Cargando…
Critical shoulder angle and failure of conservative treatment in patients with atraumatic full thickness rotator cuff tears
BACKGROUND: Atraumatic full thickness rotator cuff tears (AFTRCT) are common lesions whose incidence increases with age. Physical therapy is an effective conservative treatment in these patients with a reported success rate near 85% within 12 weeks of treatment. The critical shoulder angle (CSA) is...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9188145/ https://www.ncbi.nlm.nih.gov/pubmed/35689223 http://dx.doi.org/10.1186/s12891-022-05519-y |
_version_ | 1784725310909972480 |
---|---|
author | Meissner-Haecker, Arturo Contreras, Julio Valenzuela, Alfonso Delgado, Byron Taglioni, Angelinni De Marinis, Rodrigo Calvo, Claudio Soza, Francisco Liendo, Rodrigo |
author_facet | Meissner-Haecker, Arturo Contreras, Julio Valenzuela, Alfonso Delgado, Byron Taglioni, Angelinni De Marinis, Rodrigo Calvo, Claudio Soza, Francisco Liendo, Rodrigo |
author_sort | Meissner-Haecker, Arturo |
collection | PubMed |
description | BACKGROUND: Atraumatic full thickness rotator cuff tears (AFTRCT) are common lesions whose incidence increases with age. Physical therapy is an effective conservative treatment in these patients with a reported success rate near 85% within 12 weeks of treatment. The critical shoulder angle (CSA) is a radiographic metric that relates the glenoid inclination with the lateral extension of the acromion in the coronal plane. A larger CSA has been associated with higher incidence of AFTRCT and a higher re-tear rate after surgical treatment. However, no study has yet described an association between a larger CSA and failure of conservatory treatment in ARCT. The main objective of this study is to determine whether there is an association between CSA and failure of physical therapy in patients with AFTRCT. METHODS: We reviewed the imaging and clinical records of 48 patients (53 shoulders), 60% female, with a mean age of 63.2 years (95% CI ± 10.4 years); treated for AFTRCT who also underwent a true anteroposterior radiograph of the shoulder within a year of diagnosis of the tear. We recorded demographic (age, sex, type of work), clinical (comorbidities), and imaging data (CSA, size and location of the tear). We divided the patients into two groups according to success or failure of conservative treatment (indication for surgery), so 21 shoulders (39.6%) required surgery and were classified as failure of conservative treatment. Univariate and multivariate analysis was performed to detect predictors of failure of conservative treatment. RESULTS: The median CSA was 35.5º with no differences between those with failure (median 35.5º, range 29º to 48.2º) and success of conservative treatment (median 35.45º, range 30.2º to 40.3º), p = 0.978. The multivariate analysis showed a younger age in patients with failure of conservative treatment (56.14 ± 9.2 vs 67.8 ± 8.4, p < 0.001) and that male gender was also associated with failure of conservative treatment (57% of men required surgery vs 28% of women, p = 0.035). CONCLUSIONS: It is still unclear if CSA does predict failure of conservative treatment. A lower age and male gender both could predicted failure of conservative treatment in AFTRCT. Further research is needed to better address this subject. |
format | Online Article Text |
id | pubmed-9188145 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-91881452022-06-12 Critical shoulder angle and failure of conservative treatment in patients with atraumatic full thickness rotator cuff tears Meissner-Haecker, Arturo Contreras, Julio Valenzuela, Alfonso Delgado, Byron Taglioni, Angelinni De Marinis, Rodrigo Calvo, Claudio Soza, Francisco Liendo, Rodrigo BMC Musculoskelet Disord Research BACKGROUND: Atraumatic full thickness rotator cuff tears (AFTRCT) are common lesions whose incidence increases with age. Physical therapy is an effective conservative treatment in these patients with a reported success rate near 85% within 12 weeks of treatment. The critical shoulder angle (CSA) is a radiographic metric that relates the glenoid inclination with the lateral extension of the acromion in the coronal plane. A larger CSA has been associated with higher incidence of AFTRCT and a higher re-tear rate after surgical treatment. However, no