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Thacher RR, Retzky JS, Dekhne MS, Oquendo YA, Greditzer HG. Current Concepts in the Measurement of Glenohumeral Bone Loss. Curr Rev Musculoskelet Med 2023; 16:419-431. [PMID: 37341857 PMCID: PMC10427601 DOI: 10.1007/s12178-023-09852-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE The extent of glenohumeral bone loss seen in anterior shoulder dislocations plays a major role in guiding surgical management of these patients. The need for accurate and reliable preoperative assessment of bone loss on imaging studies is therefore of paramount importance to orthopedic surgeons. This article will focus on the tools that are available to clinicians for quantifying glenoid bone loss with a focus on emerging trends and research in order to describe current practices. RECENT FINDINGS Recent evidence supports the use of 3D CT as the most optimal method for quantifying bone loss on the glenoid and humerus. New trends in the use of 3D and ZTE MRI represent exciting alternatives to CT imaging, although they are not widely used and require further investigation. Contemporary thinking surrounding the glenoid track concept and the symbiotic relationship between glenoid and humeral bone loss on shoulder stability has transformed our understanding of these lesions and has inspired a new focus of study for radiologists and orthopedist alike. Although a number of different advanced imaging modalities are utilized to detect and quantify glenohumeral bone loss in practice, the current literature supports 3D CT imaging to provide the most reliable and accurate assessments. The emergence of the glenoid track concept for glenoid and humeral head bone loss has inspired a new area of study for researchers that presents exciting opportunities for the development of a deeper understanding of glenohumeral instability in the future. Ultimately, however, the heterogeneity of literature, which speaks to the diverse practices that exist across the world, limits any firm conclusions from being drawn.
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Affiliation(s)
- Ryan R Thacher
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70Th Street, New York, NY, 10021, USA.
| | - Julia S Retzky
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70Th Street, New York, NY, 10021, USA
| | - Mihir S Dekhne
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70Th Street, New York, NY, 10021, USA
| | - Yousi A Oquendo
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70Th Street, New York, NY, 10021, USA
| | - Harry G Greditzer
- Department of Radiology, Hospital for Special Surgery, 535 East 70Th Street, New York, NY, 10021, USA
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2
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Bedrin MD, Owens BD, Slaven SE, LeClere LE, Donohue MA, Tennent DJ, Goodlett RP, Cameron KL, Posner MA, Dickens JF. Prospective Evaluation of Posterior Glenoid Bone Loss After First-time and Recurrent Posterior Glenohumeral Instability Events. Am J Sports Med 2022; 50:3028-3035. [PMID: 35983958 DOI: 10.1177/03635465221115828] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although posterior glenohumeral instability is becoming an increasingly recognized cause of shoulder pain, the role of posterior glenoid bone loss on outcomes remains incompletely understood. PURPOSES To prospectively determine the amount of bone loss associated with posterior instability events and to determine predisposing factors based on preinstability imaging. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 1428 shoulders were evaluated prospectively for ≥4 years. At baseline, a subjective history of shoulder instability was ascertained for each patient, and bilateral noncontrast magnetic resonance imaging (MRI) scans of the shoulders were obtained regardless of any reported history of shoulder instability. The cohort was prospectively followed during the study period, and those who were diagnosed with posterior glenohumeral instability were identified. Postinjury MRI scans were obtained and compared with the screening MRI scans. Glenoid version, perfect-circle-based bone loss was measured for each patient's pre- and postinjury MRI scans using previously described methods. RESULTS Of the 1428 shoulders that were prospectively followed, 10 shoulders sustained a first-time posterior instability event and 3 shoulders sustained a recurrent posterior instability event. At baseline, 11 of 13 shoulders had some amount of glenoid dysplasia and/or bone loss. The change in glenoid bone loss was 5.4% along the axis of greatest loss (95% CI, 3.8%-7.0%; P = .009), 4.4% at the glenoid equator (95% CI, 2.7%-6.2%; P = .016), and 4.2% of total glenoid area (95% CI, 2.9%-5.3%; P = .002). Recurrent glenoid instability was associated with a greater amount of absolute bone loss along the axis of greatest loss compared with first-time instability (recurrent: 16.8% ± 1.1%; 95% CI, 14.6%-18.9%; first-time: 10.0% ± 1.5%; 95% CI, 7.0%-13.0%; P = .005). Baseline glenoid retroversion ≥10° was associated with a significantly greater percentage of bone loss along the axis of greatest loss (≥10° of retroversion: 13.5% ± 2.0%; 95% CI, 9.6%-17.4%; <10° of retroversion: 8.5% ± 0.8%; 95% CI, 7.0%-10.0%; P = .045). CONCLUSIONS Posterior glenohumeral instability events were associated with glenoid bone loss of 5%. The amount of glenoid bone loss after a recurrent posterior glenohumeral instability event was greater than that after first-time instability. Glenoid retroversion ≥10° was associated with a greater amount of posterior glenoid bone loss after a posterior instability event.
