14.8%±24.4%, 5.9%±9.7%, 7.2% (0, 9.1%), 17.2% (5.9%, 26.9%), 8.3%±21.3%, and 10.2% (2.8%, 15.4%), respectively. The muscle imbalance indices of the anterior bundle of the deltoid, supraspinatus, and infraspinatus were significantly lower in male patients compared to female patients ( P<0.05); however, there was no significant difference in muscle imbalance indices among other muscle groups between male and female patients or between the dominant and non-dominant sides ( P>0.05). There was a positive correlation between the muscle imbalance indices of infraspinatus and VAS score ( P<0.05), and a positive correlation between CSA and the muscle imbalance indices of middle bundle of deltoid ( P<0.05). There was no correlation between the muscle imbalance indices of other muscle groups and VAS score or CSA ( P>0.05). Preoperative CSA ranged from 17.6° to 39.4°, with a mean of 31.1°. There were 9 cases in group A and 33 cases in group B. The muscle imbalance indices of the anterior bundle of the deltoid was significantly lower in group A compared to group B ( P<0.05), while there was no significant difference in muscle imbalance indices among other muscle groups between group A and group B ( P>0.05).
Conclusion:
Patients with RCT have a phenomenon of deltoid muscle strength reduction, which is more pronounced in the population with a larger CSA.
Nonoperative and operative strategies exist to manage rotator cuff pathology. Although surgical repair is successful for most patients, others may experience retear or nonhealing of the rotator cuff. Several modifiable and nonmodifiable risk factors are associated with an increased retear rate. The literature shows consistency and agreement regarding many of these risk factors, most notably, patient age, tear size, and rotator cuff muscular atrophy, whereas others remain controversial. It is important that shoulder surgeons are familiar with modifiable and nonmodifiable risk factors associated with retear, to better advise patients and optimize their chances of success following rotator cuff repair surgery.
