Advertisement
Journal of Shoulder and Elbow Surgery

Does scapular morphology affect the integrity of the rotator cuff?

Published:December 01, 2015DOI:https://doi.org/10.1016/j.jse.2015.09.016

      Background

      Current evidence suggests that distinct scapular morphologies may predispose patients to a rotator cuff tear. The objective of this longitudinal study was to evaluate the relationship between symptomatic degenerative cuff tears and different radiographic acromial characteristics, including acromion shape, indices (acromial index [AI], critical shoulder angle [CSA]), and acromial spur.

      Methods

      We divided 166 patients into 3 groups matched for age and sex: group 1, degenerative full-thickness tear; group 2, partial thickness bursal tear; and group 3, normal cuff. Patients were evaluated with standard radiographs and ultrasonography.

      Results

      The presence of an acromial spur was strongly associated with a full-thickness cuff tear (odds ratio, 3.5; P = .001). AI and CSA revealed a statistically significant difference between means of group 1 (P = .006) and group 3 (P < .001). There was no statistically significant difference in means of AI between groups 1 and 2 (P = .695) and between groups 2 and 3, with respect to AI (P = .071) and CSA (P = .125). Receiver operating characteristic curve revealed a higher area for CSA (0.70) than for AI (0.61). Stepwise logistic regression rejected AI as a cuff tear predictor but confirmed CSA and a spur to be stronger predictors of a full-thickness cuff tear. There was no association between the Bigliani acromial type and rotator cuff tear (P = .06).

      Conclusions

      The presence of an acromion spur is strongly associated with full-thickness cuff tear. Higher AI and CSA are associated with a full-thickness tear but not with partial tears. The type of acromion is not related to cuff tear.

