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How much acromial bone should be removed to decrease the critical shoulder angle? A 3D CT acromioplasty planning

Anselme Billaud1, Paul M Lacroix2, Yacine Carlier3

  • 1Clinique du Sport, 2 rue Georges Negrevergne, 33700, Mérignac, France. anselme75@gmail.com.

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Summary
This summary is machine-generated.

High critical shoulder angle (CSA) is linked to rotator cuff tears. Three-dimensional (3D) CT planning helps tailor acromioplasty to reduce CSA, improving outcomes for patients with rotator cuff tears.

Keywords:
AcromioplastyCT scansCritical shoulder anglePlanificationRotator cuff tear

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Area of Science:

  • Orthopedic Surgery
  • Radiology
  • Biomedical Engineering

Background:

  • A high critical shoulder angle (CSA) is a known risk factor for rotator cuff tears (RCT) and retear after surgical repair.
  • Reducing CSA to below 33° via acromioplasty is associated with improved clinical outcomes and healing rates.
  • A significant percentage of patients (up to 24%) still have a CSA exceeding 35° even after standard acromioplasty.

Purpose of the Study:

  • To evaluate the efficacy of 3D imaging in planning acromioplasty procedures.
  • To accurately measure the dimensions of acromial bone removed during acromioplasty.
  • To correlate preoperative CSA with the extent of bone resection required.

Main Methods:

  • Retrospective analysis of CT scans from 45 patients with RCT and a preoperative CSA ≥ 38°.
  • Utilized a 33° CSA cutting plane for virtual acromioplasty planning.
  • Measured acromial bone resection in 5 mm slices, assessing dimensions like length, width, and height.

Main Results:

  • High intra- and inter-observer reproducibility for measurements.
  • Mean preoperative CSA was 40°; acromioplasty measurements varied significantly based on initial CSA.
  • Preoperative CSA showed a strong linear correlation with both the width (R=84%) and length (R=28%) of acromioplasty resection.

Conclusions:

  • 3D CT reconstructions provide a valid method for planning CSA-reducing acromioplasty.
  • Achieving a 33° CSA requires anterolateral resection of at least 2 cm anteroposteriorly.
  • Patient-specific anatomy necessitates tailored acromioplasty, with 3D planning being a valuable consideration.