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Bilateral coracohumeral distance discrepancy is associated with subscapularis tear in rotator cuff rupture patients

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To describe the bilateral coracohumeral morphological discrepancy in rotator cuff rupture patients with and without subscapularis (SSC) involvement and to investigate its association with SSC tears.

Methods

Two hundred and thirteen consecutive patients who were scheduled to have arthroscopic rotator cuff repair were prospectively enrolled in the current study. Patients with acute traumatic rotator cuff rupture, glenohumeral osteoarthritis, bilateral rotator cuff rupture, recurrent shoulder instability, systemic inflammatory disease, and previous shoulder surgery history were excluded. Coracohumeral distance (CHD), coracoid overlap (CO), lesser tuberosity index (LTI) and acromiohumeral interval (AHI) were measured bilaterally using CT scans. Based on arthroscopic findings, patients were included in either the SSC tear group (n = 72) or the control group (n = 141).

Results

In the SSC tear group, the affected shoulder possessed a significantly smaller CHD [95% confidence interval (CI) 6.1–7.2 vs. 7.2–8.0 mm, p < 0.0001], larger LTI (95% CI 9.4–9.9 vs. 9.0–9.6 mm, p < 0.0001), and smaller AHI (95% CI 5.0–5.5 vs. 7.1–7.5 mm, p < 0.0001) than the contralateral normal shoulder. In the control group, there was no significant difference between bilateral CHD and CO, and the AHI bilateral discrepancy was less distinct. CO did not differ significantly in the bilateral comparison in either group. Among all evaluated parameters, bilateral CHD discrepancy was the best predictor of SSC tears, with an area under the curve (AUC) of 0.882. A cutoff value of 0.5 mm had a sensitivity of 76.4% and specificity of 99.3% for SSC tears.

Conclusion

The CHD values are significantly different between affected and contralateral shoulders in SSC tear patients. Bilateral CHD discrepancy is closely associated with subcoracoid impingement and SSC tears, and its presence warrants specific intraoperative SSC inspection.

Level of evidence

Level II.

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References

  1. Adams CR, Schoolfield JD, Burkhart SS (2010) Accuracy of preoperative magnetic resonance imaging in predicting a subscapularis tendon tear based on arthroscopy. Arthroscopy 26:1427–1433

    Article  Google Scholar 

  2. Arai R, Sugaya H, Mochizuki T, Nimura A, Moriishi J, Akita K (2008) Subscapularis tendon tear: an anatomic and clinical investigation. Arthroscopy 24:997–1004

    Article  Google Scholar 

  3. Balke M, Banerjee M, Greshake O, Hoeher J, Bouillon B, Liem D (2016) The coracohumeral distance in shoulders with traumatic and degenerative subscapularis tendon tears. Am J Sports Med 44:198–201

    Article  Google Scholar 

  4. Bergin D, Parker L, Zoga A, Morrison W (2006) Abnormalities on MRI of the subscapularis tendon in the presence of a full-thickness supraspinatus tendon tear. Am J Roentgenol 186:454–459

    Article  Google Scholar 

  5. Chen S, He Y, Wu D, Hu N, Liang X, Jiang D, Huang W, Chen H (2020) Postoperative bone marrow edema lasts no more than 6 months after uncomplicated arthroscopic double-row rotator cuff repair with PEEK anchors. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-05897-7

    Article  PubMed  PubMed Central  Google Scholar 

  6. Cetinkaya M, Ataoglu MB, Ozer M, Ayanoglu T, Kanatli U (2017) Subscapularis tendon slip number and coracoid overlap are more related parameters for subcoracoid impingement in subscapularis tears: a magnetic resonance imaging comparison study. Arthroscopy 33:734–742

    Article  Google Scholar 

  7. Dugarte AJ, Davis RJ, Lynch TS, Schickendantz MS, Farrow LD (2017) Anatomic study of subcoracoid morphology in 418 shoulders: potential implications for subcoracoid impingement. Orthop J Sports Med 5:2325967117731996

    Article  Google Scholar 

  8. Dyrna F, Beitzel K, Pauzenberger L, Dwyer CR, Obopilwe E, Mazzocca AD, Imhoff AB, Braun S (2019) A superolaterally placed anchor for subscapularis “leading-edge” refixation: a biomechanical study. Arthroscopy 35(1306–1313):e1301

    Google Scholar 

  9. Gausden EB, McCarthy MM, Kontaxis A, Corpus KT, Gulotta LV, Kelly AM (2017) Subscapularis tendon loading during activities of daily living. J Shoulder Elb Surg 26:331–336

    Article  Google Scholar 

  10. Kim SJ, Choi YR, Jung M, Yoon YK, Chun YM (2018) Concomitant coracoplasty during arthroscopic subscapularis repair does not yield better clinical outcomes and structural integrity. Knee Surg Sports Traumatol Arthrosc 26:56–62

    Article  Google Scholar 

  11. Leite MJ, Sa MC, Lopes MJ, Matos RM, Sousa AN, Torres JM (2019) Coracohumeral distance and coracoid overlap as predictors of subscapularis and long head of the biceps injuries. J Shoulder Elb Surg 28:1723–1727

    Article  Google Scholar 

  12. Li X, Xu W, Hu N, Liang X, Huang W, Jiang D, Chen H (2017) Relationship between acromial morphological variation and subacromial impingement: a three-dimensional analysis. PLoS ONE 12:e0176193

    Article  Google Scholar 

  13. Liljequist D, Elfving B, Skavberg Roaldsen K (2019) Intraclass correlation—a discussion and demonstration of basic features. PLoS ONE 14:e0219854

