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Is Bony Morphology and Morphometry Associated With Degenerative Full-Thickness Rotator Cuff Tears? A Systematic Review and Meta-analysis

      Purpose

      To scope the scientific literature and analyze the influence of bony risk factors for degenerative full-thickness primary rotator cuff tear.

      Methods

      A systematic review of databases PubMed, Scopus, EMBASE, and Cochrane Library was performed up to June 30, 2018. Meta-analysis was performed with mean difference (MD) or risk ratio for degenerative full-thickness rotator cuff injury, and when there were ≥3 studies for the considered potential risk factor. Methodologic quality was assessed using the Newcastle-Ottawa scale.

      Results

      We analyzed 34 studies comprising 5,916 shoulders (3,369 shoulders with rotator cuff tear and 2,546 controls) and identified 19 potential risk factors for degenerative full-thickness rotator cuff tears. There was moderate evidence that a higher critical shoulder angle (MD = 4.41, 95% confidence interval [CI] 3.43 to 5.39), higher acromion index (MD = 0.06, 95% CI 0.04 to 0.09), and lower lateral acromion angles (MD = −7.11, 95% CI −8.32 to −5.90) were associated with degenerative full-thickness rotator cuff tears compared with controls. Moderate evidence showed that a type III acromion significantly increases the risk for full-thickness degenerative rotator cuff tear (risk ratio = 2.26, 95% CI 1.38 to 3.70).

      Conclusion

      There is moderate evidence that larger critical shoulder angle, higher acromion index, lower lateral acromion angles, and a type III acromion are significantly associated with degenerative full-thickness rotator cuff tears. Other potential risk factors identified showed insufficient evidence.

      Level of Evidence

      Level IV, systematic review of level II to IV studies.
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      References