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Affiliation(s)
- Michael D Bedrin
- Walter Reed National Military Medical Center, Department of Orthopaedic Surgery, Bethesda, Maryland, USA.,Uniformed Services University of the Health Sciences, Department of Surgery, Bethesda, Maryland, USA
| | - Brett D Owens
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Community Hospital, United States Military Academy, West Point, New York, USA.,Brown University Alpert Medical School, Providence, Rhode Island, USA
| | - Sean E Slaven
- Walter Reed National Military Medical Center, Department of Orthopaedic Surgery, Bethesda, Maryland, USA.,Uniformed Services University of the Health Sciences, Department of Surgery, Bethesda, Maryland, USA
| | - Lance E LeClere
- United States Naval Academy, Department of Orthopaedic Surgery, Annapolis, Maryland, USA.,Vanderbilt Orthopaedics, Nashville, Tennessee, USA
| | - Michael A Donohue
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Community Hospital, United States Military Academy, West Point, New York, USA.,Department of Orthopedic Surgery, Keller Army Community Hospital, West Point, New York, USA
| | - David J Tennent
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Community Hospital, United States Military Academy, West Point, New York, USA.,Department of Orthopaedic Surgery, Evans Army Community Hospital, Fort Carson, Colorado, USA
| | - Ronald P Goodlett
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Community Hospital, United States Military Academy, West Point, New York, USA.,Womack Army Medical Center, Fort Bragg, North Carolina, USA
| | - Kenneth L Cameron
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Community Hospital, United States Military Academy, West Point, New York, USA.,Department of Orthopedic Surgery, Keller Army Community Hospital, West Point, New York, USA
| | - Matthew A Posner
- John A. Feagin Jr. Sports Medicine Fellowship, Keller Army Community Hospital, United States Military Academy, West Point, New York, USA.,Department of Orthopedic Surgery, Keller Army Community Hospital, West Point, New York, USA
| | - Jonathan F Dickens
- Uniformed Services University of the Health Sciences, Department of Surgery, Bethesda, Maryland, USA.,Duke University, Department of Orthopaedic Surgery, Durham, North Carolina, USA.,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Sgroi M, Huzurudin H, Ludwig M, Zippelius T, Reichel H, Kappe T. MRI Allows Accurate Measurement of Glenoid Bone Loss. Clin Orthop Relat Res 2022; 480:1731-1742. [PMID: 35452020 PMCID: PMC9384911 DOI: 10.1097/corr.0000000000002215] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/28/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bony Bankart lesions larger than a certain size can lead to a high redislocation rate, despite treatment with Bankart repair. Detection and measurement of glenoid bone loss play key roles in selecting the appropriate surgical therapy in patients with shoulder instability. There is controversy about which diagnostic modalities, using different measurement methods, provide the best diagnostic validity. QUESTIONS/PURPOSES (1) What are the diagnostic accuracies of true AP radiographs, West Point (WP) view radiographs, MRI, and CT to detect glenoid bone loss? (2) Are there differences in the measurements of glenoid bone loss on MRI and CT? (3) What are the intrarater and interrater reliabilities of CT and MRI to measure glenoid bone loss? METHODS Between August 2012 and February 2017, we treated 80 patients for anterior shoulder instability. Of those, we considered patients with available preoperative true AP radiographs, WP radiographs, CT images, and MR images of the affected shoulder as potentially eligible. Based on that, 63% (50 of 80) of patients were eligible for analysis; 31% (25 of 80) were excluded because not all planes or slices (such as sagittal, axial, or frontal) of each diagnostic imaging modalities were available and 7% (5 of 80) because of the insufficient quality of diagnostic images (for example, setting of the layers did not allow adequate en face view of the glenoid). Preoperative true AP radiographs, WP radiographs, CT images and MR images of the affected shoulders were retrospectively assessed for the presence of glenoid bone loss by two blinded observers at a median (range) 25 months (12 to 66) postoperatively. To evaluate sensitivity, specificity, positive predictive value, negative predictive value, accuracy, diagnostic odds ratio, positive likelihood ratio, negative likelihood ratio, and area under the curve (AUC), we compared the detection of glenoid bone loss at follow-up achieved with the aforementioned imaging modalities with intraoperative arthroscopic