The pathomechanisms of eccentric osteoarthritis of the shoulder remain unclear. Although there is increasing evidence of bony differences between shoulders with rotator cuff tears and osteoarthritis, analogous differences have not been identified for primary concentric and eccentric osteoarthritis. This study examined the shape and orientation of the acromial roof as a potential risk factor for the development of posterior glenoid wear.
We analyzed computed tomography images of 105 shoulders with primary osteoarthritis. Based on the classification of Walch, 45 shoulders had concentric osteoarthritis (Walch A) and 60 shoulders were affected by eccentric osteoarthritis (Walch B; EOA). A comparison of acromial morphology was performed in a multiplanar reconstruction analysis of computed tomography scans.
Acromial shape: Acromial length, width, and area were not significantly different. Acromial roof orientation: The acromial roof in EOA was an average of 5° flatter (sagittal tilt; P < .01) and 5° more downward tilted (coronal tilt; P < .01). There was no difference in axial rotation (axial tilt; P = .47). Anteroposterior glenoid coverage: The glenoid in EOA was covered an average of 4° less posteriorly (P = .01) and 4° more anteriorly (P = .04). No differences were shown for overall glenoid coverage.
The acromial roof could play a role in the pathogenesis of EOA. Less posterior support due to a flatter acromion with less posterior glenoid coverage could contribute to static posterior subluxation of the humeral head and posterior glenoid wear. Further biomechanical investigations are needed to confirm these findings.