Is There an Association Between the "Critical Shoulder Angle" and Clinical Outcome After Rotator Cuff Repair?
Is There an Association Between the "Critical Shoulder Angle" and Clinical Outcome After Rotator Cuff Repair?
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DOI：
10.1177/2325967117702126
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发表时间：
2017-04-18
影响因子：
2.6
通讯作者：
Miller, Bruce S.
中科院分区：
文献类型：
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作者：
Kirsch, Jacob M.;Nathani, Amit;Miller, Bruce S.
背景：肩胛形态的变化与非创伤性肩袖撕裂（RCT）的发生有关。临界肩角（CSA）解释了肩胛盂的倾斜和肩峰的横向延伸。先前尚未研究过 CSA 对肩袖修复 (RCR) 后结果的影响l。假设：我们的假设是，随着时间的推移，与 CSA 较大的个体相比，CSA 较小的个体将获得更好的患者报告结果评分。理论上，较小的 CSA 可以最大限度地减少生物力学力，有利于肱骨头的更好平移，这在 RCR 后可能是有利的。这是第一个研究 RCR 后 CSA 与临床结果之间关系的研究。研究设计：队列研究；证据级别，2。方法：对 53 名接受关节镜 RCR 的无创伤性全层 RCT 患者（平均年龄 61 岁）进行前瞻性评估。在术后直至 24 个月的不同时间点前瞻性收集人口统计数据以及西安大略肩袖指数 (WORC) 评分、美国肩肘外科医生 (ASES) 评分以及疼痛视觉模拟量表 (VAS)。统计分析包括纵向多级回归模型，以调查 CSA 与 WORC、ASES 和 VAS 评分之间的关联。结果：通过 WORC、ASES 和 VAS 测量的总体临床结果显着改善 (P < .0001)。控制人口和临床特征后，多级回归分析表明，CSA 并不是关节镜 RCR 术后 24 个月时 WORC (P = .581)、ASES (P = .458) 或 VAS (P = .859) 评分变化的显着独立预测因子。 CSA 测量的观察者间和观察者内可靠性导致组间相关系数分别为 0.986 和 0.982 (P < .001)，表明非常一致。结论：CSA 似乎并不是非创伤性全层 RCT 关节镜修复后患者报告结果的显着预测因子。
Background: Variations in scapular morphology have been associated with the development of atraumatic rotator cuff tears (RCTs). The critical shoulder angle (CSA) accounts for both glenoid inclination and lateral extension of the acromion. The impact of the CSA on outcomes after rotator cuff repair (RCR) has not been investigated previousl.Hypothesis: Our hypothesis was that individuals with smaller CSAs will have better patient-reported outcome scores over time compared with those with larger CSAs. Theoretically, a smaller CSA minimizes the biomechanical forces favoring superior translation of the humeral head, which may be advantageous after RCR. This is the first study to examine the relationship between the CSA and clinical outcomes after RCR.Study Design: Cohort study; Level of evidence, 2.Methods: Fifty-three patients (mean age, 61 years) with atraumatic full-thickness RCTs who underwent arthroscopic RCR were prospectively evaluated. Demographic data as well as the Western Ontario Rotator Cuff Index (WORC) score, American Shoulder and Elbow Surgeons (ASES) score, and a visual analog scale (VAS) for pain were prospectively collected at various time points up to 24 months postoperatively. Statistical analysis included longitudinal multilevel regression modeling to investigate the association between the CSA and the WORC, ASES, and VAS scores.Results: The overall clinical outcome, as measured by the WORC, ASES, and VAS, improved significantly (P < .0001). Controlling for demographic and clinical characteristics, a multilevel regression analysis demonstrated that the CSA was not a significant independent predictor for change in WORC (P = .581), ASES (P = .458), or VAS (P = .859) scores at 24 months after arthroscopic RCR. Interobserver and intraobserver reliability for CSA measurements resulted in interclass correlation coefficients of 0.986 and 0.982, respectively (P < .001), indicating excellent agreement.Conclusion: The CSA did not appear to be a significant predictor of patient-reported outcomes after arthroscopic repair of atraumatic full-thickness RCTs.