-
Archives of Orthopaedic and Trauma... Apr 2020Although degenerative osteoarthritis of the acromioclavicular joint is a common finding on technical investigations, not every patient experiences pain or function loss.... (Review)
Review
INTRODUCTION
Although degenerative osteoarthritis of the acromioclavicular joint is a common finding on technical investigations, not every patient experiences pain or function loss. The difference between symptomatic and asymptomatic patients is currently not elucidated. Therefore, we want to investigate the acromioclavicular relationship in normal, asymptomatic, and symptomatic degenerated ACJ.
MATERIALS AND METHODS
84 normal ACJ, 39 asymptomatic degenerated ACJ, and 30 symptomatic degenerated ACJ were 3D reconstructed. The morphological dimensions and the relationship of the acromion and distal clavicle were measured using computational software. The reproducibility of this technique was evaluated using inter- and intra-observer reliability.
RESULTS
The mean anteroposterior and superoinferior distance of both the clavicle and acromion was significantly larger in asymptomatic and symptomatic degenerative ACJ compared to the normal ACJ (p < 0.001). In symptomatic osteoarthritic ACJ, both the anterior and posterior borders of the acromion were significantly more anterior to the borders of the clavicle than in the normal group and asymptomatic group (p < 0.001). Subsequent ROC curve analysis resulted in a sensitivity of 86.7% and a specificity of 88.6% for anterior subluxation of the ACJ. This technique showed an excellent inter- and intra-observer reliability.
CONCLUSIONS
In patients with degenerative ACJ, both the distal clavicle and acromion are enlarged. In asymptomatic patients, the AC relationship is the same as in normal patients, in contrast, in patients with symptomatic degenerative ACJ, the acromion is subluxated anteriorly compared to the clavicle.
Topics: Acromioclavicular Joint; Acromion; Clavicle; Humans; Imaging, Three-Dimensional; Joint Diseases; ROC Curve
PubMed: 31428850
DOI: 10.1007/s00402-019-03258-9 -
The American Journal of Sports Medicine Feb 2024Knowledge of acromioclavicular (AC) joint kinematics and distance may provide insight into the biomechanical function and development of new treatment methods. However,...
BACKGROUND
Knowledge of acromioclavicular (AC) joint kinematics and distance may provide insight into the biomechanical function and development of new treatment methods. However, accurate data on in vivo AC kinematics and distance between the clavicle and acromion remain unknown.
PURPOSE/HYPOTHESIS
The purpose of this study was to investigate 3-dimensional AC kinematics and distance during arm elevation in abduction, scaption, and forward flexion in a healthy population. It was hypothesized that AC kinematics and distance would vary with the elevation angle and plane of the arm.
STUDY DESIGN
Controlled laboratory study.
METHODS
A total of 19 shoulders of healthy participants were enrolled. AC kinematics and distance were investigated with a combined dual fluoroscopic imaging system and computed tomography. Rotation and translation of the AC joint were calculated. The AC distance was measured as the minimum distance between the medial border of the acromion and the articular surface of the distal clavicle (ASDC). The minimum distance point (MDP) ratio was defined as the length between the MDP and the posterior edge of the ASDC divided by the anterior-posterior length of the ASDC. AC kinematics and distance between different elevation planes and angles were compared.
RESULTS
Progressive internal rotation, upward rotation, and posterior tilt of the AC joint were observed in all elevation planes. The scapula rotated more upward relative to the clavicle in abduction than in scaption ( = .002) and flexion ( = .005). The arm elevation angle significantly affected translation of the AC joint. The acromion translated more laterally and more posteriorly in scaption than in abduction ( < .001). The AC distance decreased from the initial position to 75° in all planes and was significantly greater in flexion ( < .001). The MDP ratio significantly increased with the elevation angle ( < .001).
CONCLUSION
Progressive rotation and significant translation of the AC joint were observed in different elevation planes. The AC distance decreased with the elevation angle from the initial position to 75°. The minimum distance between the ASDC and the medial border of the acromion moved anteriorly as the shoulder elevation angle increased.
CLINICAL RELEVANCE
These results could serve as benchmark data for future studies aiming to improve the surgical treatment of AC joint abnormalities to restore optimal function.