detection. In all patients with glenoid bone loss, two blinded observers measured the size of the glenoid bone loss on preoperative CT and MR images using six measuring techniques: depth and length of the glenoid bone loss, Bigliani classification, best-fit circle width loss method, AP distance method, surface area method, and Gerber X ratio. Subsequently, the sizes of the glenoid bone loss determined using CT and MRI were compared. To estimate intraobserver and interobserver reliability, measurements were performed in a blinded fashion by two observers. Their level of experience was equivalent to that of orthopaedic residents, and they completed a training protocol before the measurements. RESULTS For the ability to accurately diagnose Bankart lesions, the AUC (accuracy of a diagnostic test; the closer to 1.0, the more accurate the test) was good for MRI (0.83 [95% confidence interval 0.70 to 0.94]; p < 0.01), fair for CT (0.79 [95% CI 0.66 to 0.92]; p < 0.01), poor for WP radiographs (0.69 [95% CI 0.54 to 0.85]; p = 0.02) and failed for true AP radiographs (0.55 [95% CI 0.39 to 0.72]; p = 0.69). In paired comparisons, there were no differences between CT and MRI regarding (median [range]) lesion width (2.33 mm [0.35 to 4.53] versus 2.26 mm [0.90 to 3.47], p = 0.71) and depth (0.42 mm [0.80 to 1.39] versus 0.40 mm [0.06 to 1.17]; p = 0.54), and there were no differences concerning the other measurement methods: best-fit circle width loss method (15.02% [2.48% to 41.59%] versus 13.38% [2.00% to 36.34%]; p = 0.66), AP distances method (15.48% [1.44% to 42.01%] versus 12.88% [1.43% to 36.34%]; p = 0.63), surface area method (14.01% [0.87% to 38.25] versus 11.72% [2.45% to 37.97%]; p = 0.68), and Gerber X ratio (0.75 [0.13 to 1.47] versus 0.76 [0.27 to 1.13]; p = 0.41). Except for the moderate interrater reliability of the Bigliani classification using CT (intraclass correlation coefficient = 0.599 [95% CI 0.246 to 0.834]; p = 0.03) and acceptable interrater reliability of the Gerber X ratio using CT (0.775 [95% CI 0.542 to 0.899]; p < 0.01), all other measurement methods had good or excellent intrarater and interrater reliabilities on MRI and CT. CONCLUSION The results of this study show that CT and MRI can accurately detect glenoid bone loss, whereas WP radiographs can only recognize them poorly, and true AP radiographs do not provide any adequate diagnostic accuracy. In addition, when measuring glenoid bone loss, MRI images of the analyzed measurement methods yielded sizes that were no different from CT measurements. Finally, the use of MRI images to measure Bankart bone lesions gave good-to-excellent reliability in the present study, which was not inferior to CT findings. Considering the advantages including lower radiation exposure and the ability to assess the condition of the labrum using MRI, we believe MRI can help surgeons avoid ordering additional CT imaging in clinical practice for the diagnosis of anterior shoulder instability in patients with glenoid bone loss. Future studies should investigate the reproducibility of our results with a larger number of patients, using other measurement methods that include examination of the opposite side or with three-dimensional reconstructions. LEVEL OF EVIDENCE Level I diagnostic study.
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Affiliation(s)
- Mirco Sgroi
- Department of Orthopaedic Surgery, Universitäts- und Rehabilitationskliniken Ulm (RKU), University of Ulm, Ulm, Germany
| | - Hashuka Huzurudin
- Department of Orthopaedic Surgery, Universitäts- und Rehabilitationskliniken Ulm (RKU), University of Ulm, Ulm, Germany
| | - Marius Ludwig
- Department of Orthopaedic Surgery, Universitäts- und Rehabilitationskliniken Ulm (RKU), University of Ulm, Ulm, Germany
| | - Timo Zippelius
- Department of Orthopaedic Surgery, Universitäts- und Rehabilitationskliniken Ulm (RKU), University of Ulm, Ulm, Germany
| | - Heiko Reichel
- Department of Orthopaedic Surgery, Universitäts- und Rehabilitationskliniken Ulm (RKU), University of Ulm, Ulm, Germany
| | - Thomas Kappe
- Department of Orthopaedic Surgery, Universitäts- und Rehabilitationskliniken Ulm (RKU), University of Ulm, Ulm, Germany
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Armstrong T, Henderson DJ, Entwistle I, Iball G, Rowbotham E. Combination CT and MRI shoulder arthrography: a novel technique and improved patient journey. Clin Radiol 2022; 77:738-742. [PMID: 35981923 DOI: 10.1016/j.crad.2022.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/23/2022] [Accepted: 06/26/2022] [Indexed: 11/29/2022]
Affiliation(s)
- T Armstrong
- Leeds Musculoskeletal Radiology Department & The Leeds Upper Limb Unit, Chapel Allerton Hospital, Leeds, UK.
