Purpose
To determine if an increased critical shoulder angle (CSA) predisposes patients to
higher re-tear rates and worse clinical outcomes after rotator cuff (RC) repair.
Methods
A comprehensive search of the PubMed, MEDLINE, and EMBASE databases was performed
in October 2018 for English-language studies pertaining to RC repair and an increased
CSA in accordance with Preferred Reported Items for Systematic Reviews and Meta-analyses
guidelines. Studies of all levels of evidence were included provided that any outcomes,
including pain, patient-reported outcomes, and re-tear rates, were reported.
Results
Of a group of 1126 studies that satisfied the initial search criteria, 6 studies were
included in the final analysis, comprising data from 473 patients. Three comparative
studies were assessed for an association between increased CSA and RC re-tear rates.
Among these 3 studies that compared RC re-tear rate in patients with larger and smaller
CSAs, 22 of 97 patients (23%) with a larger CSA had a RC re-tear in comparison to
10 of 99 patients (10%) with a smaller CSA. All 3 studies demonstrated higher RC re-tear
rates in patients with larger CSAs (risk ratio, 2.39-9.66, I2 = 7%.) The mean CSA in those patients who did not have RC re-tears ranged from 34.3°
to 37°, and the mean CSA in those patients who had RC re-tears ranged from 37° to
40°.
Conclusion
RC re-tear rates were higher in patients with larger CSAs among comparative, nonrandomized
studies. However, the heterogeneity of the relevant literature limits the strength
of his observation. Based on the current literature, it remains unclear as to whether
lateral acromioplasty affects clinical outcomes as a function of a reduced postoperative
CSA.
Level of Evidence
Level IV, systematic review of Level II to IV studies.
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Article info
Publication history
Published online: September 09, 2019
Accepted:
March 25,
2019
Received:
December 11,
2018
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
See commentary on page 2948
Identification
Copyright
© 2019 Published by Elsevier on behalf of the Arthroscopy Association of North America
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- Editorial Commentary: Outcomes in Arthroscopic Rotator Cuff Repairs: Are We Treating Patients or Radiographs?ArthroscopyVol. 35Issue 10
- PreviewRotator cuff tears are among the most common disorders of the shoulder girdle requiring surgical intervention, and it is no surprise that orthopaedic surgeons have searched far and wide for means to improve on rotator cuff repair outcomes. Radiological parameters such as the critical shoulder angle have recently emerged and have been associated with the presence of degenerative rotator cuff tears. However, their true impact on postoperative outcomes are still unclear. Although radiological parameters, because of their objectivity, will always remain a critical part of a surgeon's preoperative assessment, we must remember that ultimately we are treating patients and not radiographs.
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