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Knee Surgery, Sports Traumatology,... Mar 2017Acromioclavicular (AC) joint dislocation is a common sports injury. Hook plate fixation is currently widely used to treat this injury, as it can promote the natural...
PURPOSE
Acromioclavicular (AC) joint dislocation is a common sports injury. Hook plate fixation is currently widely used to treat this injury, as it can promote the natural healing of the ligament with good clinical outcomes. However, subacromial erosion and impingement are frequently observed post-operatively. It was hypothesized that the morphology and the contact characteristics between the hook portion and the acromion are the main causes of complications after hook plate fixation with the currently available commercial designs.
METHODS
Three-dimensional reconstructed models of the AC joint obtained from the computed tomographic scans of 23 male and 23 female patients (mean age, 61.1 ± 6.3 years) were evaluated, and multiple anatomical parameters were measured. For the subacromial positioning of the hook plate, an actual hook plate (Synthes Inc., West Chester, PA, USA) was scanned, and the contact between the hook plate and the acromion was estimated.
RESULTS
The thicknesses of the acromion and distal clavicle were 9.7 ± 1.5 mm (10.7 mm in men; 8.6 mm in women) and 11.3 ± 1.6 mm (11.6 mm in men; 10.0 mm in women), respectively. The width of the acromion was 28.5 ± 3.6 mm. The mean inclination angle between the hook plate and the acromion was 29.3° ± 9.7° (27.9° in men; 30.6° in women). The hook plate made a point contact with the acromion at 9.2 ± 3.3 mm (31.5 %) from the lateral end of the acromion.
CONCLUSIONS
The results revealed that the hook made a pinpoint contact with the undersurface of the acromion, and this might explain why complications commonly occur after hook plate fixation. The force concentration phenomenon associated with the hook plate of existing designs results from cases of morphological mismatch, such as excessive inclination and improper occupation of the subacromial space.
Topics: Acromioclavicular Joint; Acromion; Bone Plates; Clavicle; Equipment Design; Female; Humans; Imaging, Three-Dimensional; Joint Dislocations; Male; Middle Aged; Tomography, X-Ray Computed
PubMed: 26792567
DOI: 10.1007/s00167-016-3987-3 -
Chinese Journal of Traumatology =... Mar 2024A fracture of the acromion and coracoid processes of scapula is rarely seen in the outpatient clinic, due to the acromion's anatomical position and shape, as well as the...
A fracture of the acromion and coracoid processes of scapula is rarely seen in the outpatient clinic, due to the acromion's anatomical position and shape, as well as the strong ligaments and muscles that are attached to it. These fractures are caused by either direct or indirect high-energy trauma injuries to the shoulder joint, leading to severe pain and a grossly restricted range of motion. Several acromial classifications were reported, but this type of longitudinal plane fracture of the acromion process in our case is yet to be described in the current literature. We present a rare combination of the coracoid process and unstable acromion bony projection fractures that have not previously been noted for this type of fracture. The closest to this is Kuhn's type III classification. A 51-year-old male presented to our emergency department complaining of the right shoulder pain and difficulty raising his arm following a 2-wheeler accident. The patient was managed by open reduction and internal fixation with 3 cannulated cancellous screws fixation and progressed well with no postoperative complications. He was asymptomatic postoperatively and regained full range of motion after 4 months.
Topics: Male; Humans; Middle Aged; Acromion; Coracoid Process; Scapula; Fractures, Bone; Fracture Fixation, Internal
PubMed: 37210253
DOI: 10.1016/j.cjtee.2023.04.003 -
Orthopaedic Surgery Jun 2021To find out which structure is crucial for the formation of shoulder impingement syndrome with the purpose of directing surgical procedures of subacromial decompression...
Morphological Characteristics of Acromion and Acromioclavicular Joint in Patients with Shoulder Impingement Syndrome and Related Recommendations: A Three-Dimensional Analysis Based on Multiplanar Reconstruction of Computed Tomography Scans.
UNLABELLED
To find out which structure is crucial for the formation of shoulder impingement syndrome with the purpose of directing surgical procedures of subacromial decompression and discussing whether it is necessary to manage acromioclavicular joint during operation and how to do it properly.
