Letters to the Editor   |    
Richard W. Nyffeler, MD, Dipl. Eng. ETH; Clément M.L. Werner, MD; Atul Sukhankar, MD; Marius R. Schmid, MD; Christian Gerber, MD
View Disclosures and Other Information
These letters originally appeared, in slightly different form, on jbjs.org. They are still available on the web site in conjunction with the article to which they refer.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Aug 01;88(8):1889-a-1890
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case


R.W. Nyffeler, C.M.L. Werner, A. Sukthankar, M.R. Schmid, and C. Gerber reply:We thank Drs. Bhatia, deBeer, and du Toit for their interest in our article. They remarked that humeral head medialization in patients with massive cuff tears can influence the "acromion index" and suggested that a large lateral extension of the acromion therefore may be relative rather than absolute and that its association with rotator cuff tears may be a consequence rather than a cause.We agree that medialization of the humeral head secondary to degeneration of the articular cartilage, flattening of the humeral head, and glenoid erosion decreases the distance from the glenoid plane to the lateral aspect of the proximal part of the humerus and therefore increases the acromion index. These morphological changes were typically present in the group of patients with primary osteoarthritis and an intact cuff, who were managed with an anatomical total shoulder prosthesis (Group 2 in our study). The patients with a full-thickness rotator cuff tear involving at least the supraspinatus tendon (Group 1) had no or only mild degenerative changes of the joint surfaces. No patient in our study had a cuff tear arthropathy requiring the insertion of an extended humeral head prosthesis or a reverse total shoulder prosthesis. The patients in Group 1 were managed with a cuff repair and in some cases with an additional latissimus dorsi tendon transfer. The acromion index for the rotator cuff tear group was significantly higher than that for the osteoarthritis group with a medialized humeral head.
Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org


    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe

    Related Content
    JBJS Case Connector
    Related Audio and Videos
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    MA - Boston University Orthopedic Surgical Associates
    WV - Charleston Area Medical Center
    WY - Memorial Hospital of Sweetwater County
    IL - Hinsdale Orthopaedics