Higher Critical Shoulder Angle Increases the Risk of Re-tear after Rotator Cuff Repair


      No evaluation has been done on CSAs relationship with re-tear after repair. Our purpose was to evaluate if higher CSA is associated with re-tears after rotator cuff repair (RCR).


      This was a retrospective review of 76 patients who had undergone RCR with postoperative ultrasounds. Ultrasounds were graded no re-tear (NT), partial thickness re-tear (PT) or full thickness re-tear (FT). Preoperative radiographs were used to measure CSA, glenoid inclination (GI), lateral acromial angle (LAA) and acromion index (AI).


      Average age was 61.9 yrs (45.3-74.9). On ultrasound, 57 shoulders (74.0%) had NT, 11 (14.2%) had PT, and 8 (10.3%) had FT. There was no significant difference in re-tear rate by age, gender or tension of repair. Average CSA for the NT group was significantly lower at 34.3±2.9 deg than FT group at 38.6±3.5 deg (P<0.01). If CSA was greater than 38 degrees the odds ratio of having a full thickness re-tear was 14.8 (p<0.01). In addition, higher CSA inversely correlated with postoperative ASES scores (p<0.03). Average glenoid Inclination was significantly lower in the NT group at 12.3±2.7 deg compared to 17.3±2.6 deg in the FT group (p<0.01). If glenoid inclination was greater than 14 degrees the odds ratio of having developing a FT re-tear was 15.0 (p<0.01).


      At short-term follow up, higher CSA significantly increased the risk of a full thickness re-tear after rotator cuff repair. Also, increasing CSA correlated with worse postoperative ASES scores. This radiograph marker may help manage expectations for rotator cuff tear patients.