        • Yamamoto A.
        • Takagishi K.
        • Osawa T.
        • et al.
        Prevalence and risk factors of a rotator cuff tear in the general population.
        J Shoulder Elbow Surg. 2010; 19: 116-120
        • Sørensen A.K.
        • Bak K.
        • Krarup A.L.
        • et al.
        Acute rotator cuff tear: Do we miss the early diagnosis? A prospective study showing a high incidence of rotator cuff tears after shoulder trauma.
        J Shoulder Elbow Surg. 2007; 16: 174-180
        • Teunis T.
        • Lubberts B.
        • Reilly B.T.
        • Ring D.
        A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age.
        J Shoulder Elbow Surg. 2014; 23: 1913-1921
        • Oliva F.
        • Osti L.
        • Padulo J.
        • Maffulli N.
        Epidemiology of the rotator cuff tears: A new incidence related to thyroid disease.
        Muscles Ligaments Tendons J. 2014; 4: 309-314
        • Gerber C.
        • Snedeker J.G.
        • Baumgartner D.
        • Viehofer A.F.
        Supraspinatus tendon load during abduction is dependent on the size of the critical shoulder angle: A biomechanical analysis.
        J Orthop Res. 2014; 32: 952-957
        • Henn 3rd, R.F.
        • Kang L.
        • Tashjian R.Z.
        • Green A.
        Patients’ preoperative expectations predict the outcome of rotator cuff repair.
        J Bone Joint Surg Am. 2007; 89: 1913-1919
        • Paloneva J.
        • Koskela S.
        • Kautiainen H.
        • Vanhala M.
        • Kiviranta I.
        Consumption of medical resources and outcome of shoulder disorders in primary health care consulters.
        BMC Musculoskelet Disord. 2013; 14: 348
        • Itoi E.
        Rotator cuff tear: Physical examination and conservative treatment.
        J Orthop Sci. 2013; 18: 197-204
        • Van der Windt D.
        • Koes B.W.
        • Boeke A.
        • Devillé W.
        • De Jong B.A.
        • Bouter L.M.
        Shoulder disorders in general practice: Prognostic indicators of outcome.
        Br J Gen Pract. 1996; 46: 519-523
        • Tempelhof S.
        • Rupp S.
        • Seil R.
        Age-related prevalence of rotator cuff tears in asymptomatic shoulders.
        J Shoulder Elbow Surg. 1999; 8: 296-299
        • Kim H.M.
        • Teefey S.A.
        • Zelig A.
        • Galatz L.M.
        • Keener J.D.
        • Yamaguchi K.
        Shoulder strength in asymptomatic individuals with intact compared with torn rotator cuffs.
        J Bone Joint Surg Am. 2009; 91: 289-296
        • Moosmayer S.
        • Lund G.
        • Seljom U.S.
        • et al.
        Tendon repair compared with physiotherapy in the treatment of rotator cuff tears: A randomized controlled study in 103 cases with a five-year follow-up.
        J Bone Joint Surg Am. 2014; 96: 1504-1514
        • Lambers Heerspink F.O.
        • van Raay J.J.
        • Koorevaar R.C.
        • et al.
        Comparing surgical repair with conservative treatment for degenerative rotator cuff tears: A randomized controlled trial.
        J Shoulder Elbow Surg. 2015; 24: 1274-1281
        • Mall N.A.
        • Kim H.M.
        • Keener J.D.
        • et al.
        Symptomatic progression of asymptomatic rotator cuff tears: A prospective study of clinical and sonographic variables.
        J Bone Joint Surg Am. 2010; 92: 2623-2633
        • Maman E.
        • Harris C.
        • White L.
        • Tomlinson G.
        • Shashank M.
        • Boynton E.
        Outcome of nonoperative treatment of symptomatic rotator cuff tears monitored by magnetic resonance imaging.
        J Bone Joint Surg Am. 2009; 91: 1898-1906
        • Sevivas N.
        • Ferreira N.
        • Andrade R.
        • et al.
        Arthroscopic and open repair of massive rotator cuff tears have similar results: A systematic review.
        J ISAKOS. 2017; 2: 178-185
        • Kweon C.
        • Gagnier J.J.
        • Robbins C.B.
        • Bedi A.
        • Carpenter J.E.
        • Miller B.S.
        Surgical versus nonsurgical management of rotator cuff tears: Predictors of treatment allocation.
        Am J Sports Med. 2015; 43: 2368-2372
        • Ensor K.L.
        • Kwon Y.W.
        • Dibeneditto M.R.
        • Zuckerman J.D.
        • Rokito A.S.
        The rising incidence of rotator cuff repairs.
        J Shoulder Elbow Surg. 2013; 22: 1628-1632
        • Lohr J.F.
        • Uhthoff H.K.
        The microvascular pattern of the supraspinatus tendon.