Topics: Humans; Biomechanical Phenomena; Imaging, Three-Dimensional; Humerus; Scapula; Acromion; Acromioclavicular Joint; Range of Motion, Articular; Shoulder Joint
PubMed: 38197156
DOI: 10.1177/03635465231216116 -
Arthroscopy : the Journal of... Mar 2023Massive irreparable rotator cuff tears (MIRCTs) represent 10% to 40% of cases of rotator cuff abnormality and are challenging to treat. When MIRCTs are unresponsive to... (Randomized Controlled Trial)
Randomized Controlled Trial
Massive irreparable rotator cuff tears (MIRCTs) represent 10% to 40% of cases of rotator cuff abnormality and are challenging to treat. When MIRCTs are unresponsive to nonoperative treatment, surgery may be considered. An arthroscopically inserted biodegradable subacromial balloon spacer (InSpace; Stryker) has grown in popularity in recent years for treatment of patients with MIRCTs. The balloon spacer is made of a copolymer of poly-L-lactide-eco-ε-caprolactone and is expected to fully resorb within 12 months after implantation. Research has suggested the balloon spacer becomes progressively compressed and is slowly replaced with fibrous tissue between the humeral head and the acromion, which may support a prolonged benefit following resorption. Clinical benefits may be achieved through reduced acromiohumeral abutment and subacromial friction during shoulder movement by lowering the humeral head and facilitating humeral gliding. The primary population indicated for use of the implant are patients older than 40 years with persistent shoulder pain and functional disability due to MIRCTs. Contraindications include irreparable subscapularis tears, moderate to severe arthritis, axillary nerve palsy, and known allergy to the implant material. There are not clear indications for use of the implant for treatment of partial-thickness tears or repairable complete rotator cuff tears. Familiari et al. reported that treatment with the balloon spacer was associated with a significant improvement in shoulder function, limited need for revision surgery, and high satisfaction at mean 3-year follow-up. More recently, a prospective multicenter randomized controlled trial was conducted to evaluate the efficacy and safety of the balloon spacer in 93 patients compared to 91 patients undergoing arthroscopic partial repair. Significant and clinically relevant improvements in the American Shoulder and Elbow Surgeons score from baseline were noted in both groups up to the 2-year follow-up.
Topics: Humans; Rotator Cuff Injuries; Prospective Studies; Rotator Cuff; Shoulder; Shoulder Joint; Treatment Outcome; Arthroscopy
PubMed: 36740282
DOI: 10.1016/j.arthro.2022.11.011 -
BMC Musculoskeletal Disorders Jan 2023To evaluate the shoulder anatomical characteristics in asymptomatic Chinese adults.
BACKGROUND
To evaluate the shoulder anatomical characteristics in asymptomatic Chinese adults.
METHODS
The prospective study enrolled individuals without shoulder pain at Beijing Tiantan Hospital Affiliated to Capital Medical University between January 2019 and January 2020. Six radiographic parameters were measured and analyzed, including glenoid plane to the acromion (GA), glenoid plane to the lateral aspect of the humeral head (GH), acromion index (AI), lateral acromial angle (LAA), acromion-humeral interval (AHI), and critical shoulder angle (CSA).
RESULTS
103 participants (51 males and 52 females) were enrolled. The mean values of GA, GH, AI, CSA, LAA, and AHI were 32.88 ± 5.68 mm, 47.16 ± 4.82 mm, 0.70 ± 0.11, 37.45 ± 6.00°, 6.32 ± 3.99°, and 9.611.86 mm, respectively. Females had lower GA (30.78 ± 5.06 vs. 35.01 ± 5.51 mm, P < 0.001) and GH (44.28 ± 3.67 vs. 50.11 ± 4.02 mm, P < 0.001) than males and LAA was significantly smaller in the Bigliani flat type compared with the curved type and the hooked type (5.07 ± 2.31° vs 12.33 ± 5.46°vs 10.00 ± 3.37, P = 0.001).
CONCLUSIONS
Females had lower GA and GH than males in asymptomatic Chinese Han adults. Asymptomatic Chinese Han subjects with Bigliani flat type had lower LAA. CSA appears lager in Chinese Han individuals. Curve type of acromion performed lager LAA. The results may help establish an anatomical model of the shoulder joint and elucidate the anatomy features of the shoulder joint in asymptomatic Chinese Han adults.
Topics: Male; Female; Adult; Humans; Shoulder Joint; Rotator Cuff Injuries; Prospective Studies; East Asian People; Shoulder; Acromion
PubMed: 36709290
DOI: 10.1186/s12891-023-06172-9 -
The Journal of the American Academy of... Mar 2022With the increased use of reverse shoulder arthroplasty, the complication of postoperative scapular fracture is increasingly recognized. The incidence is variable and...
