This cadaveric study of 200 shoulders correlated pathological changes in the acromial undersurface with rotator cuff tears. It was designed to test whether acromial impingement causes cuff tears or whether acromial changes follow the tear.
The intrinsic-versus-extrinsic debate over cuff tear pathogenesis is a recurring OITE theme, and this paper anchors the intrinsic (degenerative) camp.
The mental model to carry: articular-side partial tears sit against an intact acromion, so the tear cannot have come from bony impingement. Bursal-side and complete tears then acquire acromial attrition because the torn cuff now abrades against the acromion.
That directionality matters clinically. It reframes the acromial spur as a marker of an existing tear rather than its root cause, tempering the expectation that acromioplasty alone reverses the disease. When you see an articular-sided partial tear in a middle-aged patient, think degenerative tendon failure driven by age and load, not simply a bony problem to shave down.
This remains debated, and Neer's impingement model still informs surgical decision-making, but Ozaki gives you the histologic evidence for why tendon degeneration is now considered the primary driver.
This cadaveric study of 200 shoulders correlated pathological changes in the acromial undersurface with rotator cuff tears. It was designed to test whether acromial impingement causes cuff tears or whether acromial changes follow the tear.
The intrinsic-versus-extrinsic debate over cuff tear pathogenesis is a recurring OITE theme, and this paper anchors the intrinsic (degenerative) camp.
The mental model to carry: articular-side partial tears sit against an intact acromion, so the tear cannot have come from bony impingement. Bursal-side and complete tears then acquire acromial attrition because the torn cuff now abrades against the acromion.
That directionality matters clinically. It reframes the acromial spur as a marker of an existing tear rather than its root cause, tempering the expectation that acromioplasty alone reverses the disease. When you see an articular-sided partial tear in a middle-aged patient, think degenerative tendon failure driven by age and load, not simply a bony problem to shave down.
This remains debated, and Neer's impingement model still informs surgical decision-making, but Ozaki gives you the histologic evidence for why tendon degeneration is now considered the primary driver.