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The acromiohumeral distance in the MRI should not be used as a decision criterion to assess subacromial space width in shoulders with an intact rotator cuff

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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Abstract

Purpose

The acromiohumeral distance is in practice often evaluated on MRI by radiologists and a reduction diagnosed as subacromial impingement. However, the acromiohumeral distance as indicator for a decentered glenohumeral joint is defined on a true AP radiograph with the patient standing or sitting. The present study therefore evaluated the influence of the patient position by comparing the acromiohumeral distance in both modalities in shoulders with an intact rotator cuff.

Methods

On MRI images and true AP radiographs of patients > 20 and < 80 years with an intact rotator cuff the acromiohumeral distance was measured. The maximum cranio-caudal size of the glenoid was measured as a reference to allow a direct comparison of both modalities.

Results

Two-hundred and thirty-four shoulders (mean patients age 45.8 ± 14.3 years) were included. The mean acromiohumeral distance/glenoid size ratio of all shoulders was significantly larger (P < 0.0001) on the MRI with 4.6 ± 1.0 in comparison to 4.1 ± 0.9 in the radiographs indicating a smaller acromiohumeral distance on the MRI. In absolute values, a mean acromiohumeral distance of 9.2 mm ± 1.8 on MRI in comparison to 10.4 mm ± 2.4 on the radiographs was calculated. Herewith, the acromiohumeral distance in the MRI was in the average 1.2 mm ± 2.1 (13%) smaller than the in corresponding radiographs (P < 0.0001).

Conclusion

The acromiohumeral distance is significantly smaller in the MRI in comparison to AP radiographs in shoulders with an intact rotator cuff and should not be used as a decision criterion on MRI to assess glenohumeral centering or subacromial space width.

Level of evidence

IV.

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Authors and Affiliations

  1. Department of Orthopaedics and Trauma Surgery, Medical Faculty, University of Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany

    Martin Hufeland, Christina Brusis, Hannes Kubo, Jan Grassmann & David Latz

  2. Department of Orthopaedics and Trauma Surgery, Schoenklinik Düsseldorf, Am Heerdter Krankenhaus 2, 40549, Düsseldorf, Germany

    Thilo Patzer

Authors
  1. Martin Hufeland
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  2. Christina Brusis
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  3. Hannes Kubo
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  4. Jan Grassmann
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  5. David Latz
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  6. Thilo Patzer
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Correspondence to Hannes Kubo.

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The authors declare that they have no conflicts of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (registration no. 2019-563) and with the 1975 Helsinki Declaration and its later amendments or comparable ethical standards.

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Hufeland, M., Brusis, C., Kubo, H. et al. The acromiohumeral distance in the MRI should not be used as a decision criterion to assess subacromial space width in shoulders with an intact rotator cuff. Knee Surg Sports Traumatol Arthrosc 29, 2085–2089 (2021). https://doi.org/10.1007/s00167-020-06090-6

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  • DOI: https://doi.org/10.1007/s00167-020-06090-6

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