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Journal of Orthopaedic Surgery (Hong... 2022No evaluation has been done on the relationship of the acromion-greater tuberosity impingement index (ATI) with retear after arthroscopic rotator cuff repair (ARCR). Our...
BACKGROUND
No evaluation has been done on the relationship of the acromion-greater tuberosity impingement index (ATI) with retear after arthroscopic rotator cuff repair (ARCR). Our purpose was to evaluate whether a higher ATI is associated with retear after ARCR.
METHODS
132 patients received ARCR and underwent MRI scan at a one year follow-up to assess tendon healing, and the findings were graded no retear (NR), partial-thickness retear (PR) or full-thickness retear (FR). The ATI, the critical shoulder angle (CSA), acromion index (AI) and lateral acromial angle (LAA) were measured with postoperative radiographs. Functional scores were obtained preoperatively and at a one year follow-up.
RESULTS
Postoperative Constant scores and ASES scores were significantly different between groups with inferior outcomes in the FR group ( < 0.05 for all). The UCLA score was significantly better in the NR group compared with the PR and FR groups ( < 0.05), and in the PR group compared with the FR group ( < 0.05). For ATI and CSA, the values of the PR and FR groups were larger than the NR group ( < 0.05 for all), but there were no significant differences between the PR and FR groups ( > 0.05 for all). No significant differences were observed with regard to the AI and LAA ( > 0.05, respectively). The repair integrity was positively related to the ATI (0.304, < 0.05) and CSA (0.252, < 0.05), but not related to the AI or LAA ( > 0.05 for both). ATI was not related to any functional scores ( > 0.05 for all).
CONCLUSION
This study revealed that the ATI was positively related to rotator cuff retear. Patients with retears had significantly greater ATIs after ARCR. Level of Evidence: III, case-control study.
Topics: Acromion; Arthroscopy; Case-Control Studies; Humans; Magnetic Resonance Imaging; Recurrence; Rotator Cuff; Rotator Cuff Injuries; Treatment Outcome
PubMed: 35430906
DOI: 10.1177/10225536221092219 -
Knee Surgery, Sports Traumatology,... Jul 2017Recent techniques for acromioclavicular (AC) joint reconstruction focus on additional AC cerclage to coracoclavicular (CC)-reconstructions. Due to the specific slim bone...
PURPOSE
Recent techniques for acromioclavicular (AC) joint reconstruction focus on additional AC cerclage to coracoclavicular (CC)-reconstructions. Due to the specific slim bone morphology at the acromion, there are concerns regarding these additional bone tunnels, as they may predispose to fracture and break out. The purpose of this study was to investigate anatomic properties of the acromion which may help improve surgical techniques directed at injuries to the AC joint. It was hypothesized that via measurements of thickness and density points of increased strength and support could be identified on the acromion.
METHODS
Eighty-five fresh frozen cadaveric shoulders were used for this study. A standardized 3D-net was developed and thicknesses of the acromion were taken from defined points using a certified caliper. To define the acromial arch, the angle and radius of curvature between the antero-lateral, the highest point of the acromial arch and the postero-lateral aspect of the acromion were measured. Additional bone mineral density (BMD) evaluation was performed on 43 specimens in an anterio-posterior and latero-medial direction using 5-mm slices with a maximum of 10 and 6 slices, respectively.
RESULTS
Median specimen age was 63.0 (range 36) years (55 female, and 30 male). There was no statistical significance between male (62.0, range: 35 years) and female (64.5, range 32 years) regarding age (n.s.). Thickness of acromion points of interest were ranging from 3.5 to 24.3 mm. Median radius of curvature of acromial arch for female was 48.2 (range 92.7) mm and 66.2 (range 85.6) for male (p = 0.019). The median angle for female specimens was 21.4° (range: 44.6°) and 23.3° (range 51.7°) for male (p = 0.047). The latero-medial measurements showed significant difference between the region of interest (ROI): 1 and 4, 5, 6 (p = 0.001, p = 0.001, p = 0.001), 2 and 4, 5, 6 (p = 0.007, p = 0.001, p = 0.001), 3 and 5, 6 (p = 0.001, p = 0.001), 4 and 5, 6 (p = 0.010, p = 0.001). Antero-posterior measurements showed significant difference between the ROI: 1 and 8 (p = 0.031).
