This article concerned the ‘acromial index’, defined as the ratio between (a) the distance between the glenoid plane and the lateral border of the acromion (GA) and (b) the distance between the glenoid plane and the lateral aspect of the proximal humerus (GH).
The authors did not find a relationship between the acromial index and the presence or absence of a cuff tear.
They made multiple comparisons between this measure and tear size, number of tendons torn, number of anchors used in the repair, the performance of a biceps tenotomy or tenodesis, shoulder dominance, presence of a labral lesion, instability, chondral damage, acromioclavicular morphology, subscapularis tears, coracoid impingement, repair type, follow-up ASES score, QuickDASH, SF 12, patient satisfaction, and the need for reoperation.
An arbitrary division between ‘large’ and ‘small’ acromial indices was established at .682. Shoulders having a ‘large’ index had a somewhat greater chance of having two or more tendons torn, required more anchors for the repair, and had somewhat greater disability as measured by the QuickDASH and lower satisfaction and SF12 scores. The remainder of the parameters did not show a significant difference between the ‘large’ and ‘small’ index groups. There was apparently no correction of the statistics for multiple comparisons.
The authors suggest that a large acromial index may compromise arthroscopic access to the rotator cuff. Other than this, it is difficult to understand the value of making the determination of this index. No hypothesis is offered regarding the relationship between cuff tear size and the index. There was apparently no assessment of the integrity of the cuff repair with the clinical outcome.
In studies of outcomes of cuff repair, it is valuable to define a primary outcome metric (such as the SST, ASES score, or Constant Score) and to use multivariate analysis that includes the variables that have been established to be relevant, such as patient age, smoking history, tear size and chronicity, tendon quality, repair method, rehabilitation program, and cuff integrity at follow-up. The acromial index could be added to this list if it is a variable of interest.
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If you have suggestions for topics you'd like us to address in this blog, please send an email to
shoulderarthritis@uw.edu
Use the "Search the Blog" box to the right to find other topics of interest to you.
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