      Level of evidence

      Keywords

      To read this article in full you will need to make a payment

      References

        • Ames J.B.
        • Horan M.P.
        • Van der Meijden O.A.
        • Leake M.J.
        • Millett P.J.
        Association between acromial index and outcomes following arthroscopic repair of full-thickness rotator cuff tears.
        J Bone Joint Surg Am. 2012; 94: 1862-1869https://doi.org/10.2106/jbjs.k.01500
        • Balke M.
        • Liem D.
        • Greshake O.
        • Hoeher J.
        • Bouillon B.
        • Banerjee M.
        Differences in acromial morphology of shoulders in patients with degenerative and traumatic supraspinatus tendon tears.
        Knee Surg Sports Traumatol Arthrosc. 2014; ([Epub ahead of print])https://doi.org/10.1007/s00167-014-3499-y
        • Balke M.
        • Schmidt C.
        • Dedy N.
        • Banerjee M.
        • Bouillon B.
        • Liem D.
        Correlation of acromial morphology with impingement syndrome and rotator cuff tears.
        Acta Orthop. 2013; 84: 178-183https://doi.org/10.3109/17453674.2013.773413
        • Banas M.P.
        • Miller R.J.
        • Totterman S.
        Relationship between the lateral acromion angle and rotator cuff disease.
        J Shoulder Elbow Surg. 1995; 4: 454-461
        • Bigliani L.U.
        • Morrison D.S.
        • April E.W.
        The morphology of the acromion and its relationship to rotator cuff tears.
        Orthop Trans. 1986; 10: 216
        • Bigliani L.U.
        • Ticker J.B.
        • Flatow E.L.
        • Soslowsky L.J.
        • Mow V.C.
        The relationship of acromial architecture to rotator cuff disease.
        Clin Sports Med. 1991; 10: 823-838
        • Chambler A.F.
        • Pitsillides A.A.
        • Emery R.J.
        Acromial spur formation in patients with rotator cuff tears.
        J Shoulder Elbow Surg. 2003; 12: 314-321https://doi.org/10.1016/mse.2003.S1058274603000302
        • Ellman H.
        Diagnosis and treatment of incomplete rotator cuff tears.
        Clin Orthop Relat Res. 1990; 254: 64-74
        • Epstein R.E.
        • Schweitzer M.E.
        • Frieman B.G.
        • Fenlin Jr., J.M.
        • Mitchell D.G.
        Hooked acromion: prevalence on MR images of painful shoulders.
        Radiology. 1993; 187: 479-481
        • Flatow E.L.
        • Soslowsky L.J.
        • Ticker J.B.
        • Pawluk R.J.
        • Hepler M.
        • Ark J.
        • et al.
        Excursion of the rotator cuff under the acromion. Patterns of subacromial contact.
        Am J Sports Med. 1994; 22: 779-788
        • Fujisawa Y.
        • Mihata T.
        • Murase T.
        • Sugamoto K.
        • Neo M.
        Three-dimensional analysis of acromial morphologic characteristics in patients with and without rotator cuff tears using a reconstructed computed tomography model.
        Am J Sports Med. 2014; 42: 2621-2626https://doi.org/10.1177/0363546514544683
        • Hamid N.
        • Omid R.
        • Yamaguchi K.
        • Steger-May K.
        • Stobbs G.
        • Keener J.D.
        Relationship of radiographic acromial characteristics and rotator cuff disease: a prospective investigation of clinical, radiographic, and sonographic findings.
        J Shoulder Elbow Surg. 2012; 21: 1289-1298https://doi.org/10.1016/j.jse.2011.09.028
        • Jacobson S.R.
        • Speer K.P.
        • Moor J.T.
        • Janda D.H.
        • Saddemi S.R.
        • MacDonald P.B.
        • et al.
        Reliability of radiographic assessment of acromial morphology.
        J Shoulder Elbow Surg. 1995; 4: 449-453
        • Kappe T.
        • Cakir B.
        • Lippacher S.
        • Reichel H.
        • Elsharkawi M.
        Intraarticular lesions in calcifying tendinitis: incidence and association with the acromion index.
        Arch Orthop Trauma Surg. 2011; 131: 325-329https://doi.org/10.1007/s00402-011-1263-z
        • Kim J.R.
        • Ryu K.J.
        • Hong I.T.
        • Kim B.K.
        • Kim J.H.
        Can a high acromion index predict rotator cuff tears?.
        Int Orthop. 2012; 36: 1019-1024https://doi.org/10.1007/s00264-012-1499-4
        • Kitay G.S.
        • Iannotti J.P.
        • Williams G.R.
        • Haygood T.
        • Kneeland B.J.
        • Berlin J.
        Roentgenographic assessment of acromial morphologic condition in rotator cuff impingement syndrome.
        J Shoulder Elbow Surg. 1995; 4: 441-448
        • Ko J.Y.
        • Huang C.C.
        • Chen W.J.
        • Chen C.E.
        • Chen S.H.
        • Wang C.J.
        Pathogenesis of partial tear of the rotator cuff: a clinical and pathologic study.
        J Shoulder Elbow Surg. 2006; 15: 271-278https://doi.org/10.1016/j.jse.2005.10.013
