Download PDF
CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(05): e719-e726
DOI: 10.1055/s-0043-1776136
Artigo Original | Original Article
Ombro e Cotovelo

A ressonância magnética é um método confiável para medida do ângulo crítico do ombro e do índice acromial

Article in several languages: português | English
Márcio Schiefer 
1   Professor adjunto, Departamento de Ortopedia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
2   Cirurgião ortopédico, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
,
Erika Naliato
1   Professor adjunto, Departamento de Ortopedia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
,
Roberto Oliveira
3   Cirurgião ortopédico, ex-membro do Grupo de Ombro e Cotovelo do Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
,
Leonardo Tadeu do Carmo
3   Cirurgião ortopédico, ex-membro do Grupo de Ombro e Cotovelo do Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
,
César Rubens da Costa Fontenelle
1   Professor adjunto, Departamento de Ortopedia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
,
Geraldo da Rocha Motta Filho
2   Cirurgião ortopédico, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil
› Author Affiliations Suporte Financeiro Esta pesquisa não recebeu qualquer financiamento específico de agências de fomento dos setores público, comercial ou sem fins lucrativos.
› Further Information
   Permissions and Reprints

Resumo

Objetivo Os objetivos deste estudo foram comparar os valores absolutos do índice acromial (IA) e do ângulo crítico do ombro (ACO) obtidos em radiografias e ressonâncias magnéticas (RM) do ombro e comparar a concordância interobservador e intraobservador dos valores de IA e ACO medidos nessas modalidades de imagem.

Métodos Pacientes com indicação médica de investigação de doenças dos ombros por meio de radiografias e RM foram incluídos no estudo. As imagens foram levadas para dois cirurgiões de ombro treinados que realizaram medidas de IA e ACO em radiografias e RM. Doze semanas após a primeira avaliação, uma segunda avaliação foi realizada. A confiabilidade inter e intraobservador foi apresentada como coeficiente de correlação intraclasse (CCI) e a concordância foi classificada segundo os critérios de Landis e Koch. As diferenças entre duas medidas foram avaliadas por meio de gráficos de Bland-Altman.

Resultados Cento e trinta e quatro ombros de 124 indivíduos foram incluídos no estudo. O CCI intraobservador médio para ACO em radiografias e RM foi 0,936 e 0,940, respectivamente; para IA, foi 0,908 e 0,022. O CCI interobservador médio para ACO foi 0,892 e 0,752 em radiografias e RM, respectivamente; para IA, os valores de CCI foram 0,849 e 0,685. Todas as análises individuais apresentaram poder estatístico (p < 0,001). A diferença média dos valores de IA em radiografias e RM foi 0,01 e 0,03 para os observadores 1 e 2, respectivamente. A diferença média dos valores de ACO em radiografias e RM foi 0,16 e 0,58 para os observadores 1 e 2, respectivamente.

Conclusão Tanto a RM quanto as radiografias tiveram alta concordância intra e interobservador para medida de IA e ACO. Os valores absolutos de IA e ACO foram altamente correlacionados em ambas as modalidades de imagem. Esses achados sugerem que a RM é um método adequado para determinação de IA e ACO.

Nível de Evidência II, Estudo Diagnóstico.

Palavras-chave

acrômio - imagem por ressonância magnética - ruptura do manguito rotador - síndrome de colisão do ombro - radiografia

Estudo desenvolvido no Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil.