study has yet described an association between a larger CSA and failure of conservatory treatment in ARCT. The main objective of this study is to determine whether there is an association between CSA and failure of physical therapy in patients with AFTRCT. METHODS: We reviewed the imaging and clinical records of 48 patients (53 shoulders), 60% female, with a mean age of 63.2 years (95% CI ± 10.4 years); treated for AFTRCT who also underwent a true anteroposterior radiograph of the shoulder within a year of diagnosis of the tear. We recorded demographic (age, sex, type of work), clinical (comorbidities), and imaging data (CSA, size and location of the tear). We divided the patients into two groups according to success or failure of conservative treatment (indication for surgery), so 21 shoulders (39.6%) required surgery and were classified as failure of conservative treatment. Univariate and multivariate analysis was performed to detect predictors of failure of conservative treatment. RESULTS: The median CSA was 35.5º with no differences between those with failure (median 35.5º, range 29º to 48.2º) and success of conservative treatment (median 35.45º, range 30.2º to 40.3º), p = 0.978. The multivariate analysis showed a younger age in patients with failure of conservative treatment (56.14 ± 9.2 vs 67.8 ± 8.4, p < 0.001) and that male gender was also associated with failure of conservative treatment (57% of men required surgery vs 28% of women, p = 0.035). CONCLUSIONS: It is still unclear if CSA does predict failure of conservative treatment. A lower age and male gender both could predicted failure of conservative treatment in AFTRCT. Further research is needed to better address this subject. BioMed Central 2022-06-10 /pmc/articles/PMC9188145/ /pubmed/35689223 http://dx.doi.org/10.1186/s12891-022-05519-y Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Meissner-Haecker, Arturo Contreras, Julio Valenzuela, Alfonso Delgado, Byron Taglioni, Angelinni De Marinis, Rodrigo Calvo, Claudio Soza, Francisco Liendo, Rodrigo Critical shoulder angle and failure of conservative treatment in patients with atraumatic full thickness rotator cuff tears |
title | Critical shoulder angle and failure of conservative treatment in patients with atraumatic full thickness rotator cuff tears |
title_full | Critical shoulder angle and failure of conservative treatment in patients with atraumatic full thickness rotator cuff tears |
title_fullStr | Critical shoulder angle and failure of conservative treatment in patients with atraumatic full thickness rotator cuff tears |
title_full_unstemmed | Critical shoulder angle and failure of conservative treatment in patients with atraumatic full thickness rotator cuff tears |
title_short | Critical shoulder angle and failure of conservative treatment in patients with atraumatic full thickness rotator cuff tears |
title_sort | critical shoulder angle and failure of conservative treatment in patients with atraumatic full thickness rotator cuff tears |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9188145/ https://www.ncbi.nlm.nih.gov/pubmed/35689223 http://dx.doi.org/10.1186/s12891-022-05519-y |
work_keys_str_mv | AT meissnerhaeckerarturo criticalshoulderangleandfailureofconservativetreatmentinpatientswithatraumaticfullthicknessrotatorcufftears AT contrerasjulio criticalshoulderangleandfailureofconservativetreatmentinpatientswithatraumaticfullthicknessrotatorcufftears AT valenzuelaalfonso criticalshoulderangleandfailureofconservativetreatmentinpatientswithatraumaticfullthicknessrotatorcufftears AT delgadobyron criticalshoulderangleandfailureofconservativetreatmentinpatientswithatraumaticfullthicknessrotatorcufftears AT taglioniangelinni criticalshoulderangleandfailureofconservativetreatmentinpatientswithatraumaticfullthicknessrotatorcufftears AT demarinisrodrigo criticalshoulderangleandfailureofconservativetreatmentinpatientswithatraumaticfullthicknessrotatorcufftears AT calvoclaudio criticalshoulderangleandfailureofconservativetreatmentinpatientswithatraumaticfullthicknessrotatorcufftears AT sozafrancisco criticalshoulderangleandfailureofconservativetreatmentinpatientswithatraumaticfullthicknessrotatorcufftears AT liendorodrigo criticalshoulderangleandfailureofconservativetreatmentinpatientswithatraumaticfullthicknessrotatorcufftears |