        Clin Orthop Relat Res. 1990; : 35-38
        • Bishop J.Y.
        • Santiago-Torres J.E.
        • Rimmke N.
        • Flanigan D.C.
        Smoking predisposes to rotator cuff pathology and shoulder dysfunction: A systematic review.
        Arthroscopy. 2015; 31: 1598-1605
        • Lazarides A.L.
        • Alentorn-Geli E.
        • Choi J.H.
        • et al.
        Rotator cuff tears in young patients: A different disease than rotator cuff tears in elderly patients.
        J Shoulder Elbow Surg. 2015; 24: 1834-1843
        • Nho S.J.
        • Yadav H.
        • Shindle M.K.
        • Macgillivray J.D.
        Rotator cuff degeneration: Etiology and pathogenesis.
        Am J Sports Med. 2008; 36: 987-993
        • Dabija D.I.
        • Gao C.
        • Edwards T.L.
        • Kuhn J.E.
        • Jain N.B.
        Genetic and familial predisposition to rotator cuff disease: A systematic review.
        J Shoulder Elbow Surg. 2017; 26: 1103-1112
        • Moor B.K.
        • Rothlisberger M.
        • Muller D.A.
        • et al.
        Age, trauma and the critical shoulder angle accurately predict supraspinatus tendon tears.
        Orthop Traumatol Surg Res. 2014; 100: 489-494
        • 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
        • 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: 800-805
        • Moor B.
        • Bouaicha S.
        • Rothenfluh D.
        • Sukthankar A.
        • Gerber C.
        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 Joint J. 2013; 95: 935-941
        • Cunningham G.
        • Nicodème-Paulin E.
        • Smith M.M.
        • Holzer N.
        • Cass B.
        • Young A.A.
        The greater tuberosity angle: A new predictor for rotator cuff tear.
        J Shoulder Elbow Surg. 2018; 27: 1415-1421
        • DeFranco M.J.
        • Cole B.J.
        Current perspectives on rotator cuff anatomy.
        Arthroscopy. 2009; 25: 305-320
        • 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: 347-351
        • Lee M.
        • Chen J.Y.
        • Liow M.H.L.
        • Chong H.C.
        • Chang P.
        • Lie D.
        Critical shoulder angle and acromial index do not influence 24-month functional outcome after arthroscopic rotator cuff repair.
        Am J Sports Med. 2017; 45: 2989-2994
        • Kirsch J.M.
        • Nathani A.
        • Robbins C.
        • Gagnier J.J.
        • Bedi A.
        • Miller B.S.
        Is there an association between the “critical shoulder angle” and clinical outcome after rotator cuff repair?.
        Orthop J Sports Med. 2016; 4 (2325967117702126)
        • Li H.
        • Chen Y.
        • Chen J.
        • Hua Y.
        • Chen S.
        Large critical shoulder angle has higher risk of tendon retear after arthroscopic rotator cuff repair.
        Am J Sports Med. 2018; 46: 1892-1900
        • Garcia G.H.
        • Liu J.N.
        • Degen R.M.
        • et al.
        Higher critical shoulder angle increases the risk of retear after rotator cuff repair.
        J Shoulder Elbow Surg. 2017; 26: 241-245
        • 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: 2423-2431
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.
        PLoS Med. 2009; 6: e1000100
        • Wells G.
        • Shea B.
        • O’Connell D.
        • et al.
        The Newcastle–Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analysis.
        Ottawa Health Research Institute, Ottawa, Canada2018
        • Neal B.S.
        • Lack S.D.
        • Lankhorst N.E.
        • Raye A.
        • Morrissey D.
        • van Middelkoop M.
        Risk factors for patellofemoral pain: A systematic review and meta-analysis.
        Br J Sports Med. 2018; 53: 270-281
        • Peduzzi P.
        • Concato J.
        • Kemper E.
        • Holford T.R.
        • Feinstein A.R.
        A simulation study of the number of events per variable in logistic regression analysis.
        J Clin Epidemiol. 1996; 49: 1373-1379
        • van Tulder M.
        • Furlan A.
        • Bombardier C.
        • Bouter L.
        Updated method guidelines for systematic reviews in the cochrane collaboration back review group.
        Spine. 2003; 28: 1290-1299
        • Faraone S.V.
        Interpreting estimates of treatment effects: Implications for managed care.
        P t. 2008; 33: 700-711
        • Higgins J.P.
        • Thompson S.G.
        • Deeks J.J.
        • Altman D.G.
        Measuring inconsistency in meta-analyses.
