This retrospective study asked whether the shape of the acromion drives rotator cuff tearing and repair failure. Using MRI validated against CT, the authors measured acromial tilt, width, coverage, and glenoid orientation. They compared torn versus intact cuffs and healed versus retorn repairs to test the subacromial impingement theory.
When you counsel a patient before rotator cuff repair, tear size and retraction predict healing, not the shape of the acromion or the critical shoulder angle.
This paper tested the long-standing subacromial impingement theory directly. The morphologic differences between torn and intact cuffs were either trivially small (0.1 mm width) or pointed the wrong way (steeper, not flatter, acromial slope in tears).
For healing, none of the acromial measures mattered, and the one that reached significance, acromial width, went backward: narrower acromions retore more, the opposite of what lateral-extension theory predicts.
Combined with randomized trials showing acromioplasty does not improve repair outcomes, this argues against resecting the lateral acromion to lower the CSA. Fix the cuff well and counsel based on tear size. Remember the caveats: Level III retrospective design, a convenience comparison group, and no power analysis, so it is evidence against a large effect rather than proof of none.
This retrospective study asked whether the shape of the acromion drives rotator cuff tearing and repair failure. Using MRI validated against CT, the authors measured acromial tilt, width, coverage, and glenoid orientation. They compared torn versus intact cuffs and healed versus retorn repairs to test the subacromial impingement theory.
When you counsel a patient before rotator cuff repair, tear size and retraction predict healing, not the shape of the acromion or the critical shoulder angle.
This paper tested the long-standing subacromial impingement theory directly. The morphologic differences between torn and intact cuffs were either trivially small (0.1 mm width) or pointed the wrong way (steeper, not flatter, acromial slope in tears).
For healing, none of the acromial measures mattered, and the one that reached significance, acromial width, went backward: narrower acromions retore more, the opposite of what lateral-extension theory predicts.
Combined with randomized trials showing acromioplasty does not improve repair outcomes, this argues against resecting the lateral acromion to lower the CSA. Fix the cuff well and counsel based on tear size. Remember the caveats: Level III retrospective design, a convenience comparison group, and no power analysis, so it is evidence against a large effect rather than proof of none.