CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(05): e719-e726
DOI: 10.1055/s-0043-1776136
Artigo Original | Original Article
Ombro e Cotovelo

MRI is a Reliable Method for Measurement of Critical Shoulder Angle and Acromial Index

Article in several languages: português | English
1   Professor adjunto, Departamento de Ortopedia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
2   Cirurgião ortopédico, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
,
Erika Naliato
1   Professor adjunto, Departamento de Ortopedia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
,
Roberto Oliveira
3   Cirurgião ortopédico, ex-membro do Grupo de Ombro e Cotovelo do Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
,
Leonardo Tadeu do Carmo
3   Cirurgião ortopédico, ex-membro do Grupo de Ombro e Cotovelo do Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
,
César Rubens da Costa Fontenelle
1   Professor adjunto, Departamento de Ortopedia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
,
Geraldo da Rocha Motta Filho
2   Cirurgião ortopédico, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
› Author Affiliations
Financial Support The present survey has not received any specific funding from public, commercial, or not-for-profit funding agencies.

Abstract

Objective The objectives of this study are to compare absolute values of acromial index (AI) and critical shoulder angle (CSA) obtained in both radiographs and magnetic resonance image (MRI) of the shoulder; and to compare the interobserver and intra-observer agreement for AI and CSA values measured in these image modalities.

Methods Patients who had medical indication of investigating shoulders conditions through radiographs and MRI were included. Images were taken to two fellowship-trained shoulder surgeons, which conducted measurements of AI and CSA in radiographs and in MRI. Twelve weeks after the first evaluation, a second evaluation was conducted. Inter- and intra-observer reliability was presented as an Intraclass Correlation Coefficient (ICC) and agreement was classified according to Landis & Koch criteria. The differences between two measurements were evaluated using Bland-Altman plots.

Results 134 shoulders in 124 subjects were included. Mean intra-observer ICC for CSA in X-rays and in MRI were 0.936 and 0.940, respectively; for AI, 0.908 and 0.022. Mean inter-observer ICC for CSA were 0.892 and 0.752 in X-rays and MRI respectively; for AI, ICC values were 0.849 and 0.685. All individual analysis reached statistical power (p < 0.001). Mean difference for AI values measured in X-rays and in MRI was 0.01 and 0.03 for observers 1 and 2, respectively. Mean difference for CSA values obtained in X-rays and MRI was 0.16 and 0.58 for observers 1 and 2, respectively.

Conclusion Both MRI and X-rays provided high intra- and interobserver agreement for measurement of AI and CSA. Absolute values found for AI and CSA were highly correlated in both image modalities. These findings suggest that MRI is a suitable method to measure AI and CSA.

Level of Evidence II, Diagnostic Study.

Work developed in the National Institute of Trauma and Orthopedics Rio de Janeiro, RJ, Brazil.