        BMJ. 2003; 327: 557-560
        • Brockwell S.E.
        • Gordon I.R.
        A comparison of statistical methods for meta-analysis.
        Stat Med. 2001; 20: 825-840
        • 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: 1862-1869
        • 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: 178-183
        • Bjarnison A.O.
        • Sorensen T.J.
        • Kallemose T.
        • Barfod K.W.
        The critical shoulder angle is associated with osteoarthritis in the shoulder but not rotator cuff tears: A retrospective case-control study.
        J Shoulder Elbow Surg. 2017; 26: 2097-2102
        • Blonna D.
        • Giani A.
        • Bellato E.
        • et al.
        Predominance of the critical shoulder angle in the pathogenesis of degenerative diseases of the shoulder.
        J Shoulder Elbow Surg. 2016; 25: 1328-1336
        • Chalmers P.N.
        • Salazar D.
        • Steger-May K.
        • Chamberlain A.M.
        • Yamaguchi K.
        • Keener J.D.
        Does the critical shoulder angle correlate with rotator cuff tear progression?.
        Clin Orthop Relat Res. 2017; 475: 1608-1617
        • Chalmers P.N.
        • Beck L.
        • Granger E.
        • Henninger H.
        • Tashjian R.Z.
        Superior glenoid inclination and rotator cuff tears.
        J Shoulder Elbow Surg. 2018; 27: 1444-1450
        • Cherchi L.
        • Ciornohac J.F.
        • Godet J.
        • Clavert P.
        • Kempf J.F.
        Critical shoulder angle: Measurement reproducibility and correlation with rotator cuff tendon tears.
        Orthop Traumatol Surg Res. 2016; 102: 559-562
        • 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
        • Farley T.E.
        • Neumann C.H.
        • Steinbach L.S.
        • Petersen S.A.
        The coracoacromial arch: MR evaluation and correlation with rotator cuff pathology.
        Skeletal Radiol. 1994; 23: 641-645
        • Gill T.J.
        • McIrvin E.
        • Kocher M.S.
        • Homa K.
        • Mair S.D.
        • Hawkins R.J.
        The relative importance of acromial morphology and age with respect to rotator cuff pathology.
        J Shoulder Elbow Surg. 2002; 11: 327-330
        • Gomide L.C.
        • Carmo T.C.D.
        • Bergo G.H.M.
        • Oliveira G.A.
        • Macedo I.S.
        Relationship between the critical shoulder angle and the development of rotator cuff lesions: A retrospective epidemiological study.
        Rev Bras Ortop. 2017; 52: 423-427
        • 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: 1289-1298
        • Heuberer P.R.
        • Plachel F.
        • Willinger L.
        • et al.
        Critical shoulder angle combined with age predict five shoulder pathologies: A retrospective analysis of 1000 cases.
        BMC Musculoskelet Disord. 2017; 18: 259
        • Hirano M.
        • Ide J.
        • Takagi K.
        Acromial shapes and extension of rotator cuff tears: magnetic resonance imaging evaluation.
        J Shoulder Elbow Surg. 2002; 11: 576-578
        • Kongmalai P.
        • Apivatgaroon A.
        • Chernchujit B.
        Morphological classification of acromial spur: Correlation between Rockwood tilt view and arthroscopic finding.
        Sicot J. 2017; 3: 4
        • Kum D.H.
        • Kim J.H.
        • Park K.M.
        • Lee E.S.
        • Park Y.B.
        • Yoo J.C.
        Acromion index in Korean population and its relationship with rotator cuff tears.
        Clin Orthop Surg. 2017; 9: 218-222
        • Miswan M.F.
        • Saman M.S.
        • Hui T.S.
        • Al-Fayyadh M.Z.
        • Ali M.R.
        • Min N.W.
        Correlation between anatomy of the scapula and the incidence of rotator cuff tear and glenohumeral osteoarthritis via radiological study.
        J Orthop Surg (Hong Kong). 2017; 25 (2309499017690317)
        • Miyazaki A.N.
        • Itoi E.
        • Sano H.
        • et al.
        Comparison between the acromion index and rotator cuff tears in the Brazilian and Japanese populations.
        J Shoulder Elbow Surg. 2011; 20: 1082-1086
        • Mohamed R.E.
        • Abo-Sheisha D.M.
        Assessment of acromial morphology in association with rotator cuff tear using magnetic resonance imaging.
        Egyptian J Radiol Nucl Med. 2014; 45: 169-180
        • 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: 536-541
        • Musil D.
        • Sadovsky P.
        • Rost M.
        • Stehlik J.
