ShoulderRelationship of radiographic acromial characteristics and rotator cuff disease: a prospective investigation of clinical, radiographic, and sonographic findings
Section snippets
Study subjects
Data for this investigation were obtained as a separate, specific aim of an ongoing prospective, longitudinal study of asymptomatic rotator cuff tears. To be included into this prospective study, patients had to have (1) presented for bilateral shoulder ultrasonography at our institution for investigation of unilateral shoulder pain secondary to rotator cuff disease, (2) been discovered to have a partial or full-thickness rotator cuff tear in the asymptomatic shoulder, (3) no history of trauma
Study subjects and tear characteristics
The analysis consisted of 216 subjects who were an average age of 64.8 ± 10 years (range, 37.1-90.2 years); of these, 123 had full-thickness rotator cuff tears, 46 had partial-thickness tears, and 47 had no rotator cuff tear (control) at the most recent surveillance visit. The average age was 62.8 ± 10 years for the patients with an intact rotator cuff or partial-thickness tear, and 66.2 ± 10 years for patients with a full-thickness tear (P = .01). Of the 216 study subjects, 88 (41%) were
Discussion
The acromion has been implicated in the pathogenesis of rotator cuff disease for many years. Neer24 investigated the mechanism of impingement and described a focal, critical area of contact between the supraspinatus tendon and the undersurface of the anterolateral acromion. Further cadaveric investigations showed a close relationship between acromial shape and rotator cuff disease.4, 23 These findings led to the widespread use of partial anterior acromioplasty to treat rotator cuff disease, and
Conclusions
The presence of an acromial spur at the acromial insertion of the coracoacromial ligament is highly associated with the presence of a full-thickness rotator cuff tear in both symptomatic and asymptomatic subjects, even after controlling for confounding variables such as age and sex. Spurs measuring greater than 5 mm are associated with larger rotator cuff tears. Acromial morphology is an unreliable classification system with poor interobserver reliability. The acromial index is associated with
Acknowledgments
The authors thank Tomoyuki Mochizuki, MD, and Chanteak Lim, MD, for their invaluable contributions to this study.
Disclaimer
The funding source for this study was an R01 grant (AR051026-01A1) from the National Institutes of Health.
Dr Yamaguchi receives royalties from Tornier, which is unrelated to the subject of this article. The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
References (41)
- et al.
The relationship of acromial architecture to rotator cuff disease
Clin Sports Med
(1991) - et al.
Acromial spur formation in patients with rotator cuff tears
J Shoulder Elbow Surg
(2003) - et al.
Anterior acromioplasty: effect of litigation and workers' compensation
J Shoulder Elbow Surg
(1995) - et al.
The relative importance of acromial morphology and age with respect to rotator cuff pathology
J Shoulder Elbow Surg
(2002) - et al.
Inhomogeneous mechanical behavior of the human supraspinatous tendon under axial loading
J Orthop Res
(2005) - et al.
Reliability of radiographic assessment of acromial morphology
J Shouder Elbow Surg
(1995) - et al.
Asymptomatic rotator cuff tears: patient demographics and baseline shoulder function
J Shoulder Elbow Surg
(2010) - et al.
Roentgenographic assessment of acromial morphologic condition in rotator cuff impingement syndrome
J Shoulder Elbow Surg
(1995) - et al.
Acromial spur: relationship to aging and morphologic changes in the rotator cuff
J Shoulder Elbow Surg
(2005) - et al.
Acromial structure and tears of the rotator cuff
J Shoulder Elbow Surg
(1995)
The influence of the acromial coverage index in rotator cuff tears
J Shoulder Elbow Surg
Interobserver reliability of acromial morphology classification: an anatomic study
J Shoulder Elbow Surg
Clinical application for measuring the slope of the acromion
Microcirculation associated with degenerative rotator cuff lesions: in vivo assessment with orthogonal polarization spectral imaging during arthroscopy of the shoulder
J Bone Joint Surg Am
Anterior acromioplasty for subacromial impingement in patients younger than 40 years of age
Clin Orthop Relat Res
The morphology of the acromion and its relationship to rotator cuff tears
Orthop Trans
Reliability of radiographic evaluation for acromial morphology
Skeletal Radiol
Rare lesions of the shoulder
Hooked acromion: prevalence on MR images of painful shoulders
Radiology
Pathology and pathogenesis of bursal-side rotator cuff tears viewed from en block histologic sections
Clin Orthop Relat Res
Cited by (90)
Update on Diagnostic Imaging of the Rotator Cuff
2023, Clinics in Sports MedicineAre critical shoulder angle and acromion index correlated to the size of a rotator cuff tear
2022, Orthopaedics and Traumatology: Surgery and ResearchCitation Excerpt :Although partial bursal-side tears thought to be related with extrinsic factors, these results may show us that higher AI might be related with full thickness RCT rather than partial bursal side tears. On the other hand, Hamid et al. stated that the presence of an acromial spur was highly associated with full thickness RCT (p = 0.003), and they did not find any association between AI and RCT (p = 0.92) [22]. Moor et al. found greater AI and CSA in full-thickness RCT than intact RC patients.
Sharpened lateral acromion morphology (SLAM sign) as an indicator of rotator cuff tear: a retrospective matched study
2021, JSES InternationalCitation Excerpt :This sign shows correlation with cuff tears and compares well with the 2 most commonly used radiological parameters in relation to RCTs in current practice; type III acromion and high CSA. Similar to previously published literature,1,3,5,10,20,27 the present study also found greater incidence of a high CSA and type III acromion in the RCT group than in the control group. However, these parameters are also observed in the non-RCT patients.
The biomechanics of the rotator cuff in health and disease – A narrative review
2021, Journal of Clinical Orthopaedics and TraumaAcromial morphology is not associated with rotator cuff tearing or repair healing
2020, Journal of Shoulder and Elbow Surgery
This study was approved by the Washington University Human Research Protection Office (Investigational Review Board #201103230).