| | - D J Henderson
- Leeds Musculoskeletal Radiology Department & The Leeds Upper Limb Unit, Chapel Allerton Hospital, Leeds, UK
| | - I Entwistle
- Leeds Musculoskeletal Radiology Department & The Leeds Upper Limb Unit, Chapel Allerton Hospital, Leeds, UK
| | - G Iball
- Leeds Musculoskeletal Radiology Department & The Leeds Upper Limb Unit, Chapel Allerton Hospital, Leeds, UK
| | - E Rowbotham
- Leeds Musculoskeletal Radiology Department & The Leeds Upper Limb Unit, Chapel Allerton Hospital, Leeds, UK
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5
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Evaluating Bone Loss in Anterior Shoulder Instability. J Am Acad Orthop Surg 2022; 30:563-572. [PMID: 35653280 DOI: 10.5435/jaaos-d-22-00016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/23/2022] [Indexed: 02/01/2023] Open
Abstract
Anterior shoulder instability is a common orthopaedic condition that often involves damage to the bony architecture of the glenohumeral joint in addition to the capsulolabral complex. Patients with recurrent shoulder dislocations are at increased risk for glenohumeral bone loss, as each instability event leads to the accumulation of additional glenoid and/or humeral head bone defects. Depending on the degree of bone loss, successful treatment may need to address bony lesions in addition to injured soft-tissue structures. As such, a thorough understanding of methods for evaluating bone loss preoperatively, in terms of location, size, and significance, is essential. Although numerous imaging modalities can be used, three-dimensional imaging has proven particularly useful and is now an integral component of preoperative planning.
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6
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Weil S, Arnander M, Pearse Y, Tennent D. Reporting of glenoid bone loss measurement in clinical studies and the need for standardization : a systematic review. Bone Joint J 2022; 104-B:12-18. [PMID: 34969273 DOI: 10.1302/0301-620x.104b1.bjj-2021-0751.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIMS The amount of glenoid bone loss is an important factor in deciding between soft-tissue and bony reconstruction when managing anterior shoulder instability. Accurate and reproducible measurement of glenoid bone loss is therefore vital in evaluation of shoulder instability and recommending specific treatment. The aim of this systematic review is to identify the range methods and measurement techniques employed in clinical studies treating glenoid bone loss. METHODS A systematic review of the PubMed, MEDLINE, and Embase databases was undertaken to cover a ten-year period from February 2011 to February 2021. We identified clinical studies that incorporated bone loss assessment in the methodology as part of the decision-making in the management of patients with anterior shoulder instability. The Preferred Reporting Items for Systematic Reviews (PRISMA) were used. RESULTS A total of 5,430 articles were identified from the initial search, of which 82 studies met the final inclusion criteria. A variety of imaging methods were used: three studies did not specify which modality was used, and a further 13 used CT or MRI interchangeably. There was considerable heterogeneity among the studies that specified the technique used to quantify glenoid bone loss. A large proportion of the studies did not specify the technique used. CONCLUSION This systematic review has identified significant heterogeneity in both the imaging modality and method used to measure glenoid bone loss. The recommendation is that as a minimum for publication, authors should be required to reference the specific measurement technique used. Without this simple standardization, it is impossible to determine whether any published paper should influence clinical practice or should be dismissed. Cite this article: Bone Joint J 2022;104-B(1):12-18.
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Affiliation(s)
- Simon Weil
- Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Magnus Arnander
- Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Yemi Pearse
- Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Duncan Tennent
- Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, UK
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7
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Chong LR, Lee K, Sim FY. 3D MRI with CT-like bone contrast - An overview of current approaches and practical clinical implementation. Eur J Radiol 2021; 143:109915. [PMID: 34461599 DOI: 10.1016/j.ejrad.2021.109915] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/13/2021] [Accepted: 08/15/2021] [Indexed: 12/24/2022]
Abstract
CT is the imaging modality of choice for assessment of 3D bony morphology but incurs the penalty of ionizing radiation. Improving the ability of 3D MRI to provide high-resolution images of cortical bone with CT-like bone contrast has been a focus of recent research. The ability of 3D MRI to deliver cortical bone information with similar diagnostic performance to CT would complement assessment of soft tissues and medullary bone from a single MRI examination, simplifying evaluation and obviating radiation exposure from additional CT. This article presents an overview of current 3D MRI approaches for imaging cortical bone with CT-like bone contrast including ultrashort echo time, zero echo time, T1-weighted gradient recalled echo, susceptibility-weighted imaging and deep learning techniques. We also discuss clinical implementation of an optimized stack-of-stars 3D gradient recalled echo pulse sequence (3D-Bone) on commercially available MRI scanners for rendering 3D MRI with CT-like bone contrast in our institutional practice.