With the increased use of reverse shoulder arthroplasty, the complication of postoperative scapular fracture is increasingly recognized. The incidence is variable and dependent on a combination of factors including patient age, sex, bone mineral density, diagnosis of inflammatory arthritis, acromial thickness, and implant-related factors. Acromial stress reactions are a clinical diagnosis based on a history and physical examination. These are treated successfully with 4 to 6 weeks of immobilization. Acromial stress fractures are visible on imaging studies and are classified based on anatomic location by the classification systems of Crosby and Levy. In approximately 20% of fractures, a CT scan is necessary to make the diagnosis. Treatment is typically nonsurgical that leads to a high rate of nonunion or symptomatic malunion. Scapular spine fractures (type III) can be treated with either nonsurgical or surgical management; however, obtaining fracture union is challenging, and the outcomes are typically inferior to that of type I and II fractures. Although the nonsurgical and surgical treatment of acromial stress fractures improves the clinical outcomes from the patient's preoperative state, the outcomes of a control group undergoing reverse shoulder arthroplasty without fracture are better. The exception to this is oftentimes the displaced and angulated type III fracture.
Topics: Acromion; Arthroplasty, Replacement, Shoulder; Fractures, Bone; Humans; Retrospective Studies; Shoulder Fractures; Shoulder Joint; Treatment Outcome
PubMed: 35050935
DOI: 10.5435/JAAOS-D-20-01205 -
Journal of Shoulder and Elbow Surgery Jun 2023Acromion and scapular spine stress fractures can be catastrophic complications following reverse shoulder arthroplasty (RSA). A variety of host, implant, and technical...
INTRODUCTION
Acromion and scapular spine stress fractures can be catastrophic complications following reverse shoulder arthroplasty (RSA). A variety of host, implant, and technical factors have been identified that increase the risk of this complication. The glenoid component in particular has been closely evaluated for its impact on rates of stress fractures following RSA. The goal of this biomechanical study is to evaluate if humeral stem version has an impact on acromion and scapular spine strain after RSA.
METHODS
Eight cadaveric specimens were tested on a custom dynamic shoulder frame. Commercially available RSA components were implanted with the humeral component inserted in 0° of retroversion. Acromion and scapular spine strain were measured at 0°, 30°, and 60° of abduction using strain rosettes secured to the acromion and scapular spine in the typical locations for Levy type II and type III stress fractures, respectively. The humeral stem was then removed and reimplanted in 30° of retroversion and the measurements were repeated. Student t test was performed to analyze the relationship between humeral stem version and acromion and scapular spine strain at various abduction angles.
RESULTS
Strain at the both the acromion and scapular spine were found to have no significant difference at any abduction angle when comparing 0° and 30° version of the humeral stem. With 0° and 30° versions pooled together, there is significantly lower acromion and scapular spine strain at 60° of abduction when compared to 0° of abduction (strain at 0° abduction - strain at 60° abduction: acromion 313.1 μꜪ; P = .0409, Scapular spine 304.9 μꜪ; P = .0407). There was no significant difference in strain at either location when comparing 0° of abduction to 30° of abduction and when comparing 30° of abduction to 60° of abduction.
CONCLUSIONS
This biomechanical study found no significant difference in scapular spine and acromion strain after RSA when comparing variations in humeral stem version. There does appear to be lower strain at both the acromion and scapular spine at 60° of abduction when compared to 0° of abduction regardless of stem version.
Topics: Humans; Acromion; Arthroplasty, Replacement, Shoulder; Fractures, Stress; Shoulder Joint; Range of Motion, Articular; Humerus
PubMed: 36828287
DOI: 10.1016/j.jse.2023.02.012 -
Arthroscopy : the Journal of... Dec 2022The treatment of an irreparable rotator cuff tear is an enigma. There are so many treatment options, with different experts recommending different treatments. These...
The treatment of an irreparable rotator cuff tear is an enigma. There are so many treatment options, with different experts recommending different treatments. These include physical therapy, partial repairs, tendon transfers such as the latissimus dorsi and the lower trapezius, biceps tenotomy, tissue augmentation with allografts or autografts, balloon spacers, and finally a reverse prosthesis. It is an easy decision when the patient is physiologically old with many medical comorbidities and arthritis. It is much more difficult when the patient is younger with no arthritis. Many patients with a failed massive cuff repair do well with a supervised therapy program despite the absence of 2 tendons (the supraspinatus and infraspinatus). Nothing works well when the subscapularis and/or teres minor are irreparable. I will usually try a 3-month physical therapy program, and if this is not successful in improving pain and function, consider surgery. If I can do an adequate partial repair, where the residual defect is small enough that the humeral head does not button hole through the defect like a boutonniere deformity, that is my treatment of choice. I will only do grafts with Hamada stage 1 or 2, as stage 3 with a fixed humeral head against the acromion do not do well. I am intrigued by the balloon spacer and why the results are still adequate, even when there is no balloon present after about 1 year. I'm holding judgment on that until there are more published studies. A reverse prosthesis I use as a last resort.
