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J Shoulder Elbow Surg. 2016 Mar;25(3):413-21. doi: 10.1016/j.jse.2015.09.016. Epub 2015 Dec 2.

Does scapular morphology affect the integrity of the rotator cuff?

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Department of Orthopaedics, Kasturba Medical College, Manipal, Karnataka, India. Electronic address:
Department of Orthopaedics, Kasturba Medical College, Manipal, Karnataka, India.
Community Medicine and Statistics, Kasturba Medical College, Manipal, Karnataka, India.
Department of Radiodiagnosis, Kasturba Medical College, Manipal, Karnataka, India.
Shoulder Unit, Lairesse Kliniek, Amsterdam, The Netherlands.



Current evidence suggests that distinct scapular morphologies may predispose patients to a rotator cuff tear. The objective of this longitudinal study was to evaluate the relationship between symptomatic degenerative cuff tears and different radiographic acromial characteristics, including acromion shape, indices (acromial index [AI], critical shoulder angle [CSA]), and acromial spur.


We divided 166 patients into 3 groups matched for age and sex: group 1, degenerative full-thickness tear; group 2, partial thickness bursal tear; and group 3, normal cuff. Patients were evaluated with standard radiographs and ultrasonography.


The presence of an acromial spur was strongly associated with a full-thickness cuff tear (odds ratio, 3.5; P = .001). AI and CSA revealed a statistically significant difference between means of group 1 (P = .006) and group 3 (P < .001). There was no statistically significant difference in means of AI between groups 1 and 2 (P = .695) and between groups 2 and 3, with respect to AI (P = .071) and CSA (P = .125). Receiver operating characteristic curve revealed a higher area for CSA (0.70) than for AI (0.61). Stepwise logistic regression rejected AI as a cuff tear predictor but confirmed CSA and a spur to be stronger predictors of a full-thickness cuff tear. There was no association between the Bigliani acromial type and rotator cuff tear (P = .06).


The presence of an acromion spur is strongly associated with full-thickness cuff tear. Higher AI and CSA are associated with a full-thickness tear but not with partial tears. The type of acromion is not related to cuff tear.


Scapular morphology; acromion; acromion index; acromion shape; acromion spur; critical shoulder angle; degenerative tear; rotator cuff

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