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Arch Orthop Trauma Surg. 2016 Jun;136(6):799-804. doi: 10.1007/s00402-016-2431-y. Epub 2016 Feb 26.

Arthroscopic lateral acromion resection (ALAR) optimizes rotator cuff tear relevant scapula parameters.

Author information

1
Sporthopaedicum Regensburg, Hildegard-von-Bingen-Str. 1, 93053, Regensburg, Germany.
2
Sporthopaedicum Regensburg, Hildegard-von-Bingen-Str. 1, 93053, Regensburg, Germany. greiner@sporthopaedicum.de.

Abstract

BACKGROUND:

The acromion index (AI), critical shoulder angle (CSA) and lateral acromion angle (LAA) are predictive for degenerative rotatory cuff tears. Their unfavorable values are associated with a suboptimal deltoid force vector. The aim of this study was to evaluate whether an optimization of the radiological parameters could be achieved through a specific arthroscopic lateral acromion resection (ALAR).

MATERIALS AND METHODS:

The procedure was performed in eight fresh frozen cadaver shoulders. True a.p. and axial radiographs were taken before and after the intervention for radiological evaluation. The anterior and posterior acromion edges were marked with a spinal needle. Then 1 cm of the lateral acromion was resected with a 5.0 acromionizer (Arthrex Inc., Naples, FL, USA) beginning from the anterior aspect. The resection was completed over the total width of 1 cm from anterior to posterior. Finally the deltoid insertion was dissected via an open approach to ensure its integrity. The fluoroscopy images were evaluated regarding the pre- and postinterventional parameters AI, CSA and LAA.

RESULTS:

After the intervention, the mean AI could be significantly reduced from 0.62 ± 0.11 to 0.40 ± 0.15 (p = 0.012). Also the mean CSA was significantly reduced from 35.0° ± 7.65° to 25.12° ± 8.29° (p = 0.018). The LAA could not be significantly changed (76.5° ± 14.02° vs. 82.13 ± 8.93; p = 0.107). There was no injury to the deltoid insertion.

CONCLUSION:

The radiographic parameters AI und CSA can be optimized significantly by ALAR without macroscopic discontinuity of the deltoid insertion.

LEVEL OF EVIDENCE:

Level IV, case series without comparison group.

KEYWORDS:

Acromial morphology; Acromion index; Arthroscopic acromion resection; Critical shoulder angle; Lateral acromion angle; Rotator cuff disease; Scapular anatomy

PMID:
26920400
DOI:
10.1007/s00402-016-2431-y
[Indexed for MEDLINE]

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