CONCLUSION
The posterior-medial acromion close to the AC joint revealed the highest BMD with an increasing density from lateral to medial. In combination with thickness measurements this region would support additional anatomical fixation of the AC joint using bone tunnels if necessary.
CLINICAL RELEVANCE
To anatomically reproduce the insertions of the AC ligaments at the acromion, either bone tunnels or anchors are needed. Therefore, several techniques have been developed. This study provides the anatomical data for these techniques and confirms the reconstructive approach of techniques using anatomical points of fixation and orientation.
Topics: Absorptiometry, Photon; Acromioclavicular Joint; Acromion; Aged; Bone Density; Cadaver; Female; Humans; Male; Middle Aged; Sex Characteristics
PubMed: 28434036
DOI: 10.1007/s00167-017-4539-1 -
Journal of Computer Assisted Tomography Jan 2017The aims were to study the acromion parameters in the population and to assess the extremity or sex variation in the acromion morphology.
OBJECTIVE
The aims were to study the acromion parameters in the population and to assess the extremity or sex variation in the acromion morphology.
METHODS
The lateral acromion angle (LAA) and the acromion index (AI) were assessed in a computed tomographic scan database of 250 individuals in the age group of 20 to 49 years. For the analysis of LAA and AI, 286 and 234 shoulders were available, respectively.
RESULTS
The LAA was 73.6 ± 6.6 degrees; 73.7 ± 6.9 and 72.5 ± 6.1 degrees for the right and left shoulder, respectively. The AI was 0.755 ± 0.12; 0.82 ± 0.12 and 0.69 ± 0.12 for the left and the right shoulder, respectively. The AI of the right shoulder was significantly different between the 2 sexes (P = 0.04). The difference in the AI and the LAA of the right and left shoulders was significant (P < 0.0001, P = 0.04).
CONCLUSIONS
The morphology of the acromion differs between the right and the left shoulders as well as between sexes.
Topics: Acromion; Adult; Female; Germany; Humans; Male; Middle Aged; Reproducibility of Results; Sensitivity and Specificity; Sex Distribution; Sex Factors; Tomography, X-Ray Computed
PubMed: 27680413
DOI: 10.1097/RCT.0000000000000474 -
Journal of Orthopaedic Trauma Jan 1999The case of a twenty-three-year-old male with a symptomatic pseudarthrosis of the acromion is presented. Open reduction and internal fixation with a plate, screw, and... (Review)
Review
The case of a twenty-three-year-old male with a symptomatic pseudarthrosis of the acromion is presented. Open reduction and internal fixation with a plate, screw, and tension band construct supplemented with a bone graft was performed and early range of motion was initiated. Nine months after surgery, the fracture was healed and the patient had excellent function of the shoulder. The literature on pseudarthrosis of the acromion is reviewed.
Topics: Acromion; Adult; Fracture Fixation, Internal; Humans; Male; Pseudarthrosis; Radiography
PubMed: 9892131
DOI: 10.1097/00005131-199901000-00016 -
Medicine Oct 2022This study aimed to radiologically evaluate the effect of hook plates used in the treatment of acromioclavicular joint (ACJ) dislocations on the development of...
This study aimed to radiologically evaluate the effect of hook plates used in the treatment of acromioclavicular joint (ACJ) dislocations on the development of subacromial osteolysis (SAO) according to acromion types. A total of 43 patients with mean age of 38.5 (19-77) years who were diagnosed with AC dislocation and applied neutral clavicular hook plate between 2013 and 2020 were retrospectively evaluated. Acromion types were determined by measuring acromion slope angle on lateral shoulder radiography and 3-dimensional (D)-CT of the patients. Presence of SAO was classified according to the severity of erosion in the subacromial region (grade I: minimal osteolysis, grade II: subacromial erosion <2 mm, grade III: subacromial erosion >2 mm, grade IV: cut-through of the acromion) on postoperative 3D - CT and correlation with acromion types was analyzed. Incidence of SAO was significantly higher among type 1 acromion compared to type 2 and type 3 acromion (P = .003). While osteolysis was observed in 21 patients, no osteolysis was observed in 22 patients. Osteolysis occurred in all patients with type 1 acromion, 7 patients with type 2 acromion, and 5 patients with type 3 acromion. Since the hook tip in the sagittal plane passes posterior to the center of the acromion and the concavity of the subacromial surface is inadequate in the type 1 acromion, we believe that the increased pressure applied by the hook tip on the subacromial cartilage increases the risk of SAO. We predict that the use of hook plates with an angle of 15-20 degrees, similar to the patient's AC angle, rather than neutral hook plate, will reduce the risk of osteolysis in patients with type 1 acromion.