Publication History

Received: 19 March 2023

Accepted: 05 May 2023

Article published online:
30 October 2023

© 2023. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 
  • Referências

  • 1 Maffulli N, Longo UG, Berton A, Loppini M, Denaro V. Biological factors in the pathogenesis of rotator cuff tears. Sports Med Arthrosc Rev 2011; 19 (03) 194-201
  • 2 Sayampanathan AA, Andrew THC. Systematic review on risk factors of rotator cuff tears. J Orthop Surg (Hong Kong) 2017; 25 (01) 2309499016684318
  • 3 Morikawa D, Itoigawa Y, Nojiri H. et al. Contribution of oxidative stress to the degeneration of rotator cuff entheses. J Shoulder Elbow Surg 2014; 23 (05) 628-635
  • 4 Figueiredo EA, Loyola LC, Belangero PS. et al. Rotator cuff tear susceptibility is associated with variants in genes involved in tendon extracellular matrix homeostasis. J Orthop Res 2020; 38 (01) 192-201
  • 5 Assunção JH, Godoy-Santos AL, Dos Santos MCLG, Malavolta EA, Gracitelli MEC, Ferreira Neto AA. Matrix metalloproteases 1 and 3 promoter gene polymorphism is associated with rotator cuff tear. Clin Orthop Relat Res 2017; 475 (07) 1904-1910
  • 6 Tashjian RZ, Kim SK, Roche MD, Jones KB, Teerlink CC. Genetic variants associated with rotator cuff tearing utilizing multiple population-based genetic resources. J Shoulder Elbow Surg 2021; 30 (03) 520-531
  • 7 Bishop JY, Santiago-Torres JE, Rimmke N, Flanigan DC. Smoking Predisposes to rotator cuff pathology and shoulder dysfunction: A systematic review. Arthroscopy 2015; 31 (08) 1598-1605
  • 8 Lundgreen K, Lian OB, Scott A, Nassab P, Fearon A, Engebretsen L. Rotator cuff tear degeneration and cell apoptosis in smokers versus nonsmokers. Arthroscopy 2014; 30 (08) 936-941
  • 9 Huang SW, Wang WT, Chou LC, Liou TH, Chen YW, Lin HW. Diabetes mellitus increases the risk of rotator cuff tear repair surgery: A population-based cohort study. J Diabetes Complications 2016; 30 (08) 1473-1477
  • 10 Passaretti D, Candela V, Venditto T, Giannicola G, Gumina S. Association between alcohol consumption and rotator cuff tear. Acta Orthop 2016; 87 (02) 165-168
  • 11 Neer II CS. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am 1972; 54 (01) 41-50
  • 12 Bigliani LU, Morrison DSAE. The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans 1986; 10: 216
  • 13 Nyffeler RW, Werner CM, Sukthankar A, Schmid MR, Gerber C. Association of a large lateral extension of the acromion with rotator cuff tears. J Bone Joint Surg Am 2006; 88 (04) 800-805
  • 14 Moor BK, Bouaicha S, Rothenfluh DA, 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-B (07) 935-941
  • 15 Li X, Olszewski N, Abdul-Rassoul H, Curry EJ, Galvin JW, Eichinger JK. Relationship Between the Critical Shoulder Angle and Shoulder Disease. JBJS Rev 2018; 6 (08) e1
  • 16 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 (02) 178-183
  • 17 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 (08) 1328-1336
  • 18 Gomide LC, Carmo TCD, Bergo GHM, Oliveira GA, Macedo IS. Relationship between the critical shoulder angle and the development of rotator cuff lesions: a retrospective epidemiological study. Rev Bras Ortop 2017; 52 (04) 423-427
  • 19 Heuberer PR, 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 (01) 259
  • 20 Kaur R, Dahuja A, Garg S, Bansal K, Garg RS, Singh P. Correlation of acromial morphology in association with rotator cuff tear: a retrospective study. Pol J Radiol 2019; 84: e459-e463
  • 21 Moor BK, Röthlisberger M, Müller DA. et al. Age, trauma and the critical shoulder angle accurately predict supraspinatus tendon tears. Orthop Traumatol Surg Res 2014; 100 (05) 489-494
  • 22 Park HB, Gwark JY, Kwack BH, Na JB. Are any radiologic parameters independently associated with degenerative postero-superior rotator cuff tears?. J Shoulder Elbow Surg 2021; 30 (08) 1856-1865
  • 23 Seo J, Heo K, Kwon S, Yoo J. Critical shoulder angle and greater tuberosity angle according to the partial thickness rotator cuff tear patterns. Orthop Traumatol Surg Res 2019; 105 (08) 1543-1548
  • 24 Smith GCS, Liu V, Lam PH. The critical shoulder angle shows a reciprocal change in magnitude when evaluating symptomatic full-thickness rotator cuff tears versus primary glenohumeral osteoarthritis as compared with control subjects: A systematic review and meta-analysis. Arthroscopy 2020; 36 (02) 566-575
  • 25 Stamiris D, Stamiris S, Papavasiliou K, Potoupnis M, Tsiridis E, Sarris I. Critical shoulder angle is intrinsically associated with the development of degenerative shoulder diseases: A systematic review. Orthop Rev (Pavia) 2020; 12 (01) 8457
  • 26 Docter S, Khan M, Ekhtiari S. et al. The relationship between the critical shoulder angle and the incidence of chronic, full-thickness rotator cuff tears and outcomes after rotator cuff repair: A systematic review. Arthroscopy 2019; 35 (11) 3135-3143.e4
  • 27 Garcia GH, Liu JN, Degen RM. et al. Higher critical shoulder angle increases the risk of retear after rotator cuff repair. [published correction appears in J Shoulder Elbow Surg. 2017;26(4):732] J Shoulder Elbow Surg 2017; 26 (02) 241-245
  • 28 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 (08) 1892-1900
  • 29 Scheiderer B, Imhoff FB, Johnson JD. et al. Higher critical shoulder angle and acromion index are associated with increased retear risk after isolated supraspinatus tendon repair at short-term follow up. Arthroscopy 2018; 34 (10) 2748-2754
  • 30 Sheean AJ, Sa D, Woolnough T, Cognetti DJ, Kay J, Burkhart SS. Does an increased critical shoulder angle affect re-tear rates and clinical outcomes following primary rotator cuff repair? A systematic review. Arthroscopy 2019; 35 (10) 2938-2947.e1
  • 31 Suter T, Gerber Popp A, Zhang Y, Zhang C, Tashjian RZ, Henninger HB. The influence of radiographic viewing perspective and demographics on the critical shoulder angle. J Shoulder Elbow Surg 2015; 24 (06) e149-e158
  • 32 Tang Y, Hou J, Li Q. et al. The effectiveness of using the critical shoulder angle and acromion index for predicting rotator cuff tears: accurate diagnosis based on standard and nonstandard anteroposterior radiographs. Arthroscopy 2019; 35 (09) 2553-2561
  • 33 Kim JH, Gwak HC, Kim CW, Lee CR, Kwon YU, Seo HW. Difference of Critical Shoulder Angle (CSA) according to minimal rotation: Can minimal rotation of the scapula be allowed in the evaluation of CSA?. Clin Orthop Surg 2019; 11 (03) 309-315
  • 34 Iannotti JP, Zlatkin MB, Esterhai JL, Kressel HY, Dalinka MK, Spindler KP. Magnetic resonance imaging of the shoulder. Sensitivity, specificity, and predictive value. J Bone Joint Surg Am 1991; 73 (01) 17-29
  • 35 Spiegl UJ, Horan MP, Smith SW, Ho CP, Millett PJ. 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 (07) 2244-2251
  • 36 İncesoy MA, Yıldız KI, Türk ÖI. et al. The critical shoulder angle, the acromial index, the glenoid version angle and the acromial angulation are associated with rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 2021; 29 (07) 2257-2263
  • 37 Landis JR, Koch GG. An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 1977; 33 (02) 363-374
  • 38 Chalmers PN, Salazar D, Steger-May K, Chamberlain AM, Yamaguchi K, Keener JD. Does the critical shoulder angle correlate with rotator cuff tear progression?. Clin Orthop Relat Res 2017; 475 (06) 1608-1617
  • 39 Karns MR, Jacxsens M, Uffmann WJ, Todd DC, Henninger HB, Burks RT. The critical acromial point: the anatomic location of the lateral acromion in the critical shoulder angle. J Shoulder Elbow Surg 2018; 27 (01) 151-159