2023 ISAKOS Biennial Congress ePoster
The Role Of Coracoacromial Ligament Degeneration in Massive Rotator Cuff Tear: Association with Tear Patterns and Re-tear Rate
Hao-Chun Chuang, MD TAIWAN
Wei-Ren Su, MD, MSc, Tainan TAIWAN
Chih-Kai Hong, MD, Tainan City TAIWAN
Fachuan Kuan, MD, Taichuang, Taiwan TAIWAN
Kai-Lan Hsu, MD, Rochester, MN UNITED STATES
Joe-Zhi Yen, MD, Tainan TAIWAN
National Cheng Kung University Hospital, Tainan, Taiwan, TAIWAN
FDA Status Not Applicable
Summary
Coracoacromial ligament degeneration was more severe in anterosuperior-type massive rotator cuff tears. Interestingly, even without acromioplasty, the severity of CAL degeneration did not affect the retear rate of the repaired supraspinatus tendon. Regarding the evaluation of CAL, arthroscopic Copeland-Levy classification is more histologically relevant than MRI scans.
ePosters will be available shortly before Congress
Abstract
Background
Coracoacromial ligament (CAL) degeneration has been proposed as a factor of external impingement in bursal-sided rotator cuff tears, but CAL release is associated with many adverse effects. The role and pathophysiology of CAL degeneration in massive rotator cuff tears have not yet been elucidated.
Purpose
This study aimed to investigate the association between CAL degeneration and the pattern of massive rotator cuff tears using multiple modalities. Postoperative follow-up magnetic resonance imaging (MRI) scans were obtained to investigate the effect of CAL degeneration on supraspinatus tendon retear.
Study Design
Prospective cohort study.
Methods
We prospectively recruited 44 patients who had undergone arthroscopic rotator cuff repair without acromioplasty or CAL release. Preoperative radiographs and MRI scans were reviewed to determine acromial morphology and CAL thickness, respectively. The patterns of rotator cuff tears and acromial degeneration were analyzed arthroscopically using the Copeland-Levy classification. The CAL was biopsied intraoperatively and histologically analyzed using the Bonar score. The integrity of the repaired supraspinatus tendon was analyzed on follow-up MRI at six months postoperatively using the Sugaya classification. Finally, the associations among CAL degeneration, rotator cuff tear pattern, and arthroscopic grading were investigated.
Results
Patients with Collin type B rotator cuff tear had significantly higher Bonar scores than those with Collin type A or isolated supraspinatus tears (10 vs. 6.8 and 3.4; p = 0.03 and p < 0.001, respectively). Patients with degenerative acromial undersurface of Copeland-Levy stage II or III had CALs with significantly higher Bonar scores than those with intact acromial undersurface (8.4 and 8.2 vs. 3.5; p = 0.034 and p = 0.027, respectively). The Bonar scores of patients with different stages of the Sugaya classification were comparable (6.5, 7.2, 8.0, and 7.8 for stages 1, 2, 3, and 4, respectively; p = 0.751).
Conclusion
CAL degeneration was more severe in anterosuperior-type massive rotator cuff tears. Interestingly, even without acromioplasty, the severity of CAL degeneration did not affect the retear rate of the supraspinatus tendon. The optimal indication for CAL release requires further investigation. Regarding the evaluation of CAL, arthroscopic Copeland-Levy classification is more histologically relevant than MRI scans.