Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-06-2016 | Arthroscopy and Sports Medicine

Arthroscopic lateral acromion resection (ALAR) optimizes rotator cuff tear relevant scapula parameters

Authors: Burak Altintas, Max Kääb, Stefan Greiner

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 6/2016

Abstract

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.

Bedi A, Maak T, Walsh C et al (2012) Cytokines in rotator cuff degeneration and repair. J Shoulder Elb Surg 21:218–227. doi:10.1016/j.jse.2011.09.020 CrossRef

Ko JY, Huang CC, Chen WJ et al (2006) Pathogenesis of partial tear of the rotator cuff: a clinical and pathologic study. J Shoulder Elb Surg 15:271–278. doi:10.1016/j.jse.2005.10.013 CrossRef

Chaudhury S, Carr AJ (2012) Lessons we can learn from gene expression patterns in rotator cuff tears and tendinopathies. J Shoulder Elb Surg 21:191–199. doi:10.1016/j.jse.2011.10.022 CrossRef

Neer CS (1983) Impingement lesions. Clin Orthop Relat Res. doi:10.1097/00003086-198303000-00010 PubMed

Bigliani L, Morrison D, April E (1986) The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans 10:216

Banas MP, Miller RJ, Totterman S (1995) Relationship between the lateral acromion angle and rotator cuff disease. J Shoulder Elb Surg 4:454–461. doi:10.1016/S1058-2746(05)80038-2 CrossRef

Wong AS, Gallo L, Kuhn JE et al (2003) The effect of glenoid inclination on superior humeral head migration. J Shoulder Elb Surg 12:360–364. doi:10.1016/S1058-2746(03)00026-0 CrossRef

Nyffeler RW, Werner CML, Sukthankar A et al (2006) Association of a large lateral extension of the acromion with rotator cuff tears. J Bone Joint Surg Am 88:800–805. doi:10.2106/JBJS.D.03042 CrossRefPubMed

Moor BK, Bouaicha S, Rothenfluh DA et al (2013) Is there an association between the individual anatomy of the scapula and the development of rotator cuff tears or osteoarthritis of the glenohumeral joint? A radiological study of the critical shoulder angle. Bone Jt J 95B:935–941. doi:10.1302/0301-620X.95B7.31028 CrossRef

10.

Gerber C, Snedeker JG, Baumgartner D, Viehöfer AF (2014) Supraspinatus tendon load during abduction is dependent on the size of the critical shoulder angle: a biomechanical analysis. J Orthop Res 32:952–957. doi:10.1002/jor.22621 CrossRefPubMed

11.

Moor BK, Wieser K, Slankamenac K et al (2014) Relationship of individual scapular anatomy and degenerative rotator cuff tears. J Shoulder Elb Surg 23:536–541. doi:10.1016/j.jse.2013.11.008 CrossRef

12.

Balke M, Schmidt C, Dedy N et al (2013) Correlation of acromial morphology with impingement syndrome and rotator cuff tears. Acta Orthop 84:178–183. doi:10.3109/17453674.2013.773413 CrossRefPubMedPubMedCentral

13.

Kitay GS, Iannotti JP, Williams GR et al (1995) Roentgenographic assessment of acromial morphologic condition in rotator cuff impingement syndrome. J Shoulder Elb Surg 4:441–448. doi:10.1016/S1058-2746(05)80036-9 CrossRef

14.

Aoki M, Ishii S, Usui M (1986) The slope of the acromion and rotator cuff impingement. Orthop Trans 10(2):228–235

15.

Balke M, Banerjee M, Vogler T et al (2014) Acromial morphology in patients with calcific tendinitis of the shoulder. Knee Surg Sport Traumatol Arthrosc 22:415–421. doi:10.1007/s00167-012-2327-5 CrossRef

16.

Kim JR, Ryu KJ, Hong IT et al (2012) Can a high acromion index predict rotator cuff tears? Int Orthop 36:1019–1024. doi:10.1007/s00264-012-1499-4 CrossRefPubMedPubMedCentral

17.

Miyazaki AN, Itoi E, Sano H et al (2011) Comparison between the acromion index and rotator cuff tears in the Brazilian and Japanese populations. J Shoulder Elb Surg 20:1082–1086. doi:10.1016/j.jse.2011.04.028 CrossRef

18.

Torrens C, López JM, Puente I, Cáceres E (2007) The influence of the acromial coverage index in rotator cuff tears. J Shoulder Elb Surg 16:347–351. doi:10.1016/j.jse.2006.07.006 CrossRef

19.

Melean P, Lichtenberg S, Montoya F et al (2013) The acromial index is not predictive for failed rotator cuff repair. Int Orthop 37:2173–2179. doi:10.1007/s00264-013-1963-9 CrossRefPubMedPubMedCentral

Title: Arthroscopic lateral acromion resection (ALAR) optimizes rotator cuff tear relevant scapula parameters
Authors: Burak Altintas
Max Kääb
Stefan Greiner
Publication date: 01-06-2016
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 6/2016
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-016-2431-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Arthroscopic lateral acromion resection (ALAR) optimizes rotator cuff tear relevant scapula parameters

Abstract

Background

Materials and methods

Results

Conclusion

Level of evidence

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusion

Level of evidence

Please log in to get access to this content

Other articles of this Issue 6/2016

Patella tracking and patella contact pressure in modular patellofemoral arthroplasty: a biomechanical in vitro analysis

Does surgical reconstruction produce better stability than conservative treatment in the isolated PCL injuries?

Evaluation of the interaction between contact force and decision making on lower extremity biomechanics during a side-cutting maneuver

6-week radiographs unsuitable for diagnosis of suspected scaphoid fractures

A novel method to measure femoral component migration by computed tomography: a cadaver study

Real-time elastography of patellar tendon in patients with auto-graft bone–tendon–bone anterior cruciate ligament reconstruction