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How much acromial bone should be removed to decrease the critical shoulder angle? A 3D CT acromioplasty planning study

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

A high critical shoulder angle (CSA) is associated with rotator cuff tear (RCT) and retear rate after repair. CSA reduced to less than 33° by acromioplasty is correlated with better clinical results and healing. But up to 24% of patients retain a CSA above 35° after acromioplasty. The objective of the study was to evaluate the use of 3D when planning acromioplasty and measure acromial bone removal volume dimensions.

Methods

Computed tomography (CT) scans from 45 patients with RCT and CSA ≥ 38° were retrospectively included. A 33° CSA cutting plane was positioned. Acromion was divided into 5 mm slices and acromial bone resection measured on each slice.

Results

Intra- and inter-observer reproducibility measurements were rated strong or very strong. Patients’ mean preoperative CSA was 40° (38°, 49° ± 2.3°). Measurements of acromial resection were: anteroposterior length: 32.7 mm (20, 50 ± 7.4); inferior width: 7.6 mm (4.2, 19 ± 2.9); superior width: 4.1 mm (0, 16 ± 3.0); height: 6.1 mm (1.7, 6.7 ± 1.6); and cutting angle: 74° (46, 91 ± 8.0). Maximum width of acromial resection was located 10.6 mm (5, 17.5 ± 0.6) from the acromion’s anterior edge and decreased gradually moving posteriorly. Preoperative CSA was linearly correlated with width (P < 0.0001, R = 84%) and length (P = 0.0001, R = 28%) of acromioplasty; the higher the CSA, the greater the width and length.

Conclusions

3D CT reconstructions are valid for planning a CSA decreasing acromioplasty. To reduce CSA to 33°, acromioplasty must be performed anterolaterally and resection is at least 2 cm long anteroposteriorly. For higher CSAs, acromioplasty may require lateral resection over 1 cm in width and up to 5 cm in length. To decrease the CSA efficiently, acromioplasty must be adapted to patient anatomy and 3D planning could be considered.

Level of evidence

IV

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Acknowledgements

Editorial support was provided by Ingrid Shepherd PhD and Mark English PhD of Bellbird Medical Communications Ltd.

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Authors and Affiliations

  1. Clinique du Sport, 2 rue Georges Negrevergne, 33700, Mérignac, France

    Anselme Billaud & Yacine Carlier

  2. CHU Pellegrin, Bordeaux, France

    Paul M. Lacroix

  3. Centre d’Imagerie Ostéo-Articulaire, 2 rue Georges Negrevergne, 33700, Mérignac, France

    Lionel Pesquer

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  1. Anselme Billaud
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  3. Yacine Carlier
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  4. Lionel Pesquer
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Correspondence to Anselme Billaud.

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Billaud, A., Lacroix, P.M., Carlier, Y. et al. How much acromial bone should be removed to decrease the critical shoulder angle? A 3D CT acromioplasty planning study. Arch Orthop Trauma Surg 142, 3909–3915 (2022). https://doi.org/10.1007/s00402-021-04292-2

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  • DOI: https://doi.org/10.1007/s00402-021-04292-2

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