Topics: Humans; Adult; Middle Aged; Aged; Acromion; Acromioclavicular Joint; Clavicle; Retrospective Studies; Joint Dislocations; Bone Plates; Shoulder Dislocation; Osteolysis; Treatment Outcome
PubMed: 36316844
DOI: 10.1097/MD.0000000000031632 -
The Journal of Orthopaedic and Sports... Mar 2018In 1972, American orthopaedic surgeon Charles Neer published his seminal paper, "Anterior Acromioplasty for the Chronic Impingement Syndrome in the Shoulder: A...
In 1972, American orthopaedic surgeon Charles Neer published his seminal paper, "Anterior Acromioplasty for the Chronic Impingement Syndrome in the Shoulder: A Preliminary Report." It wasn't a robust scientific paper; however, it changed the direction of orthopaedic practice for the next half century. Neer argued that a primary cause of shoulder pain was attrition of the supraspinatus tendon and related structures from the overlying acromion, especially when the arm was elevated. Neer recommended surgical removal to stop the impingement, and over the last half century, it could be argued that millions of people around the globe would have undergone acromioplasty surgery to stop this portion of the bone impinging onto the soft tissues located in the subacromial space. More recently, against the tide of subacromial decompression surgery there has been dissent, and the relationship between the acromion and symptoms has been challenged. J Orthop Sports Phys Ther 2018;48(3):127-129. doi:10.2519/jospt.2018.0102.
Topics: Acromion; Arthroplasty; Decompression, Surgical; Humans; Shoulder Impingement Syndrome
PubMed: 29490599
DOI: 10.2519/jospt.2018.0102 -
Archives of Orthopaedic and Trauma... Jun 2016The acromion index (AI), critical shoulder angle (CSA) and lateral acromion angle (LAA) are predictive for degenerative rotatory cuff tears. Their unfavorable values are...
BACKGROUND
The acromion index (AI), critical shoulder angle (CSA) and lateral acromion angle (LAA) are predictive for degenerative rotatory cuff tears. Their unfavorable values are associated with a suboptimal deltoid force vector. The aim of this study was to evaluate whether an optimization of the radiological parameters could be achieved through a specific arthroscopic lateral acromion resection (ALAR).
MATERIALS AND METHODS
The procedure was performed in eight fresh frozen cadaver shoulders. True a.p. and axial radiographs were taken before and after the intervention for radiological evaluation. The anterior and posterior acromion edges were marked with a spinal needle. Then 1 cm of the lateral acromion was resected with a 5.0 acromionizer (Arthrex Inc., Naples, FL, USA) beginning from the anterior aspect. The resection was completed over the total width of 1 cm from anterior to posterior. Finally the deltoid insertion was dissected via an open approach to ensure its integrity. The fluoroscopy images were evaluated regarding the pre- and postinterventional parameters AI, CSA and LAA.
RESULTS
After the intervention, the mean AI could be significantly reduced from 0.62 ± 0.11 to 0.40 ± 0.15 (p = 0.012). Also the mean CSA was significantly reduced from 35.0° ± 7.65° to 25.12° ± 8.29° (p = 0.018). The LAA could not be significantly changed (76.5° ± 14.02° vs. 82.13 ± 8.93; p = 0.107). There was no injury to the deltoid insertion.
CONCLUSION
The radiographic parameters AI und CSA can be optimized significantly by ALAR without macroscopic discontinuity of the deltoid insertion.
LEVEL OF EVIDENCE
Level IV, case series without comparison group.