        • Filip L.
        [Relationship of acromial morphology and rotator cuff tears].
        Acta Chir Orthop Traumatol Cech. 2012; 79: 238-242
        • 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: 1542-1550
        • Pandey V.
        • Vijayan D.
        • Tapashetti S.
        • et al.
        Does scapular morphology affect the integrity of the rotator cuff?.
        J Shoulder Elbow Surg. 2016; 25: 413-421
        • Saygi B.
        • Karahan N.
        • Karakus O.
        • Demir A.I.
        • Ozkan O.C.
        • Soylu-Boy F.N.
        Analysis of glenohumeral morphological factors for anterior shoulder instability and rotator cuff tear by magnetic resonance imaging.
        J Orthop Surg (Hong Kong). 2018; 26 (2309499018768100)
        • Shah S.H.
        • Small K.M.
        • Sinz N.J.
        • Higgins L.D.
        Morphology of the lesser tuberosity and intertubercular groove in patients with arthroscopically confirmed subscapularis and biceps tendon pathology.
        Arthroscopy. 2016; 32: 968-975
        • Shinagawa K.
        • Hatta T.
        • Yamamoto N.
        • et al.
        Critical shoulder angle in an East Asian population: Correlation to the incidence of rotator cuff tear and glenohumeral osteoarthritis.
        J Shoulder Elbow Surg. 2018; 27: 1602-1606
        • 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. 2016; 24: 2244-2251
        • Torrens C.
        • Alentorn-Geli E.
        • Sanchez J.F.
        • Isart A.
        • Santana F.
        Decreased axial coracoid inclination angle is associated with rotator cuff tears.
        J Orthop Surg (Hong Kong). 2017; 25 (2309499017690329)
        • Watanabe A.
        • Ono Q.
        • Nishigami T.
        • Hirooka T.
        • Machida H.
        Differences in risk factors for rotator cuff tears between elderly patients and young patients.
        Acta Med Okayama. 2018; 72: 67-72
        • Yi A.
        • Avramis I.A.
        • Argintar E.H.
        • White E.R.
        • Villacis D.C.
        • Hatch III, G.F.
        Subacromial volume and rotator cuff tears: Does an association exist?.
        Indian J Orthop. 2015; 49: 300-303
        • Hughes R.E.
        • Bryant C.R.
        • Hall J.M.
        • et al.
        Glenoid inclination is associated with full-thickness rotator cuff tears.
        Clin Orthop Relat Res. 2003; 407: 86-91
        • Moor B.K.
        • Kuster R.
        • Osterhoff G.
        • et al.
        Inclination-dependent changes of the critical shoulder angle significantly influence superior glenohumeral joint stability.
        Clin Biomech (Bristol, Avon). 2016; 32: 268-273
        • Miyazaki A.N.
        • Fregoneze M.
        • Santos P.D.
        • et al.
        Radiographic study on the acromion index and its relationship with rotator cuff tears.
        Rev Bras Ortop. 2010; 45: 151-154
        • 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: 1019-1024
        • Bigliani L.
        • Morrison D.S.
        • April E.W.
        The morphology of the acromion and its relationship to rotator cuff tears.
        Orthop Trans. 1986; 10: 228
        • 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
        • Shah N.N.
        • Bayliss N.C.
        • Malcolm A.
        Shape of the acromion: Congenital or acquired--A macroscopic, radiographic, and microscopic study of acromion.
        J Shoulder Elbow Surg. 2001; 10: 309-316
        • Speer K.P.
        • Osbahr D.C.
        • Montella B.J.
        • Apple A.S.
        • Mair S.D.
        Acromial morphotype in the young asymptomatic athletic shoulder.
        J Shoulder Elbow Surg. 2001; 10: 434-437
        • Wang J.C.
        • Shapiro M.S.
        Changes in acromial morphology with age.
        J Shoulder Elbow Surg. 1997; 6: 55-59
        • Nyffeler R.W.
        • Meyer D.C.
        Acromion and glenoid shape: Why are they important predictive factors for the future of our shoulders?.
        EFORT Open Rev. 2017; 2: 141-150
        • Bittencourt N.
        • Meeuwisse W.
        • Mendonça L.
        • Nettel-Aguirre A.
        • Ocarino J.
        • Fonseca S.
        Complex systems approach for sports injuries: Moving from risk factor identification to injury pattern recognition—Narrative review and new concept.
        Br J Sports Med. 2016; 50: 1309-1314
        • Philippe P.
        • Mansi O.
        Nonlinearity in the epidemiology of complex health and disease processes.