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Affiliation(s)
- Le Roy Chong
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Republic of Singapore.
| | - Kathy Lee
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Republic of Singapore.
| | - Fang Yang Sim
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Republic of Singapore.
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8
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Abstract
Fractures of the anteroinferior aspect of the glenoid rim, known as a bony Bankart lesions, can occur frequently in the setting of traumatic anterior shoulder dislocation. If these lesions are large and are left untreated in active patients, then recurrent glenohumeral instability due to glenoid bone deficiency may occur. Therefore, the clinician must recognize these lesions when they occur and provide appropriate treatment to restore physiological joint stability. This article aims to provide an overview focusing on clinical and technical considerations in the diagnosis and treatment of bony Bankart lesions.
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9
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Kuberakani K, Aizawa K, Yamamoto N, Shinagawa K, Suzuki T, Hatta T, Kawakami J, Itoi E. Comparison of best-fit circle versus contralateral comparison methods to quantify glenoid bone defect. J Shoulder Elbow Surg 2020; 29:502-507. [PMID: 31564576 DOI: 10.1016/j.jse.2019.07.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 07/13/2019] [Accepted: 07/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Several measurement techniques have been reported to quantify glenoid bone defect in patients with anterior shoulder instability. Among them, the method that uses a best-fit circle and another that uses the contralateral glenoid as a control are most commonly used. However, to our knowledge, no study has been reported that compared the reliability of these methods. The purpose of this study, therefore, was to determine which of these methods has higher reproducibility. METHOD In this study, 3-dimensional computed tomography data from 94 patients (mean age 29 years) with unilateral anterior shoulder instability were used. Three examiners measured the glenoid bone defect of each patient 3 times using 2 techniques: the best-fit circle method and the contralateral comparison method. Intra- and interobserver reliabilities were measured using intraclass correlation coefficient (ICC). RESULTS The intraobserver reliability was found to be 0.91 for the best-fit circle method and 0.98 for the contralateral comparison method. The interobserver reliability was 0.77 for the best-fit circle method and 0.88 for the contralateral method. The percentage of glenoid defect was 11.5% when using the best-fit circle and 10.7% with the contralateral method. CONCLUSION The contralateral comparison method was more reliable than the best-fit circle method for quantifying the amount of glenoid bone loss.
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Affiliation(s)
- Karthikraj Kuberakani
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Kazuho Aizawa
- Department of Orthopaedic Surgery, Iwaki City Medical Center, Iwaki, Japan
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Kiyotsugu Shinagawa
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Takayuki Suzuki
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Taku Hatta
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Jun Kawakami
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.
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10
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Weel H, Krekel PR, Willigenburg N, Willems WJ, Randelli P, Compagnoni R, van Deurzen DFP. Dynamic contact area ratio in shoulder instability: an innovative diagnostic technique measuring interplay of bony lesions. Knee Surg Sports Traumatol Arthrosc 2020; 28:2361-2366. [PMID: 31807834 PMCID: PMC7347673 DOI: 10.1007/s00167-019-05816-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 11/27/2019] [Indexed: 12/04/2022]
Abstract
PURPOSE The hypothesis of this study is that Dynamic Contact Area Ratio of the humerus and glenoid, measured with CT scans, is significantly reduced in patients with anterior shoulder instability compared to the Dynamic Contact Area Ratio in a control group of people without shoulder instability. METHODS Preoperative CT scans of patients who underwent surgery for anterior shoulder instability were collected. Additionally, the radiologic database was searched for control subjects. Using a validated software tool (Articulis) the CT scans were converted into 3-dimensional models and the amount the joint contact surface during simulated motion was calculated. RESULTS CT scans of 18 patients and 21 controls were available. The mean Dynamic Contact Area Ratio of patients was 25.2 ± 6.7 compared to 30.1 ± 5.1 in healthy subjects (p = 0.014). CONCLUSION Dynamic Contact Area Ratio was significantly lower in patients with anterior shoulder instability compared to controls, confirming the hypothesis of the study. The findings of this study indicate that calculating the Dynamic Contact Area Ratio based on CT scan images may help surgeons in diagnosing anterior shoulder instability. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hanneke Weel
- Amsterdam University Medical Centres, Amsterdam, The Netherlands.