Topics: Acromion; Arthroscopy; Cadaver; Deltoid Muscle; Fluoroscopy; Humans; Rotator Cuff; Rotator Cuff Injuries; Scapula; Shoulder Joint
PubMed: 26920400
DOI: 10.1007/s00402-016-2431-y -
The Gulf Journal of Oncology Jul 2009Primary "xanthoma" of the bone is a rare lesion of unsettled histogenesis that may pose a diagnostic challenge owing to its wide range of differential diagnosis. Herein,... (Review)
Review
Primary "xanthoma" of the bone is a rare lesion of unsettled histogenesis that may pose a diagnostic challenge owing to its wide range of differential diagnosis. Herein, we present a case of primary xanthoma of the right acromion in a middle aged woman who had no aberrant lipid metabolism or evidence of other pre-existing bone lesions. To our knowledge, this is the second reported case of a primary xanthoma involving the acromion in an adult.
Topics: Acromion; Adult; Bone Diseases; Diagnosis, Differential; Female; Humans; Radiography; Xanthomatosis
PubMed: 20194092
DOI: No ID Found -
Journal of Shoulder and Elbow Surgery Jan 2023Postoperative fracture of the acromion is a complication uniquely more common after reverse shoulder arthroplasty (RSA) than other forms of shoulder arthroplasty. There...
INTRODUCTION
Postoperative fracture of the acromion is a complication uniquely more common after reverse shoulder arthroplasty (RSA) than other forms of shoulder arthroplasty. There is limited knowledge regarding the etiology of these fractures or the anatomic risk factors. The purpose of this study is to identify associations of the acromioclavicular (AC) joint and relative humeral and glenoid positioning on the occurrence of acromial fractures after RSA.
METHODS
A retrospective case-controlled study was performed on primary RSA patients treated by a single surgeon from September 2009 to September 2019. Patients with a postoperative acromion fracture were matched in a 3:1 ratio based on gender, indication, and age to those without a fracture and with a 2-year minimum follow-up. Preoperative and the immediate postoperative radiographs were reviewed by 2 investigators to measure critical shoulder angle, acromion-humeral interval, global lateralization, delta angle, preoperative glenoid height, and the level of inlay or onlay of the humeral stem. The morphology, width, and stigmata of osteoarthritis in the AC joint were assessed using computed tomography scans taken preoperatively.
RESULTS
Of a total of 920 RSAs performed, 47 (5.1%) patients suffered a postoperative acromion fracture. These patients were compared with a control group of 141 patients, with a mean age of 76.4 years and similar distributions of gender and surgical indication. Patients in both groups had similar preoperative glenoid height (P = .953) and postoperative degree of inset or offset of humeral implant relative to the anatomic neck (P = .413). There were no differences in critical shoulder angle, acromion-humeral interval, global lateralization, and delta angle both preoperatively and postoperatively between the fracture and nonfracture groups. Computed tomography analysis also showed no differences in AC joint morphology (P = .760), joint space (P = .124), and stigma of osteoarthritis (P = .161).
CONCLUSION
There was no relation between the features of the AC joint and the anatomic parameters of the humerus relative to the glenoid and acromion on postoperative acromion fractures after RSA.
Topics: Humans; Aged; Arthroplasty, Replacement, Shoulder; Shoulder Joint; Retrospective Studies; Acromion; Shoulder Prosthesis; Fractures, Bone; Osteoarthritis; Treatment Outcome
PubMed: 35940534
DOI: 10.1016/j.jse.2022.06.020 -
Acta Bio-medica : Atenei Parmensis Dec 2019Fractures of the acromion are uncommon clinical entities, and stress fractures are even more rare, with few cases reported. Due to their rarity, stress fractures are...
Fractures of the acromion are uncommon clinical entities, and stress fractures are even more rare, with few cases reported. Due to their rarity, stress fractures are often misdiagnosed. Here, we report a case of an elderly patient with an acromion stress fracture, which was overlooked, resulting in nonunion followed by the displacement of the distal portion of the acromion. The purpose of this report was to discuss this rare fracture, highlighting the importance of an accurate evaluation of radiological imaging as well as clinical data. (www.actabiomedica.it).
Topics: Acromion; Aged, 80 and over; Female; Fractures, Stress; Humans; Pseudarthrosis
PubMed: 31910194
DOI: 10.23750/abm.v90i4.7778