        Theor Med Bioeth. 1998; 19: 591-607
        • Deutsch A.
        Arthroscopic repair of partial-thickness tears of the rotator cuff.
        J Shoulder Elbow Surg. 2007; 16: 193-201
        • Ellman H.
        Diagnosis and treatment of incomplete rotator cuff tears.
        Clin Orthop Relat Res. 1990; : 64-74
        • Cordasco F.A.
        • Backer M.
        • Craig E.V.
        • Klein D.
        • Warren R.F.
        The partial-thickness rotator cuff tear: Is acromioplasty without repair sufficient?.
        Am J Sports Med. 2002; 30: 257-260
        • Sano H.
        • Ishii H.
        • Trudel G.
        • Uhthoff H.K.
        Histologic evidence of degeneration at the insertion of 3 rotator cuff tendons: A comparative study with human cadaveric shoulders.
        J Shoulder Elbow Surg. 1999; 8: 574-579
        • Nakajima T.
        • Rokuuma N.
        • Hamada K.
        • Tomatsu T.
        • Fukuda H.
        Histologic and biomechanical characteristics of the supraspinatus tendon: Reference to rotator cuff tearing.
        J Shoulder Elbow Surg. 1994; 3: 79-87
        • 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
        • Fukuda H.
        The management of partial-thickness tears of the rotator cuff.
        J Bone Joint Surg Br. 2003; 85: 3-11
        • Kim S.-J.
        • Kim S.-H.
        • Lim S.-H.
        • Chun Y.-M.
        Use of magnetic resonance arthrography to compare clinical features and structural integrity after arthroscopic repair of bursal versus articular side partial-thickness rotator cuff tears.
        Am J Sports Med. 2013; 41: 2041-2047
        • Xiao J.
        • Cui G.
        Clinical and structural results of arthroscopic repair of bursal-side partial-thickness rotator cuff tears.
        J Shoulder Elbow Surg. 2015; 24: e41-e46
        • Gerber C.
        • Catanzaro S.
        • Betz M.
        • Ernstbrunner L.
        Arthroscopic correction of the critical shoulder angle through lateral acromioplasty: A safe adjunct to rotator cuff repair.
        Arthroscopy. 2018; 34: 771-780
        • Katthagen J.C.
        • Marchetti D.C.
        • Tahal D.S.
        • Turnbull T.L.
        • Millett P.J.
        The effects of arthroscopic lateral acromioplasty on the critical shoulder angle and the anterolateral deltoid origin: an anatomic cadaveric study.
        Arthroscopy. 2016; 32: 569-575
        • Gartsman G.M.
        • O’Connor D.P.
        Arthroscopic rotator cuff repair with and without arthroscopic subacromial decompression: A prospective, randomized study of one-year outcomes.
        J Shoulder Elbow Surg. 2004; 13: 424-426
        • MacDonald P.
        • McRae S.
        • Leiter J.
        • Mascarenhas R.
        • Lapner P.
        Arthroscopic rotator cuff repair with and without acromioplasty in the treatment of full-thickness rotator cuff tears: A multicenter, randomized controlled trial.
        J Bone Joint Surg Am. 2011; 93: 1953-1960
        • Familiari F.
        • Gonzalez-Zapata A.
        • Ianno B.
        • Galasso O.
        • Gasparini G.
        • McFarland E.G.
        Is acromioplasty necessary in the setting of full-thickness rotator cuff tears? A systematic review.
        J Orthop Traumatol. 2015; 16: 167-174
        • Sun Z.
        • Fu W.
        • Tang X.
        • Chen G.
        • Li J.
        Systematic review and Meta-analysis on acromioplasty in arthroscopic repair of full-thickness rotator cuff tears.
        Acta Orthop Belg. 2018; 84: 54-61
        • Higgins J.
        • Green S.
        Handbook for Systematic Reviews of Interventions.
        (version 5.1. 0 [updated March 2011]) The Cochrane Collaboration, London2011

      Linked Article

      • Editorial Commentary: Does the Morphology of the Acromion Explain All Rotator Cuff Tears?
        ArthroscopyVol. 35Issue 12
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          Given the high prevalence of rotator cuff tears and their socioeconomic impact, surgeons and researchers have tried to understand their etiology and pathomechanism for almost hundred years. Articles about tendon degeneration with increasing age dominate the literature, and numerous factors contributing to tendon degeneration have been identified. One of them, the lateral extension of the acromion, as quantitated using the acromion index or the critical shoulder angle, has become very popular in the last few years.
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