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Are bursal-sided supraspinatus tendon lesions caused by subacromial impingement?

A radiological matched-pair analysis

Werden bursalseitige Supraspinatussehnenläsionen durch subakromiales Impingement verursacht?

Eine radiologische Matched-Pair-Analyse

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Abstract

Background

Mechanical outlet impingement is believed to be a significant factor in the pathogenesis of bursal-sided supraspinatus (SSP) tendon partial tear, a rare and poorly described entity. This relationship has not yet been confirmed.

Objective

We compared the radiological impingement parameters between complete, isolated SSP tears and bursal-sided SSP tears. The study hypothesis was that the impingement parameters in the bursal-sided SSP tear group would be significantly more pronounced.

Materials and methods

In total, 43 patients with bursal-sided SSP tendon partial tear (group 1; n = 43) and 43 patients with complete, isolated SSP tendon tear (group 2; n = 43) were included and matched for age (groups 1 and 2: 58 ± 9 years) and gender (70% male and 30% female patients). Standardized preoperative radiographs (anteroposterior; outlet view) were compared for radiological impingement parameters: critical shoulder angle (CSA), lateral acromial angle (LAA), acromiohumeral index (AHI), acromiohumeral distance (AHD), acromion type according to Bigliani (ATB).

Results

Radiological parameters did not differ significantly between groups: CSA: 36° ± 4° (group 1) and 36° ± 4° (group 2); LAA: 79° ± 6° vs. 80° ± 8°; AHD: 11 mm ± 2 mm vs. 10 mm ± 2 mm. The AHI was 0.7 ± 0.1 for both groups. Furthermore, ATB II was most common in both groups (group 1 = 74%; group 2 = 63%), followed by ATB I (group 1 = 14%; group 2 = 23%) and ATB III (group 1 = 12%; group 2 = 14%; p = 0.443).

Conclusion

We found no difference in radiological impingement parameters between bursal-sided and complete SSP tears and therefore reject the study hypothesis. Mechanical outlet impingement does not seem to play a greater role in the development of bursal-sided lesions compared to complete SSP lesions.

Zusammenfassung

Hintergrund

Das mechanische Outlet-Impingement (MOI) wird als ein bedeutender Faktor bei der Pathogenese von Partialrupturen der bursaseitigen Supraspinatussehne (SSP) betrachtet. Allerdings wurde dieser Zusammenhang bisher nicht bestätigt.

Ziel

Ziel der vorliegenden Arbeit war ein Vergleich der radiologischen Impingement-Parameter von Patienten mit vollständigen, isolierten SSP-Läsionen mit denen von Patienten mit bursaseitigen SSP-Läsionen. Die Studienhypothese bestand darin, dass die Impingement-Parameter in der Gruppe mit bursaseitigen SSP-Rupturen signifikant ausgeprägter sein würden.

Material und Methoden

In diese Studie wurden 43 Patienten mit bursaseitigen SSP-Partialläsionen (Gruppe 1; n = 43) und 43 Patienten mit vollständigen, isolierten Läsionen der SSP-Sehne (Gruppe 2; n = 43) einbezogen. Die Patienten wurden hinsichtlich des Alters (Gruppe 1 und 2: 58 ± 9 Jahre) und Geschlechts (70 % männlich, 30 % weiblich) gematcht. Die standardisierten präoperativen Röntgenaufnahmen (a.-p.- und Outlet-Aufnahme) wurden hinsichtlich folgender radiologischer Impingement-Parameter verglichen: kritischer Schulterwinkel (CSA), lateraler Akromialwinkel (LAA), Akromiohumeralindex (AHI), Akromiohumeralabstand (AHD) und Akromiontyp nach Bigliani (ATB).

Ergebnisse

Die radiologischen Parameter unterschieden sich nicht signifikant (p = 0,371): Der CSA betrug 36° ± 4° in Gruppe 1 und 36° ± 4° in Gruppe 2. Der LAA betrug 79° ± 6° vs. 80° ± 8° in Gruppe 1 und 2, der AHD betrug 11 mm ± 2 mm vs. 10 mm ± 2 mm, und der AHI lag bei 0,70 ± 0,1 in beiden Gruppen. Ein ATB II war der häufigste beobachtete Typ in beiden Gruppen (Gruppe 1 = 74 %, Gruppe 2 = 63 %), gefolgt von ATB I (Gruppe 1 = 14 %, Gruppe 2 = 23 %) und ATB III (Gruppe 1 = 12 %, Gruppe 2 = 14 %). Dieser Unterschied war statistisch nicht signifikant (p = 0,443).

Schlussfolgerung

Es fand sich kein Unterschied in den radiologischen Impingement-Parametern zwischen bursaseitigen und vollständigen SSP-Läsionen, daher verwerfen die Autoren die Studienhypothese. MOI scheint keine größere Rolle bei der Entwicklung von bursaseitigen im Vergleich zu vollständigen SSP-Läsionen zu spielen.

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Authors and Affiliations

  1. Deutsches Gelenkzentrum Heidelberg, Atos Klinik Heidelberg, Bismarckstraße 9, 69115, Heidelberg, Germany

    Sebastian Fromm,  Sven Lichtenberg MD,  Markus Loew MD PhD &  Marc Schnetzke MD PhD

  2. Schulterzentrum München, Törringstraße 6, 81675, Munich, Germany

    Peter Habermeyer MD PhD

  3. Kaiserstr. 51, 69115, Heidelberg, Germany

    Sebastian Fromm

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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by SF. The first draft of the manuscript was written by SF and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Fromm, S., Lichtenberg, S., Loew, M. et al. Are bursal-sided supraspinatus tendon lesions caused by subacromial impingement?. Obere Extremität (2024). https://doi.org/10.1007/s11678-024-00795-7

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