Safiye Sanem Dereli Bulut, İsmail Türkmen, Deniz Kara, Haluk Çelik, Kerem Bilsel, Güray Altun

The effect of sagittal orientation of the acromion relative to the scapular spine on the location of rotator cuff tears

Objective: The aim of this study was to investigate the effect of the angle between the scapular spine and acromion in the sagittal plane on the location of chronic rotator cuff tears (RCTs). Methods: The magnetic resonance images of patients who had undergone an arthroscopic shoulder surgery were evaluated. The patients were divided into two groups: patients who had undergone RCT repair and those who had experienced different shoulder surgery as a control group. The RCT group (study group) was then subgrouped in terms of the location of the tear as posterior-superior RCT type 3, 4, 5 or combination (group A) and anterior-superior RCT type 1,2,3 or combination using the Patte sagittal classification (group B). A novel angle, scapular spine-acromion angle (SSAA), was described in the sagittal plane and compared between the groups and subgroups. Results: A total of 96 patients underwent an arthroscopic RCT repair with a mean age of 59.5 years (range, 36-65 years), and the control group was composed of 40 patients with a mean age of 52.5 (range, 41-63 years). Comparison the group B (mean value: 73.41°±5.98°, median: 73,8°, range: 60.6°-89.7°) has significantly higher degrees of SSAA than group A (mean value: 63.92°±6.82°, median: 64,8°, range: 52.3°-77.9°) (P < 0.001). Conclusion: This study demonstrated a higher incidence of posterior- superior RCTs in patients with lower SSAA and anterior-superior RCTs in patients with higher SSAA in the sagittal plane compared to the control group. So sagittal acromial orientation might influence the RCT location.

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1. Martetschläger F, Rios D, Boykin RE, Giphart JE, de Waha A, Millett PJ. Cora- coid impingement: current concepts. Knee Surg Sports Traumatol Arthrosc. 2012;20(11):2148-2155. [CrossRef]
2. Moor BK, Bouaicha S, Rothenfluh DA, Sukthankar A, Gerber C. Is there anas- sociation between the individual anatomy of the scapula and the development ofrotator cuff tears or osteoarthritis of the glenohumeral joint?: a radiological study of thecritical shoulder angle. Bone Joint J. 2013;95-B(7):935-941. [CrossRef]
3. Nyffeler RW, Werner CM, Sukthankar A, Schmid MR, Gerber C. Association of alarge lateral extension of the acromion with rotator cuff tears. J Bone Joint Surg Am. 2006;88(4):800-805. [CrossRef]
4. Walch G, Liotard JP, Boileau P, Noël E. Postero-superior glenoid impingement. another impingement of the shoulder. J Radiol. 1993;74(1):47-50.
5. Yamamoto A, Takagishi K, Osawa T, et al. Prevalence and risk factors of a rota- tor cuff tear in the general population. J Shoulder Elbow Surg. 2010;19(1):116- 120. [CrossRef]
6. Acar B, Köse Ö, Aytaç G, et al. Diabetes mellitus accelerates fatty degeneration of the supraspinatus muscle after tendon tear: an experimental study in rats. Eklem Hastalik Cerrahisi. 2018;29(3):176-183. [CrossRef]
7. Ranger TA, Wong AM, Cook JL, Gaida JE. Is there an association betweenten- dinopathy and diabetes mellitus? A systematic review with meta-analysis. Br J Sports Med. 2016;50(16):982-989. [CrossRef]
8. Codman EA. Complete rupture of the supraspinatus tendon. Operative treat- ment with report of two successful cases. Boston Med Surg J. 1911;164(20):708- 710. [CrossRef]
9. Bigliani LU, Morrison DS, April EW. The morphology of the acromion and itsrelationship to rotator cuff tears. Orthopade Trans. 1986;10:228.
10. Balke M, Schmidt C, Dedy N, Banerjee M, Bouillon B, Liem D. Correlation ofacromial morphology with impingement syndrome and rotator cuff tears. Acta Orthop. 2013;84(2):178-183. [CrossRef]
11. Aoki M, Ishii S, Usui M. The slope of the acromion and rotator cuff impingement.Orthopade Trans. 1986;10:228.
12. Banas MP, Miller RJ, Totterman S. Relationship between the lateral acromion angleand rotator cuff disease. J Shoulder Elbow Surg. 1995;4(6):454-461. [CrossRef]
13. Chalmers PN, Beck L, Miller M, et al. Acromial morphology is not associated with rotator cuff tearing or repair healing. J Shoulder Elbow Surg. 2020;29:2229-2239.
14. Patte D. Classification of rotator cuff lesions. Clin Orthop Relat Res. 1990;254(254):81-86. [CrossRef]
15. Tétreault P, Krueger A, Zurakowski D, Gerber C. Glenoid version and rotator cufftears. J Orthop Res. 2004;22(1):202-207. [CrossRef]
16. Torrens C, López JM, Puente I, Cáceres E. The influence of the acromialcover- age index in rotator cuff tears. J Shoulder Elbow Surg. 2007;16(3):347-351. [CrossRef]
17. Werthel JD, Bertelli J, Elhassan BT. Shoulder function in patients with deltoid- paralysis and intact rotator cuff. Orthop Traumatol Surg Res. 2017;103(6):869- 873. [CrossRef]
18. Dyrna F, Kumar NS, Obopilwe E, et al. Relationship Between deltoid and rota- tor cuff muscles during dynamic shoulder abduction: a biomechanical study of rotator cuff tear progression. Am J Sports Med. 2018;46(8):1919-1926. [CrossRef]
19. Poppen NK, Walker PS. Forces at the glenohumeral joint in abduction. Clin Orthop Relat Res. 1978;135(135):165-170. [CrossRef]
20. Fathi M, Cheah PS, Ahmad U, et al. Anatomic variation in morphometry of human coracoid process among Asian population. BioMed Res Int. 2017;2017:1- 10. [CrossRef]