METHODS
This was a retrospective study. Clinical data and preoperative computed tomography (CT) images were collected from patients who were diagnosed with rotator cuff tears between January 2017 and August 2019 (sample size: 46) and those who were diagnosed without rotator cuff tears between March 2018 and August 2019 (sample size: 44) in our institution, respectively. Three-dimensional models of shoulders were established by multiplanar reconstruction of CT scans and measurements were performed on these models. The parameters such as the acromial length and width, the axial tilt, and the distance from acromial margin to glenoid plane were measured in an adjusted axial plane, and the critical shoulder angle and the spatial volume under acromioclavicular joint were measured in an adjusted coronal plane. The demographic characteristics, the acromial morphology and the spatial volume under acromioclavicular joint were compared to find significant differences between the two groups. The association between the axial tilt and the distance from acromial margin to glenoid plane was evaluated by an ordinary least squares linear regression.
RESULTS
The patients with rotator cuff tears consisted of 16 males and 30 females, among which 30 right shoulders and 16 left shoulders were included. The patients without rotator cuff tears consisted of 28 males and 16 females, among which 15 right shoulders and 29 left shoulders were involved. Significant differences between the groups were found in the acromial width (3.332 cm vs 3.111 cm), the axial tilt (33.765° vs 23.829°), the critical shoulder angle (32.630° vs 30.363°), the distance from anterior 3 cm of lateral acromial margin (range, 2.476 cm-3.302 cm vs 1.993 cm-3.089 cm), and anterior 0.9 cm of medial acromial margin (range, 0.967 cm-2.369 cm vs 0.668 cm-1.993 cm) to glenoid plane, and the spatial volume under acromioclavicular joint (1.089 cm vs 1.446 cm) in the two groups. No significant differences were found in the age (60.0 years vs 58.3 years) or the acromial length (4.187 cm vs 4.184 cm). Significant association was revealed by linear regression analysis between the axial tilt and the distance from anterior two-thirds of lateral acromial margin to glenoid plane, and similar association was also found in the anterior half of medial margin.
CONCLUSION
Anterior two-thirds of lateral acromial margin, anterior half of medial acromial margin, and inferior aspect of acromioclavicular joint are crucial structures and need to be fully decompressed when treating patients with rotator cuff tears.
Topics: Acromioclavicular Joint; Acromion; Female; Humans; Imaging, Three-Dimensional; Male; Middle Aged; Retrospective Studies; Rotator Cuff Injuries; Shoulder Impingement Syndrome; Tomography, X-Ray Computed
PubMed: 33955185
DOI: 10.1111/os.13001 -
International Orthopaedics Apr 2018Scapular fractures after reverse shoulder arthroplasty (RSA) are often associated with substantial shoulder impairment. Patient outcomes following either conservative or...
PURPOSE
Scapular fractures after reverse shoulder arthroplasty (RSA) are often associated with substantial shoulder impairment. Patient outcomes following either conservative or operative treatment have not been favourable, and consensus is lacking on the best treatment approach. We describe a technique for anatomic reconstruction of fractured lateral and basal acromion in patients at higher risk for diminished function or those for which conservative treatment has already failed.
METHODS
Of the 95 patients who underwent RSA at our institution between December 2013 and December 2016, three had post-operative acromion fractures (type II). Two of these patients had secondary dislocation and one underwent conservative treatment that failed. In all three cases, the acromion was reconstructed using an open technique with plate and interfragmentary screw fixation.
RESULTS
After the acromial fracture and prior to reconstructive surgery, the shoulder function decreased substantially in all three cases. Following reconstruction, forward flexion improved from 53.0° to 127°, and abduction improved from 52.0 to 125°. The range of the Constant scores at the one year follow-up was 55-71, and the subjective shoulder value (SSV) was 50-90. One patient reached the same active range of motion (ROM) as her pre-fracture status, and the two other patients improved but did not regain the previous ROM level.
CONCLUSION
Acromion fractures after RSA are serious complications that have the potential to cause severe shoulder function impairment. Our fixation technique for anatomic lateral and basal acromion reconstruction was used safely to treat three patients with poor shoulder function due to secondary dislocation or non-unions.
Topics: Acromion; Aged; Aged, 80 and over; Arthroplasty, Replacement, Shoulder; Female; Humans; Postoperative Complications; Range of Motion, Articular; Plastic Surgery Procedures; Shoulder Fractures; Shoulder Joint; Treatment Outcome
PubMed: 29222664
DOI: 10.1007/s00264-017-3710-0 -
Acta Orthopaedica Belgica Dec 2011This study investigated the role of acromion morphology in the aetiology of chronic subacromial impingement syndrome. Forty five patients with chronic subacromial...