    Article  CAS  Google Scholar 

  14. Lin L, Yan H, Xiao J, Ao Y, Cui G (2015) Internal rotation resistance test at abduction and external rotation: a new clinical test for diagnosing subscapularis lesions. Knee Surg Sports Traumatol Arthrosc 23:1247–1252

    Article  Google Scholar 

  15. Lin L, Yan H, Xiao J, He Z, Luo H, Cheng X, Ao Y, Cui G (2016) The diagnostic value of magnetic resonance imaging for different types of subscapularis lesions. Knee Surg Sports Traumatol Arthrosc 24:2252–2258

    Article  Google Scholar 

  16. Lo IK, Burkhart SS (2003) The etiology and assessment of subscapularis tendon tears: a case for subcoracoid impingement, the roller-wringer effect, and TUFF lesions of the subscapularis. Arthroscopy 19:1142–1150

    Article  Google Scholar 

  17. Malavolta EA, Assuncao JH, Gracitelli MEC, Yen TK, Bordalo-Rodrigues M, Ferreira Neto AA (2019) Accuracy of magnetic resonance imaging (MRI) for subscapularis tear: a systematic review and meta-analysis of diagnostic studies. Arch Orthop Trauma Surg 139:659–667

    Article  Google Scholar 

  18. Martetschlager F, Rios D, Boykin RE, Giphart JE, de Waha A, Millett PJ (2012) Coracoid impingement: current concepts. Knee Surg Sports Traumatol Arthrosc 20:2148–2155

    Article  Google Scholar 

  19. McKernan MJ, Schickendantz MS, Frangiamore SJ (2021) Diagnosis and management of subcoracoid impingement. J Am Acad Orthop Surg 29:100–107

    Article  Google Scholar 

  20. Oh JH, Song BW, Choi JA, Lee GY, Kim SH, Kim DH (2016) Measurement of coracohumeral distance in 3 shoulder positions using dynamic ultrasonography: correlation with subscapularis tear. Arthroscopy 32:1502–1508

    Article  Google Scholar 

  21. Richards DP, Burkhart SS, Campbell SE (2005) Relation between narrowed coracohumeral distance and subscapularis tears. Arthroscopy 21:1223–1228

    Article  Google Scholar 

  22. Sahu D, Fullick R, Giannakos A, Lafosse L (2016) Sentinel sign: a sign of biceps tendon which indicates the presence of subscapularis tendon rupture. Knee Surg Sports Traumatol Arthrosc 24:3745–3749

    Article  Google Scholar 

  23. Saltzman BM, Collins MJ, Leroux T, Arns TA, Griffin JW, Romeo AA, Verma NN, Forsythe B (2017) Arthroscopic repair of isolated subscapularis tears: a systematic review of technique-specific outcomes. Arthroscopy 33:849–860

    Article  Google Scholar 

  24. Shim JW, Pang CH, Min SK, Jeong JY, Yoo JC (2019) A novel diagnostic method to predict subscapularis tendon tear with sagittal oblique view magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc 27:277–288

    Article  Google Scholar 

  25. Sundararajan SR, Joseph JB, Ramakanth R, Jha AK, Rajasekaran S (2020) Do coracohumeral interval and glenoid version play a role in subscapularis tears? JSES Int 4:888–892

    Article  Google Scholar 

  26. Tan V, Moore RS Jr, Omarini L, Kneeland JB, Williams GR Jr, Iannotti JP (2002) Magnetic resonance imaging analysis of coracoid morphology and its relation to rotator cuff tear. Am J Orthop (Belle Mead NJ) 31:329–333

    Google Scholar 

  27. Ticker JB, Burkhart SS (2011) Why repair the subscapularis? A logical rationale. Arthroscopy 27:1123–1128

    Article  Google Scholar 

  28. Tollemar VC, Wang J, Koh JL, Lee MJ, Shi LL (2020) Coracoid morphology is not associated with subscapularis tears. J Shoulder Elb Surg 29:1162–1167

    Article  Google Scholar 

  29. Zhang H, Zhang Q, Li ZL (2019) Coracohumeral index and coracoglenoid inclination as predictors for different types of degenerative subscapularis tendon tears. Int Orthop 43:1909–1916

    Article  Google Scholar 

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Funding

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Author information

Author notes

  1. Sizheng Zhu, Jixiang Tan, Wei Huang and Hong Chen contributed equally to this study.

Authors and Affiliations

  1. Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing, 400016, China

    Sizheng Zhu, Ning Hu, Wei Huang & Hong Chen

  2. Department of Emergency and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, China

    Jixiang Tan

  3. Department of Rehabilitation, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, China

    Dandong Wu

Authors
  1. Sizheng Zhu
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  2. Jixiang Tan
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  4. Ning Hu
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  5. Wei Huang
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Corresponding author

Correspondence to Hong Chen.

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Conflict of interest

Author Sizheng Zhu, Jixiang Tan, Dandong Wu, Ning Hu, Wei Huang and Hong Chen declare that they have no conflict of interest.

Ethical approval

All procedures performed in this prospective study were in accordance with the ethical standards of the First Affiliated Hospital of Chongqing Medical University. This study was approved by our institutional review board (IRB, No. 20194701) and registered in the Chinese Clinical Trial Register (ChiCTR1900026059).

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Zhu, S., Tan, J., Wu, D. et al. Bilateral coracohumeral distance discrepancy is associated with subscapularis tear in rotator cuff rupture patients. Knee Surg Sports Traumatol Arthrosc 29, 3936–3942 (2021). https://doi.org/10.1007/s00167-021-06597-6

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