Publication History

Received: 19 March 2023

Accepted: 05 May 2023

Article published online:
30 October 2023

© 2023. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • Referências

  • 1 Maffulli N, Longo UG, Berton A, Loppini M, Denaro V. Biological factors in the pathogenesis of rotator cuff tears. Sports Med Arthrosc Rev 2011; 19 (03) 194-201
    CrossrefPubMedGoogle Scholar
  • 2 Sayampanathan AA, Andrew THC. Systematic review on risk factors of rotator cuff tears. J Orthop Surg (Hong Kong) 2017; 25 (01) 2309499016684318
    CrossrefPubMedGoogle Scholar
  • 3 Morikawa D, Itoigawa Y, Nojiri H. et al. Contribution of oxidative stress to the degeneration of rotator cuff entheses. J Shoulder Elbow Surg 2014; 23 (05) 628-635
    CrossrefPubMedGoogle Scholar
  • 4 Figueiredo EA, Loyola LC, Belangero PS. et al. Rotator cuff tear susceptibility is associated with variants in genes involved in tendon extracellular matrix homeostasis. J Orthop Res 2020; 38 (01) 192-201
    CrossrefPubMedGoogle Scholar
  • 5 Assunção JH, Godoy-Santos AL, Dos Santos MCLG, Malavolta EA, Gracitelli MEC, Ferreira Neto AA. Matrix metalloproteases 1 and 3 promoter gene polymorphism is associated with rotator cuff tear. Clin Orthop Relat Res 2017; 475 (07) 1904-1910
    CrossrefPubMedGoogle Scholar
  • 6 Tashjian RZ, Kim SK, Roche MD, Jones KB, Teerlink CC. Genetic variants associated with rotator cuff tearing utilizing multiple population-based genetic resources. J Shoulder Elbow Surg 2021; 30 (03) 520-531
    CrossrefPubMedGoogle Scholar
  • 7 Bishop JY, Santiago-Torres JE, Rimmke N, Flanigan DC. Smoking Predisposes to rotator cuff pathology and shoulder dysfunction: A systematic review. Arthroscopy 2015; 31 (08) 1598-1605
    CrossrefPubMedGoogle Scholar
  • 8 Lundgreen K, Lian OB, Scott A, Nassab P, Fearon A, Engebretsen L. Rotator cuff tear degeneration and cell apoptosis in smokers versus nonsmokers. Arthroscopy 2014; 30 (08) 936-941
    CrossrefPubMedGoogle Scholar
  • 9 Huang SW, Wang WT, Chou LC, Liou TH, Chen YW, Lin HW. Diabetes mellitus increases the risk of rotator cuff tear repair surgery: A population-based cohort study. J Diabetes Complications 2016; 30 (08) 1473-1477
    CrossrefPubMedGoogle Scholar
  • 10 Passaretti D, Candela V, Venditto T, Giannicola G, Gumina S. Association between alcohol consumption and rotator cuff tear. Acta Orthop 2016; 87 (02) 165-168
    CrossrefPubMedGoogle Scholar
  • 11 Neer II CS. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am 1972; 54 (01) 41-50
    CrossrefPubMedGoogle Scholar
  • 12 Bigliani LU, Morrison DSAE. The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans 1986; 10: 216
    Google Scholar
  • 13 Nyffeler RW, Werner CM, Sukthankar A, Schmid MR, Gerber C. Association of a large lateral extension of the acromion with rotator cuff tears. J Bone Joint Surg Am 2006; 88 (04) 800-805
    CrossrefPubMedGoogle Scholar
  • 14 Moor BK, Bouaicha S, Rothenfluh DA, Sukthankar A, Gerber C. Is there an association between the individual anatomy of the scapula and the development of rotator cuff tears or osteoarthritis of the glenohumeral joint?: A radiological study of the critical shoulder angle. Bone Joint J 2013; 95-B (07) 935-941
    CrossrefPubMedGoogle Scholar
  • 15 Li X, Olszewski N, Abdul-Rassoul H, Curry EJ, Galvin JW, Eichinger JK. Relationship Between the Critical Shoulder Angle and Shoulder Disease. JBJS Rev 2018; 6 (08) e1
    CrossrefPubMedGoogle Scholar
  • 16 Balke M, Schmidt C, Dedy N, Banerjee M, Bouillon B, Liem D. Correlation of acromial morphology with impingement syndrome and rotator cuff tears. Acta Orthop 2013; 84 (02) 178-183
    CrossrefPubMedGoogle Scholar
  • 17 Blonna D, Giani A, Bellato E. et al. Predominance of the critical shoulder angle in the pathogenesis of degenerative diseases of the shoulder. J Shoulder Elbow Surg 2016; 25 (08) 1328-1336
    CrossrefPubMedGoogle Scholar
  • 18 Gomide LC, Carmo TCD, Bergo GHM, Oliveira GA, Macedo IS. Relationship between the critical shoulder angle and the development of rotator cuff lesions: a retrospective epidemiological study. Rev Bras Ortop 2017; 52 (04) 423-427
    CrossrefPubMedGoogle Scholar
  • 19 Heuberer PR, Plachel F, Willinger L. et al. Critical shoulder angle combined with age predict five shoulder pathologies: a retrospective analysis of 1000 cases. BMC Musculoskelet Disord 2017; 18 (01) 259
    CrossrefPubMedGoogle Scholar
  • 20 Kaur R, Dahuja A, Garg S, Bansal K, Garg RS, Singh P. Correlation of acromial morphology in association with rotator cuff tear: a retrospective study. Pol J Radiol 2019; 84: e459-e463
    CrossrefPubMedGoogle Scholar
  • 21 Moor BK, Röthlisberger M, Müller DA. et al. Age, trauma and the critical shoulder angle accurately predict supraspinatus tendon tears. Orthop Traumatol Surg Res 2014; 100 (05) 489-494