| | | | | | - W. Jaap Willems
- grid.440209.bOnze Lieve Vrouwe Gasthuis Oost, Amsterdam, The Netherlands ,Clinical Graphics, Delft, The Netherlands ,grid.7177.60000000084992262Amsterdam University Medical Centres, Amsterdam, The Netherlands ,Lairesse Kliniek, Amsterdam, The Netherlands
| | - Pietro Randelli
- grid.4708.b0000 0004 1757 2822Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy ,1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Riccardo Compagnoni
- grid.4708.b0000 0004 1757 2822Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy ,1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
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11
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Liu F, Cheng X, Dong J, Zhou D, Sun Q, Bai X, Wang D. Imaging modality for measuring the presence and extent of the labral lesions of the shoulder: a systematic review and meta-analysis. BMC Musculoskelet Disord 2019; 20:487. [PMID: 31656171 PMCID: PMC6815459 DOI: 10.1186/s12891-019-2876-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 10/09/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Multiple published studies quantitatively analysing the diagnostic value of MRI, MR arthrography (MRA) and CT arthrography (CTA) for labral lesions of the shoulder have had inconsistent results. The aim of this meta-analysis was to systematically compare the diagnostic performance of MRI, MRA, CTA and CT. METHODS Two databases, PubMed and EMBASE, were used to retrieve studies targeting the accuracy of MRI, MRA, CTA and CT in detecting labral lesions of the shoulder. After carefully screening and excluding studies, the studies that met the inclusion criteria were used for a pooled analysis, including calculation of sensitivity and specificity with 95% confidence intervals (CIs) and the area under the hierarchical summary receiver operating characteristic (HSROC) curves. RESULTS The retrieval process identified 2633 studies, out of which two reviewers screened out all but 14 studies, involving a total of 1216 patients who were deemed eligible for inclusion in the meta-analysis. The results assessing the diagnostic performance of MRI vs. MRA for detecting labral lesions showed a pooled sensitivity of 0.77 (95% CI 0.70-0.84) vs. 0.92 (95% CI 0.84-0.96), a specificity of 0.95 (95% CI 0.85-0.98) vs. 0.98 (95% CI 0.91-0.99), and an area under the HSROC curve of 3.78 (95% CI 2.73-4.83) vs. 6.01 (95% CI 4.30-7.73), respectively. CONCLUSION MRA was suggested for use in patients with chronic shoulder symptoms or a pathologic abnormality. MRI is by far the first choice recommendation for the detection of acute labral lesions. CT should be a necessary supplemental imaging technique when there is highly suspected glenoid bone damage.
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Affiliation(s)
- Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Xiangyun Cheng
- Department of Orthopaedics, The 2nd Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jinlei Dong
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Dongsheng Zhou
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Qian Sun
- Department of General and Paediatric Surgery, Yantai Yuhuangding Hospital affiliated Qingdao University, Yuhuangding eastern road 20, Yantai, China
| | - Xiaohui Bai
- Department of Clinical Laboratory, Shandong Provincial Hospital affiliated to Shandong University, Jing Wu Road 324, Jinan, 250021, Shandong, China.
| | - Dawei Wang
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China.
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12
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Imaging Quantification of Glenoid Bone Loss in Patients With Glenohumeral Instability: A Systematic Review. AJR Am J Roentgenol 2019; 212:1096-1105. [PMID: 30835517 DOI: 10.2214/ajr.18.20504] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
To listen to the podcast associated with this article, please select one of the following: iTunes, Google Play, or direct download. OBJECTIVE. The purpose of this study is to determine the most accurate imaging techniques to measure glenoid bone loss in anterior glenohumeral instability through a systematic review of existing literature. MATERIALS AND METHODS. We performed a comprehensive literature search of five databases for original research measuring glenoid bone loss at radiography, CT, or MRI, using prospective or retrospective cohort, case-control, or cadaveric study designs up to January 2018. The Quality Assessment of Diagnostic Accuracy Studies-2 tool aided qualitative assessment of the methods. Data extraction included results, index test interobserver agreement, and accuracy analysis. RESULTS. Twenty-seven studies (evaluating 1425 shoulders) met inclusion criteria after full-text review by two independent readers. Glenoid bone loss was assessed, comparing several index tests to nonimaging (n = 18 studies) and imaging (n = 11) reference standards. Compared with arthroscopic or cadaveric measurements, 2D CT was accurate in six of seven studies (86%), 3D CT was accurate in eight of 10 studies (80%), 2D MRI was accurate in five of seven studies (71%), 3D MRI was accurate in four of four studies (100%), and radiographs were accurate in zero of four studies (0%). Best-fit circle methods (glenoid width or Pico surface area) were the most common and both were accurate (86-90% and 75-100%, respectively) using CT and MRI. Studies had good external validity (78%). Most risk for bias arose from patient selection and reference standards. Only two studies reported sensitivity and specificity, both comparing CT to arthroscopy using different bone loss thresholds (20% and 25%). CONCLUSION. CT and MRI (2D or 3D) accurately measure glenoid bone loss in anterior shoulder instability, but radiographs do not. Best-fit circle measurement techniques are reliable and accurate. Current literature about glenoid bone loss is heterogeneous, and future studies should focus on diagnosis of clinically relevant glenoid bone loss.