This study investigated the role of acromion morphology in the aetiology of chronic subacromial impingement syndrome. Forty five patients with chronic subacromial impingement syndrome were included in the study. They were distributed into three groups according to their acromion types: six (13.3%) patients had type 1, 24 (533%) patients type 2 and 15 (333%) patients type 3 acromion. Constant scoring was used for clinical evaluation. Arthroscopic subacromial decompression was performed in all patients in the three groups, without performing any acromioplasty that would change the morphology of acromion. We then compared the average Constant scores changes in all three groups after arthroscopic subacromial decompression. The average follow-up was 28.6 months (range: 12-47). The average change in Constant score after arthroscopic subacromial decompression was 5830 in patients with type 1 acromion, 58.21 in those with type 2 and 54.07 in those with type 3. No significant difference was observed between the changes in the average Constant scores of the three groups (p > 0.005). The scores were significantly improved following arthroscopic subacromial decompression in all three groups (p < 0.005).In this study, acromion type was not found to have an important role in the aetiology of chronic impingement syndrome; arthroscopic subacromial decompression without simultaneous acromioplasty thus appears as an appropriate treatment.
Topics: Acromion; Adult; Aged; Arthroscopy; Chronic Disease; Decompression, Surgical; Humans; Middle Aged; Shoulder Impingement Syndrome
PubMed: 22308616
DOI: No ID Found -
Clinics in Orthopedic Surgery Dec 2022The aim of this study was to assess whether the anteroposterior coverage of the acromion reflecting acromial morphology affects the rotator cuff tear (RCT) and tear...
BACKGROUND
The aim of this study was to assess whether the anteroposterior coverage of the acromion reflecting acromial morphology affects the rotator cuff tear (RCT) and tear size, in addition to the lateral coverage.
METHODS
Medical records of 356 patients with RCTs, concentric osteoarthritis, and calcific tendinitis identified using three-dimensional computed tomography between January 2016 and December 2017 were retrospectively analyzed. The patients were divided into group A (those with RCTs) and group B (those with concentric osteoarthritis or calcific tendinitis). Subsequently, group A was subdivided into three categories according to the size of RCTs: small-to-medium, large, and massive. The lateral coverage was measured through the lateral acromial angle (LAA) and critical shoulder angle (CSA), whereas the anteroposterior coverage was measured via the acromial tilt (AT), acromiohumeral interval (AHI) in the sagittal view, and anteroposterior coverage index (APCI) as a new radiologic parameter.
RESULTS
Between groups A and B, CSA (34.5° ± 3.4° and 30.8° ± 3.4°, respectively), APCI (0.83 ± 0.10 and 0.75 ± 0.08, respectively), and AHI (6.3 ± 2.0 mm and 7.8 ± 1.8 mm, respectively) were significantly different (all < 0.001), whereas LAA and AT did not show a significant difference between the groups ( = 0.089 and = 0.665, respectively). The independent predictive radiologic parameters of the RCT were the CSA, APCI, and AHI ( < 0.001, < 0.001, and = 0.043, respectively); among these, the APCI showed the highest regression coefficient (odds ratio = 2.82). The parameters associated with the size of RCTs were CSA ( = 0.022) and AHI, of which AHI, in particular, had the most significant effect on both small-to-medium and large tears (all < 0.001).
CONCLUSIONS
Large CSA, high APCI, and low AHI were predictors of RCTs, with the APCI showing the strongest correlation. In addition to the large CSA, low AHI also correlated with the size of RCTs and affected the entire size groups. We suggest that both the lateral coverage and anteroposterior coverage of the acromion should be considered essential factors for predicting the presence of RCTs and tear size.
Topics: Humans; Rotator Cuff Injuries; Acromion; Shoulder Joint; Rupture; Osteoarthritis; Tendinopathy
PubMed: 36518929
DOI: 10.4055/cios22073 -
Acta Radiologica (Stockholm, Sweden :... Dec 2020The acromion index (AI) is the acromial lateral extension above the head of the humerus. Some researchers have advocated that the AI indicates the severity of the tear...
BACKGROUND
The acromion index (AI) is the acromial lateral extension above the head of the humerus. Some researchers have advocated that the AI indicates the severity of the tear size of the full-thickness supraspinatus tendon.