    CrossrefPubMedGoogle Scholar
  • 22 Park HB, Gwark JY, Kwack BH, Na JB. Are any radiologic parameters independently associated with degenerative postero-superior rotator cuff tears?. J Shoulder Elbow Surg 2021; 30 (08) 1856-1865
    CrossrefPubMedGoogle Scholar
  • 23 Seo J, Heo K, Kwon S, Yoo J. Critical shoulder angle and greater tuberosity angle according to the partial thickness rotator cuff tear patterns. Orthop Traumatol Surg Res 2019; 105 (08) 1543-1548
    CrossrefPubMedGoogle Scholar
  • 24 Smith GCS, Liu V, Lam PH. The critical shoulder angle shows a reciprocal change in magnitude when evaluating symptomatic full-thickness rotator cuff tears versus primary glenohumeral osteoarthritis as compared with control subjects: A systematic review and meta-analysis. Arthroscopy 2020; 36 (02) 566-575
    CrossrefPubMedGoogle Scholar
  • 25 Stamiris D, Stamiris S, Papavasiliou K, Potoupnis M, Tsiridis E, Sarris I. Critical shoulder angle is intrinsically associated with the development of degenerative shoulder diseases: A systematic review. Orthop Rev (Pavia) 2020; 12 (01) 8457
    CrossrefPubMedGoogle Scholar
  • 26 Docter S, Khan M, Ekhtiari S. et al. The relationship between the critical shoulder angle and the incidence of chronic, full-thickness rotator cuff tears and outcomes after rotator cuff repair: A systematic review. Arthroscopy 2019; 35 (11) 3135-3143.e4
    CrossrefPubMedGoogle Scholar
  • 27 Garcia GH, Liu JN, Degen RM. et al. Higher critical shoulder angle increases the risk of retear after rotator cuff repair. [published correction appears in J Shoulder Elbow Surg. 2017;26(4):732] J Shoulder Elbow Surg 2017; 26 (02) 241-245
    CrossrefPubMedGoogle Scholar
  • 28 Li H, Chen Y, Chen J, Hua Y, Chen S. Large critical shoulder angle has higher risk of tendon retear after arthroscopic rotator cuff repair. Am J Sports Med 2018; 46 (08) 1892-1900
    CrossrefPubMedGoogle Scholar
  • 29 Scheiderer B, Imhoff FB, Johnson JD. et al. Higher critical shoulder angle and acromion index are associated with increased retear risk after isolated supraspinatus tendon repair at short-term follow up. Arthroscopy 2018; 34 (10) 2748-2754
    CrossrefPubMedGoogle Scholar
  • 30 Sheean AJ, Sa D, Woolnough T, Cognetti DJ, Kay J, Burkhart SS. Does an increased critical shoulder angle affect re-tear rates and clinical outcomes following primary rotator cuff repair? A systematic review. Arthroscopy 2019; 35 (10) 2938-2947.e1
    CrossrefPubMedGoogle Scholar
  • 31 Suter T, Gerber Popp A, Zhang Y, Zhang C, Tashjian RZ, Henninger HB. The influence of radiographic viewing perspective and demographics on the critical shoulder angle. J Shoulder Elbow Surg 2015; 24 (06) e149-e158
    CrossrefPubMedGoogle Scholar
  • 32 Tang Y, Hou J, Li Q. et al. The effectiveness of using the critical shoulder angle and acromion index for predicting rotator cuff tears: accurate diagnosis based on standard and nonstandard anteroposterior radiographs. Arthroscopy 2019; 35 (09) 2553-2561
    CrossrefPubMedGoogle Scholar
  • 33 Kim JH, Gwak HC, Kim CW, Lee CR, Kwon YU, Seo HW. Difference of Critical Shoulder Angle (CSA) according to minimal rotation: Can minimal rotation of the scapula be allowed in the evaluation of CSA?. Clin Orthop Surg 2019; 11 (03) 309-315
    CrossrefPubMedGoogle Scholar
  • 34 Iannotti JP, Zlatkin MB, Esterhai JL, Kressel HY, Dalinka MK, Spindler KP. Magnetic resonance imaging of the shoulder. Sensitivity, specificity, and predictive value. J Bone Joint Surg Am 1991; 73 (01) 17-29
    CrossrefPubMedGoogle Scholar
  • 35 Spiegl UJ, Horan MP, Smith SW, Ho CP, Millett PJ. The critical shoulder angle is associated with rotator cuff tears and shoulder osteoarthritis and is better assessed with radiographs over MRI. Knee Surg Sports Traumatol Arthrosc 2016; 24 (07) 2244-2251
    CrossrefPubMedGoogle Scholar
  • 36 İncesoy MA, Yıldız KI, Türk ÖI. et al. The critical shoulder angle, the acromial index, the glenoid version angle and the acromial angulation are associated with rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 2021; 29 (07) 2257-2263
    CrossrefPubMedGoogle Scholar
  • 37 Landis JR, Koch GG. An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 1977; 33 (02) 363-374
    CrossrefPubMedGoogle Scholar
  • 38 Chalmers PN, Salazar D, Steger-May K, Chamberlain AM, Yamaguchi K, Keener JD. Does the critical shoulder angle correlate with rotator cuff tear progression?. Clin Orthop Relat Res 2017; 475 (06) 1608-1617
    CrossrefPubMedGoogle Scholar
  • 39 Karns MR, Jacxsens M, Uffmann WJ, Todd DC, Henninger HB, Burks RT. The critical acromial point: the anatomic location of the lateral acromion in the critical shoulder angle. J Shoulder Elbow Surg 2018; 27 (01) 151-159
    CrossrefPubMedGoogle Scholar