Archives of orthopaedic and trauma surgery · 2016
Arthroscopic lateral acromion resection (ALAR) optimizes rotator cuff tear relevant scapula parameters.
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Altintas Burak, Kääb Max, Greiner Stefan
Аннотация
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.
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.