Topics: Humans; Rotator Cuff Injuries; Rotator Cuff; Acromion; Humeral Head; Superficial Back Muscles; Arthritis
PubMed: 36462777
DOI: 10.1016/j.arthro.2022.07.013 -
Orthopaedics & Traumatology, Surgery &... Jun 2021Acromioplasty is controversial. Technically, it consists in bone resection, but there is no gold-standard technique and resection is often not quantified. The aims of... (Review)
Review
INTRODUCTION
Acromioplasty is controversial. Technically, it consists in bone resection, but there is no gold-standard technique and resection is often not quantified. The aims of the present study were 1/to assess the methodological quality of studies of acromioplasty; 2/to identify reports in which acromioplasty was quantified; and 3/to assess any correlation between clinical results and resection quantity.
MATERIAL AND METHODS
A systematic literature review was performed on PRISMA criteria in the PubMed, Springer and Ovid databases, including all articles in French or English referring to acromioplasty. Articles were analyzed by 2 surgeons and those with complete procedural description were selected. 1/Methodology was assessed on 3 grades according to aim of acromioplasty, intraoperative assessment of resection, and postoperative radiologic assessment. 2/Results were extracted from articles with robust methodology and quantitative data. 3/Correlations were assessed between clinical results and resection quantity.
RESULTS
Out of the 250 articles retrieved, 94 were selected. 1/44 of these (47%) specified the aim of the acromioplasty, 53 (56%) included an intraoperative clinical assessment criterion, and 13 (14%) included postoperative radiographic assessment. Methodologic quality was insufficient in 33 articles (35%), poor in 23 (24%) and robust in 38 (40%). 2/Seven articles (7.5%) included quantitative results. 3/Three articles assessed correlation between clinical results and resection quantity, but only 1 used reproducible radiographic assessment by critical shoulder angle (CSA); this study reported a significant positive correlation between clinical results and decreased CSA.
CONCLUSION
Methodology in studies of acromioplasty was largely insufficient and resection was usually not quantified. Current data to assess the usefulness of the procedure are sparse. We advocate including a Checklist for Acromioplasty Studies in the methodology of future studies. There is at present no gold-standard for assessing and quantifying acromial resection. CSA seems contributive, but other methods might be worth developing.
LEVEL OF EVIDENCE
IV; systematic review of level 1-4 studies.
Topics: Acromion; Arthroplasty; Arthroscopy; Humans; Rotator Cuff; Shoulder Joint
PubMed: 33771721
DOI: 10.1016/j.otsr.2021.102900 -
Arthroscopy Techniques Jun 2022Arthroscopic rotator cuff repair can be challenging and requires adequate visualization and space. However, the narrow subacromial space can make difficult to perform...
Arthroscopic rotator cuff repair can be challenging and requires adequate visualization and space. However, the narrow subacromial space can make difficult to perform tendon release and repair under arthroscopy. Inadequate visualization may lead to inaccurate suture placement, compromising the reduction and fixation of the repaired rotator cuff tendons. Manual or mechanical distraction (using an arm positioner) can be used to increase the working space. However, consistent distraction is very difficult to maintain manually over time due to fatigue, whereas mechanical distraction may overstretch the brachial plexus. To overcome these difficulties, we describe a technique using a specific laminar spreader for subacromial distraction during arthroscopic rotator cuff repair. The arthroscopic laminar spreader, inserted into the subacromial space, is used to distract the humeral head inferiorly from the acromion, improving subacromial space visualization and enabling easily rotator cuff release and repair. The shoulder distraction device improves the surgeon's performance without surgical assistance and allows reducing the operative time with safety. It can be also used anteriorly (to repair the subscapularis) or posteriorly (to repair the infraspinatus and teres minor) or to perform other procedures like superior capsular reconstruction or additional patch.
PubMed: 35782830
DOI: 10.1016/j.eats.2022.02.008