Acta Chir Orthop Traumatol Cech. 2024; 91(1):57-61 | DOI: 10.55095/achot2024/007

The Association between SLAP Lesions and Critical Shoulder Angle and Glenoid DepthOriginal papers

F. İ. CAN1, E. GÜLTAÇ2, S. YILMAZ1, R. M. KILINÇ3, C. Y. KILINÇ2
1 Muğla Research and Training Hospital, Orthopedics and Traumatology Clinic, Mugla, Turkey
2 Department of Orthopedics and Traumatology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
3 Department of Radiology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey

Purpose of the study The critical shoulder angle (CSA) is formed by the combination of glenoid inclination and acromial index and has been shown related to rotator cuff tears and glenohumeral osteoarthritis. SLAP lesions today have an important place among bicipitolabral pathologies that cause intensive shoulder pain. We aimed to investigate the relationship between CSA and glenoid depth and SLAP lesions. Material and Methods Between March 2017 and January 2022, 279 consecutive shoulder arthroscopy patients' MRI images were retrospectively examined. After the exclusion criteria, 191 patients were eligible. Patients with SLAP lesions (n=37) were assembled as the study group (Group 1), and patients with intact superior labrum (n=154) were named as the control group (Group 2). Critical shoulder angle (CSA) and glenoid depth measurements were performed using the preoperative MRI images. Results A total of 191 patients, of whom 84 were male (44%) were included. The mean age was 49.9±14.96 (range 18-79). There was a statistically significant difference between the SLAP group (Group 1) and the control group (Group 2) in terms of CSA (p=0.032). The mean CSA was 31.66°±3.51° in Group 1 and 33.57° ±5.01° in Group 2. The cut-off value for CSA in patients with SLAP lesions was calculated as 32.85° and the area under the curve was 0.61, therefore a satisfactory association was observed between the groups. The mean glenoid depth was 4.32 ±1.25 mm in Group 1, and 4.39 ±0.32 mm in Group 2. There was no statistically significant difference between the groups in terms of glenoid depth (p=0.136) and also no association between the glenoid depth and SLAP lesions was observed (cut-off=4.45 mm, AUC=0.32). Conclusions Low CSA is associated with SLAP lesions, just as in glenohumeral osteoarthritis. Further prospective clinical studies are needed to enlighten the predisposing effect of CSA to SLAP lesions and the success of superior labral repairs.

Keywords: Level of evidence: Retrospective comparative study, Level III.Critical shoulder angle, SLAP lesion, shoulder arthroscopy, glenoid depth.

Accepted: March 5, 2024; Published: February 1, 2024  Show citation

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İ. CAN F, GÜLTAÇ E, YILMAZ S, KILINÇ RM, KILINÇ CY. The Association between SLAP Lesions and Critical Shoulder Angle and Glenoid Depth. Acta Chir Orthop Traumatol Cech. 2024;91(1):57-61. doi: 10.55095/achot2024/007. PubMed PMID: 38447566.
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References

