Monday, June 13, 2016

Association of bursal sided cuff degeneration with degenerative changes of the coracoacromial ligament

Grade of coracoacromial ligament degeneration as a predictive factor for impingement syndrome and type of partial rotator cuff tear.

These authors assessed 96 patients (mean age, 50.1 years [17-76]; 34 men, 62 women) diagnosed with bursal-side and articular-side rotator cuff tears with a history of failed conservative treatment and persistent shoulder pain who underwent arthroscopic surgery.

Normal appearance of the coracoacromial ligament (CAL) was  grade 0, minor fraying as grade 1, major fraying as grade 2, and visualization of the bare bone under the CAL as grade 3.

Most of the patients with articular-side tears demonstrated grade 0 and grade 1 coracoacromial ligament degeneration, whereas patients with bursal-side tears had grade 1 and grade 2. 

There was a significant positive correlation between the grade of coracoacromial ligament degeneration and bursal-side partial rotator cuff tears, whereas no correlation was observed with articular-side tears. 

There was no significant difference between bursal-side and articular-side partial cuff tears regarding acromioglenoid angle, supraspinatus glenoid angle, and subacromial distance.

The authors state that , "Although the factors that are purely related to articular side partial tears are poorly understood, its inconsistency with CAL degeneration in the current study suggests that ... subacromial impingement is not an etiologic cause of articular-side tears."
Comment: While this research shows the association of CAL degeneration with bursal sided cuff deterioration, it does not necessarily clarify the cause of either.


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