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13
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Haas M, Plachel F, Wierer G, Heuberer P, Hoffelner T, Schulz E, Anderl W, Moroder P. Glenoid morphology is associated with the development of instability arthropathy. J Shoulder Elbow Surg 2019; 28:893-899. [PMID: 30509607 DOI: 10.1016/j.jse.2018.09.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 09/06/2018] [Accepted: 09/16/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Instability arthropathy (IA) is a major long-term concern in patients with anterior shoulder instability. This study investigated the association of glenoid morphology with the development of IA. METHODS The study included 118 patients with unilateral anterior shoulder instability and available bilateral computed tomography scans. Instability-specific information was obtained from all patients. The glenoid morphology of the affected shoulder was compared with the nonaffected contralateral side resembling the constitutional preinjury glenoid shape. Both shoulders were evaluated independently by 3 observers to assess the grade of IA according to a Comprehensive Arthropathy Rating (CAR) system. Associations between IA and the glenoid morphology parameters were investigated. RESULTS The average glenoid retroversion (P < .001), glenoid depth (P < .001), glenoid diameter (P < .001), and the bony shoulder stability ratio (P < .001) of the affected shoulder were significantly reduced compared with the contralateral side due to bony defects in 79.6% of the patients. The CAR of the affected side was significantly higher (P < .001), with more osteophytes (P = .001) and more sclerosis and cysts (P < .001). Differences in CAR (Δ-CAR) correlated positively with the age at the time of the computed tomography scan (P < .001), age at the initial dislocation (P = .001), size of the glenoid defect (P = .005), and the contralateral glenoid depth (P = .011), glenoid diameter (P = .016), and bony shoulder stability (P = .029), and negatively with glenoid retroversion of the affected side (P = .027). CONCLUSION Development of IA arthropathy is associated not only with the age of the patients but also with morphologic parameters of the glenoid, including glenoid defect size and the constitutional glenoid concavity shape.
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Affiliation(s)
- Maximilian Haas
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria.
| | - Fabian Plachel
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria; Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin, Berlin, Germany
| | - Guido Wierer
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - Philipp Heuberer
- Department of Orthopedic Surgery, St. Vincent Shoulder & Sports Clinic, Vienna, Austria
| | - Thomas Hoffelner
- Department of Orthopedic Surgery, St. Vincent Shoulder & Sports Clinic, Vienna, Austria
| | - Eva Schulz
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - Werner Anderl
- Department of Orthopedic Surgery, St. Vincent Shoulder & Sports Clinic, Vienna, Austria
| | - Philipp Moroder
- Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin, Berlin, Germany
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14
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Dickens JF, Slaven SE, Cameron KL, Pickett AM, Posner M, Campbell SE, Owens BD. Prospective Evaluation of Glenoid Bone Loss After First-time and Recurrent Anterior Glenohumeral Instability Events. Am J Sports Med 2019; 47:1082-1089. [PMID: 30943084 DOI: 10.1177/0363546519831286] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Determining the amount of glenoid bone loss in patients after anterior glenohumeral instability events is critical to guiding appropriate treatment. One of the challenges in treating the shoulder instability of young athletes is the absence of clear data showing the effect of each event. PURPOSE To prospectively determine the amount of bone loss associated with a single instability event in the setting of first-time and recurrent instability. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS The authors conducted a prospective cohort study of 714 athletes surveilled for 4 years. Baseline assessment included a subjective history of shoulder instability. Bilateral noncontrast shoulder magnetic resonance imaging (MRI) was obtained for all participants with and without a history of previous shoulder instability. The cohort was prospectively followed during the study period, and those who sustained an anterior glenohumeral instability event were identified. Postinjury MRI with contrast was obtained and compared with the screening MRI. Glenoid width was measured for each patient's pre- and postinjury MRI. The projected total glenoid bone loss was calculated and compared for patients with a history of shoulder instability. RESULTS Of the 714 athletes (1428 shoulders) who were prospectively followed during the 4-year period, 22 athletes (23 shoulders) sustained a first-time anterior instability event (5 dislocations, 18 subluxations), and 6 athletes (6 shoulders) with a history of instability sustained a recurrent anterior instability event (1 dislocation, 5 subluxations). On average, there was statistically significant glenoid bone loss (1.84 ± 1.47 mm) after a single instability event ( P < .001), equivalent to 6.8% (95% CI, 4.46%-9.04%; range, 0.71%-17.6%) of the glenoid width. After a first-time instability event, 12 shoulders (52%) demonstrated glenoid bone loss ≥5% and 4 shoulders, ≥13.5%; no shoulders had ≥20% glenoid bone loss. Preexisting glenoid bone loss among patients with a history of instability was 10.2% (95% CI, 1.96%-18.35%; range, 0.6%-21.0%). This bone loss increased to 22.8% (95% CI, 20.53%-25.15%; range, 21.2%-26.0%) after additional instability ( P = .0117). All 6 shoulders with recurrent instability had ≥20% glenoid bone loss. CONCLUSION Glenoid bone loss of 6.8% was observed after a first-time anterior instability event. In the setting of recurrent instability, the total calculated glenoid bone loss was 22.8%, with a high prevalence of bony Bankart lesions (5 of 6). The findings of this study support early stabilization of young active patients after a first-time anterior glenohumeral instability event.
