Relationship between coracoid apex position and anterior shoulder instability

This study investigated whether the coracoid apex position relative to the glenoid is associated with anterior shoulder instability (ASI). We hypothesized that the coracoid apex is positioned superiorly and medially in patients with ASI.

This study included 72 patients who underwent surgery for ASI and 72 age- and sex-matched controls. The sagittal central glenoid- coracoid angle (scGCA) and axial central glenoid-coracoid angle (acGCA), which assess the coracoid apex position relative to the glenoid center, the glenoid version (GV), and glenoid inclination (GI) were evaluated using magnetic resonance imaging. The critical shoulder angle (CSA) was measured using true anterior-posterior radiographs.

The ASI group had significantly lower scGCA and GV values than the control group (scGCA: 32.0°±4.3° vs. 39.2°±7°, P=0.004; GV: 2.2°±5.4° vs. 6.4°±5.4°, P=0.033, respectively). There was no significant difference in acGCA, GI, and CSA between the groups (P=0.377, P=0.524, P=0.847, respectively). Logistic regression analysis conducted with the scGCA, acGCA, GV, GI, and CSA parameters revealed a significant association only for scGCA (P=0.039, odds ratio: 1.28).

Lower scGCA values, which indicate a more superior position of the coracoid apex relative to the glenoid center, are associated with ASI independently of other parameters. scGCA values below 34.5°, indicating a superiorly positioned coracoid apex, showed an 85.7% sensitivity and 73.3% specificity for ASI. Level of evidence: III.