This retrospective cohort examined whether the critical shoulder angle (CSA) affects tendon healing after arthroscopic repair of full-thickness supraspinatus tears. 90 patients were split into large CSA (>38°) and control groups and evaluated with 2-year MRI and functional scores. The question: does scapular geometry predict retear?
When you measure a preoperative CSA above 38° on an AP shoulder radiograph, flag that patient as higher risk for structural failure after cuff repair. The mechanism is biomechanical: a steeper CSA increases cranial shear force and supraspinatus overload, so the tendon stays under load even after anatomic repair.
This paper adds a structural counterpoint to prior work. CSA does not change 2-year functional scores, echoing Kirsch and Lee, but it does drive retear, echoing Garcia and Zumstein on AI. A practical pitfall: symptom-based follow-up will miss these retears because patients report similar ASES, UCLA, and Constant scores regardless of CSA.
Remember this is a Level 3 retrospective cohort with only 90 patients and no CSA-lowering intervention, so it establishes association, not a treatment. It supports counseling and closer imaging surveillance, not yet acromioplasty to reduce CSA.
This retrospective cohort examined whether the critical shoulder angle (CSA) affects tendon healing after arthroscopic repair of full-thickness supraspinatus tears. 90 patients were split into large CSA (>38°) and control groups and evaluated with 2-year MRI and functional scores. The question: does scapular geometry predict retear?
When you measure a preoperative CSA above 38° on an AP shoulder radiograph, flag that patient as higher risk for structural failure after cuff repair. The mechanism is biomechanical: a steeper CSA increases cranial shear force and supraspinatus overload, so the tendon stays under load even after anatomic repair.
This paper adds a structural counterpoint to prior work. CSA does not change 2-year functional scores, echoing Kirsch and Lee, but it does drive retear, echoing Garcia and Zumstein on AI. A practical pitfall: symptom-based follow-up will miss these retears because patients report similar ASES, UCLA, and Constant scores regardless of CSA.
Remember this is a Level 3 retrospective cohort with only 90 patients and no CSA-lowering intervention, so it establishes association, not a treatment. It supports counseling and closer imaging surveillance, not yet acromioplasty to reduce CSA.