PURPOSE
To validate the reproducibility of the AI between shoulder magnetic resonance imaging (MRI) and standard X-ray and to verify whether the AI is a useful index for stratifying the severity of supraspinatus tendon injuries, as well as full-thickness tears.
MATERIAL AND METHODS
We enrolled 200 patients with impingement syndrome who were subsequently evaluated with standard X-ray of the shoulder in the anteroposterior view, as well as an MRI. We performed a pilot study to validate the reproducibility of the AI using standard X-ray and MRI, and to compare the AI between these imaging modalities. The severity of supraspinatus tendon injury was classified into four groups (0 = no evidence of injury, 1 = partial tear, 2 = full-thickness tear, and 3 = complete rupture) based on an official reading of the shoulder MRI. We compared the AIs of both modalities between the groups.
RESULTS
Intraclass correlation coefficients of the AIs between the two examiners were 0.819 for MRI and 0.808 for plain X-ray. The mean AI from standard X-ray was greater than that from MRI (<0.0001). There was no statistical correlation between the AI and the severity of supraspinatus tendon injury.
CONCLUSION
Our findings indicate that the AI cannot be generally used as a predictive reference for the stratified severities of supraspinatus tendon injury.
Topics: Acromion; Feasibility Studies; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Pilot Projects; Reproducibility of Results; Severity of Illness Index; Tendon Injuries
PubMed: 32202135
DOI: 10.1177/0284185120911188 -
Acta Orthopaedica Et Traumatologica... Mar 2022The 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...
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.
LEVEL OF EVIDENCE
Level III, Diagnostic Study.
Topics: Acromion; Arthroscopy; Humans; Middle Aged; Rotator Cuff; Rotator Cuff Injuries; Scapula; Shoulder Joint
PubMed: 35416163
DOI: 10.5152/j.aott.2022.21127 -
Journal of Medical Imaging and... Oct 2018
Topics: Acromion; Diagnosis, Differential; Gout; Humans; Tarsal Bones
PubMed: 30309095
DOI: 10.1111/1754-9485.24_12786 -
European Journal of Radiology Nov 2023The Critical Shoulder Angle Related Acromion Morphological Parameter (CSA- RAMP) is a valuable tool in the analyzing the etiology of the rotator cuff tears (RCTs)....
BACKGROUND
The Critical Shoulder Angle Related Acromion Morphological Parameter (CSA- RAMP) is a valuable tool in the analyzing the etiology of the rotator cuff tears (RCTs). However, its clinical application has been limited by the time-consuming and prone to inter- and intra-user variability of the measurement process.
OBJECTIVES
To develop and validate a deep learning algorithm for fully automated assessment of shoulder anteroposterior radiographs associated with RCTs and calculation of CSA-RAMP.
METHODS
Retrospective analysis was conducted on radiographs obtained from computed tomography (CT) scans and X-rays performed between 2018 and 2020 at our institution. The development of the system involved the utilization of digitally reconstructed radiographs (DRRs) generated from each CT scan. The system's performance was evaluated by comparing it with manual and semiautomated measurements on two separate test datasets: dataset I (DRRs) and dataset II (X-rays). Standard metrics, including mean average precision (AP), were utilized to assess the segmentation performance. Additionally, the consistency among fully automated, semiautomated, and manual measurements was comprehensively evaluated using the Pearson correlation coefficient and Bland-Altman analysis.
RESULTS
A total of 1080 DRRs generated from 120 consecutive CT scans and 159 X-ray films were included in the study. The algorithm demonstrated excellent segmentation performance, with a mean AP of 57.67 and an AP of 94.31. Strong inter-group correlations were observed for all CSA-RAMP measurements in both test datasets I (automated versus manual, automated versus semiautomated, and semiautomated versus manual; r = [0.990---0.997], P < 0.001) and dataset II (r = [0.984---0.995], P < 0.001). Bland-Altman analysis revealed low bias for all CSA-RAMP measurements in both test datasets I and II, except for CD (with a maximum bias of 2.49%).
CONCLUSIONS
We have successfully developed a fully automated algorithm capable of rapidly and accurately measuring CSA-RAMP on shoulder anteroposterior radiographs. A consistent automated CSA- RAMP measurement system may accelerate powerful and precise studies of disease biology in future large cohorts of RCTs patients.
Topics: Humans; Acromion; Shoulder Joint; Deep Learning; Shoulder; Radiography; Rotator Cuff Injuries
PubMed: 37714046
DOI: 10.1016/j.ejrad.2023.111083