  1. Andrews JR, Carson WG Jr., McLeod WD. Glenoid labrum tears related to the long head of the biceps. Am J Sports Med. 1985;13:337-341. Go to original source... Go to PubMed...
  2. Barber FA, Field LD, Ryu RK. Biceps tendon and superior labrum injuries: decision making. Instr Course Lect. 2008;57:527-538.
  3. Blonna D, Giani A, Bellato E, Mattei L, Caló M, Rossi R, Castoldi F. Predominance of the critical shoulder angle in the pathogenesis of degenerative diseases of the shoulder. J Shoulder Elbow Surg. 2016;25:1328-1336. Go to original source... Go to PubMed...
  4. Burkhart SS, Morgan C. SLAP lesions in the overhead athlete. Orthop Clin North Am. 2001;32:431-441, viii. Go to original source... Go to PubMed...
  5. Burkhart SS, Morgan CD. The peel-back mechanism: its role in producing and extending posterior type II SLAP lesions and its effect on SLAP repair rehabilitation. Arthroscopy. 1998;14:637-640. Go to original source... Go to PubMed...
  6. Cunningham G, Cocor C, Smith MM, Young AA, Cass B, Moor BK. Implication of bone morphology in degenerative rotator cuff lesions: a prospective comparative study between greater tuberosity angle and critical shoulder angle. Orthop Traumatol Surg Res. 2022;108:103046. Go to original source... Go to PubMed...
  7. Drakos MC, Barker JU, Osbahr DC, Lehto S, Rudzki JR, Potter H, Coleman SH, Allen AA, Altchek DW. Effective glenoid version in professional baseball players. Am J Orthop (Belle Mead NJ). 2010;39:340-344.
  8. İncesoy MA, Yildiz KI, Türk ÖI, Akinci ª, Turgut E, Aycan OE, Bayhan IA. 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;29:2257-2263.
  9. Kanatli U, Ozturk BY, Bolukbasi S. Anatomical variations of the anterosuperior labrum: prevalence and association with type II superior labrum anterior-posterior (SLAP) lesions. J Shoulder Elbow Surg. 2010;19:1199-1203. Go to original source... Go to PubMed...
  10. Kanatli U, Ozturk BY, Bolukbasi S. Arthroscopic repair of type II superior labrum anterior posterior (SLAP) lesions in patients over the age of 45 years: a prospective study. Arch Orthop Trauma Surg. 2011;131:1107-1113. Go to original source... Go to PubMed...
  11. 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:e1. Go to original source... Go to PubMed...
  12. Mantell MT, Nelson R, Lowe JT, Endrizzi DP, Jawa A. Critical shoulder angle is associated with full-thickness rotator cuff tears in patients with glenohumeral osteoarthritis. J Shoulder Elbow Surg. 2017;26:e376-e381. Go to original source... Go to PubMed...
  13. McGinley JC, Agrawal S, Biswal S. Rotator cuff tears: association with acromion angulation on MRI. Clin Imaging. 2012;36:791-796. Go to original source... Go to PubMed...
  14. Mihata T, McGarry MH, Tibone JE, Fitzpatrick MJ, Kinoshita M, Lee TQ. Biomechanical assessment of Type II superior labral anterior-posterior (SLAP) lesions associated with anterior shoulder capsular laxity as seen in throwers: a cadaveric study. Am J Sports Med. 2008;36:1604-1610. Go to original source... Go to PubMed...
  15. 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:935-941. Go to original source... Go to PubMed...
  16. Moor BK, Röthlisberger M, Müller DA, Zumstein MA, Bouaicha S, Ehlinger M, Gerber C. Age, trauma and the critical shoulder angle accurately predict supraspinatus tendon tears. Orthop Traumatol Surg Res. 2014;100:489-494. Go to original source... Go to PubMed...
  17. Nam EK, Snyder SJ. The diagnosis and treatment of superior labrum, anterior and posterior (SLAP) lesions. Am J Sports Med. 2003;31:798-810. Go to original source... Go to PubMed...
  18. Onyekwelu I, Khatib O, Zuckerman JD, Rokito AS, Kwon YW. The rising incidence of arthroscopic superior labrum anterior and posterior (SLAP) repairs. J Shoulder Elbow Surg. 2012;21:728-731. Go to original source... Go to PubMed...
  19. Pagnani MJ, Deng XH, Warren RF, Torzilli PA, O'Brien SJ. Role of the long head of the biceps brachii in glenohumeral stability: a biomechanical study in cadavera. J Shoulder Elbow Surg. 1996;5:255-262. Go to original source... Go to PubMed...
  20. Patzer T, Kircher J, Lichtenberg S, Sauter M, Magosch P, Habermeyer P. Is there an association between SLAP lesions and biceps pulley lesions? Arthroscopy. 2011;27:611-618. Go to original source... Go to PubMed...
  21. Patzer T, Wimmer N, Verde PE, Hufeland M, Krauspe R, Kubo HK. The association between a low critical shoulder angle and SLAP lesions. Knee Surg Sports Traumatol Arthrosc. 2019;27:3944-3951. Go to original source... Go to PubMed...
  22. Rodosky MW, Harner CD, Fu FH. The role of the long head of the biceps muscle and superior glenoid labrum in anterior stability of the shoulder. Am J Sports Med. 1994;22:121-130. Go to original source... Go to PubMed...
  23. Rose-Reneau Z, Moorefield AK, Schirmer D, Ismailov E, Downing R, Wright BW. The critical shoulder angle as a diagnostic measure for osteoarthritis and rotator cuff pathology. Cureus. 2020;11;12:e11447. Go to original source... Go to PubMed...
  24. Scheiderer B, Imhoff FB, Johnson JD, Aglio J, Cote MP, Beitzel K, Imhoff AB, Arciero RA, Mazzocca AD, Morikawa D. 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;34:2748-2754. Go to original source... Go to PubMed...
  25. Smith GCS, Liu V. High critical shoulder angle values are associated with full-thickness posterosuperior cuff tears and low values with primary glenohumeral osteoarthritis. Arthroscopy. 2022;38:709-715.e1. Go to original source... Go to PubMed...
  26. Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ. SLAP lesions of the shoulder. Arthroscopy. 1990;6:274-279. Go to original source... Go to PubMed...
  27. Vellingiri K, Ethiraj P, Shanthappa AH. Critical shoulder angle and its clinical correlation in shoulder pain. Cureus. 2020;17;12:e9810. Go to original source... Go to PubMed...