        • Moor B.K.
        • Wieser K.
        • Slankamenac K.
        • Gerber C.
        • Bouaicha S.
        Relationship of individual scapular anatomy and degenerative rotator cuff tears.
        J Shoulder Elbow Surg. 2014; 23: 536-541https://doi.org/10.1016/j.jse.2013.11.008
        • Neer 2nd, C.S.
        Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report.
        J Bone Joint Surg Am. 1972; 54: 41-50
        • Neer 2nd, C.S.
        Impingement lesions.
        Clin Orthop Relat Res. 1983; 173: 70-77
        • Nicholson G.P.
        • Goodman D.A.
        • Flatow E.L.
        • Bigliani L.U.
        The acromion: morphologic condition and age-related changes. A study of 420 scapulas.
        J Shoulder Elbow Surg. 1996; 5: 1-11
        • Nyffeler R.W.
        • Werner C.M.
        • Sukthankar A.
        • Schmid M.R.
        • Gerber C.
        Association of a large lateral extension of the acromion with rotator cuff tears.
        J Bone Joint Surg Am. 2006; 88: 800-805https://doi.org/10.2106/jbjs.d.03042
        • Ogawa K.
        • Yoshida A.
        • Inokuchi W.
        • Naniwa T.
        Acromial spur: relationship to aging and morphologic changes in the rotator cuff.
        J Shoulder Elbow Surg. 2005; 14: 591-598https://doi.org/10.1016/j.jse.2005.03.007
        • Oh J.H.
        • Kim J.Y.
        • Lee H.K.
        • Choi J.A.
        Classification and clinical significance of acromial spur in rotator cuff tear: heel-type spur and rotator cuff tear.
        Clin Orthop Relat Res. 2010; 468: 1542-1550https://doi.org/10.1007/s11999-009-1058-5
        • Ozaki J.
        • Fujimoto S.
        • Nakagawa Y.
        • Masuhara K.
        • Tamai S.
        Tears of the rotator cuff of the shoulder associated with pathological changes in the acromion. A study in cadavera.
        J Bone Joint Surg Am. 1988; 70: 1224-1230
        • Panni A.S.
        • Milano G.
        • Lucania L.
        • Fabbriciani C.
        • Logroscino C.A.
        Histological analysis of the coracoacromial arch: correlation between age-related changes and rotator cuff tears.
        Arthroscopy. 1996; 12: 531-540
        • Park T.S.
        • Park D.W.
        • Kim S.I.
        • Kweon T.H.
        Roentgenographic assessment of acromial morphology using supraspinatus outlet radiographs.
        Arthroscopy. 2001; 17: 496-501
        • Spiegl U.J.
        • Horan M.P.
        • Smith S.W.
        • Ho C.P.
        • Millett P.J.
        The critical shoulder angle is associated with rotator cuff tears and shoulder osteoarthritis and is better assessed with radiographs over MRI.
        Knee Surg Sports Traumatol Arthrosc. 2015; ([Epub ahead of print])https://doi.org/10.1007/s00167-015-3587-7
        • Teefey S.A.
        • Middleton W.D.
        • Payne W.T.
        • Yamaguchi K.
        Detection and measurement of rotator cuff tears with sonography: analysis of diagnostic errors.
        AJR Am J Roentgenol. 2005; 184: 1768-1773https://doi.org/10.2214/ajr.184.6.01841768
        • Toivonen D.A.
        • Tuite M.J.
        • Orwin J.F.
        Acromial structure and tears of the rotator cuff.
        J Shoulder Elbow Surg. 1995; 4: 376-383
        • Torrens C.
        • Lopez J.M.
        • Puente I.
        • Caceres E.
        The influence of the acromial coverage index in rotator cuff tears.
        J Shoulder Elbow Surg. 2007; 16: 347-351https://doi.org/10.1016/j.jse.2006.07.006
        • Vahakari M.
        • Leppilahti J.
        • Hyvonen P.
        • Ristiniemi J.
        • Paivansalo M.
        • Jalovaara P.
        Acromial shape in asymptomatic subjects: a study of 305 shoulders in different age groups.
        Acta Radiol. 2010; 51: 202-206https://doi.org/10.3109/02841850903476556
        • Wang J.C.
        • Shapiro M.S.
        Changes in acromial morphology with age.
        J Shoulder Elbow Surg. 1997; 6: 55-59
        • Worland R.L.
        • Lee D.
        • Orozco C.G.
        • SozaRex F.
        • Keenan J.
        Correlation of age, acromial morphology, and rotator cuff tear pathology diagnosed by ultrasound in asymptomatic patients.
        J South Orthop Assoc. 2003; 12: 23-26
        • Zuckerman J.D.
        • Kummer F.J.
        • Cuomo F.
        • Simon Jo
        • Rosenblum S.
        • Katz N.
        The influence of coracoacromial arch anatomy on rotator cuff tears.
        J Shoulder Elbow Surg. 1992; 1: 4-14https://doi.org/10.1016/s1058-2746(09)80010-4
        • Zumstein M.A.
        • Jost B.
        • Hempel J.
        • Hodler J.
        • Gerber C.
        The clinical and structural long-term results of open repair of massive tears of the rotator cuff.
        J Bone Joint Surg Am. 2008; 90: 2423-2431https://doi.org/10.2106/jbjs.g.00677