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Affiliation(s)
- Jonathan F Dickens
- Keller Army Hospital, United States Military Academy, West Point, New York, USA.,Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Sean E Slaven
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA.,Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Kenneth L Cameron
- Keller Army Hospital, United States Military Academy, West Point, New York, USA
| | - Adam M Pickett
- Keller Army Hospital, United States Military Academy, West Point, New York, USA.,Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Matthew Posner
- Keller Army Hospital, United States Military Academy, West Point, New York, USA.,Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | | | - Brett D Owens
- Uniformed Services University of Health Sciences, Bethesda, Maryland, USA.,Brown Alpert Medical School, Providence, Rhode Island, USA
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15
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Provencher MT, Peebles LA, Dekker TJ, Aman ZS, Kennedy MI. Assessment of Bone Loss in the Shoulder. OPER TECHN SPORT MED 2019. [DOI: 10.1053/j.otsm.2019.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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16
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New multidetector computed tomography quantitative technique in evaluation of shoulder instability. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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17
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Gulati A, Dessouky R, Wadhwa V, Sanders D, Chhabra A. New concepts of radiologic preoperative evaluation of anterior shoulder instability: on-track and off-track lesions. Acta Radiol 2018; 59:966-972. [PMID: 29216740 DOI: 10.1177/0284185117745573] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The shoulder is the most frequently dislocated joint in the body due to a larger range of motion and a small area of articulation between the humeral and glenoid surfaces. Traumatic shoulder dislocations, especially those associated with injury to the labroligamentous or bony stabilizers of the joint, lead to further reduction of articular surface contact with resultant glenohumeral instability and recurrent shoulder dislocations. Imaging plays an increasingly important role in the preoperative evaluation of patients with traumatic shoulder instability by evaluating glenohumeral bone loss (uni- or bipolar), assessing soft tissue injuries and identifying patients at risk of postoperative recurrence. Quantification of bone loss is key to differentiate engaging vs. non-engaging Hill-Sachs lesions, while newer concepts of "on-track" vs. "off-track" lesions are being discussed that can determine the required surgical approaches. In this article, we review the preoperative imaging approaches, traditional treatments, outline the bone loss measurement strategies and review these new tracking concepts with relevant case examples.
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Affiliation(s)
| | - Riham Dessouky
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
- Radiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Vibhor Wadhwa
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Drew Sanders
- Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Avneesh Chhabra
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
- Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
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18
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Ma YJ, West J, Nazaran A, Cheng X, Hoenecke H, Du J, Chang EY. Feasibility of using an inversion-recovery ultrashort echo time (UTE) sequence for quantification of glenoid bone loss. Skeletal Radiol 2018; 47:973-980. [PMID: 29396694 PMCID: PMC5960612 DOI: 10.1007/s00256-018-2898-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/11/2018] [Accepted: 01/18/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To utilize the 3D inversion recovery prepared ultrashort echo time with cones readout (IR-UTE-Cones) MRI technique for direct imaging of lamellar bone with comparison to the gold standard of computed tomography (CT). MATERIALS AND METHODS CT and MRI was performed on 11 shoulder specimens and three patients. Five specimens had imaging performed before and after glenoid fracture (osteotomy). 2D and 3D volume-rendered CT images were reconstructed and conventional T1-weighted and 3D IR-UTE-Cones MRI techniques were performed. Glenoid widths and defects were independently measured by two readers using the circle method. Measurements were compared with those made from 3D CT datasets. Paired-sample Student's t tests and intraclass correlation coefficients were performed. In addition, 2D CT and 3D IR-UTE-Cones MRI datasets were linearly registered, digitally overlaid, and compared in consensus by these two readers. RESULTS Compared with the reference standard (3D CT), glenoid bone diameter measurements made on 2D CT and 3D IR-UTE-Cones were not significantly different for either reader, whereas T1-weighted images underestimated the diameter (mean difference of 0.18 cm, p = 0.003 and 0.16 cm, p = 0.022 for readers 1 and 2, respectively). However, mean margin of error for measuring glenoid bone loss was small for all modalities (range, 1.46-3.92%). All measured ICCs were near perfect. Digitally registered 2D CT and 3D IR-UTE-Cones MRI datasets yielded essentially perfect congruity between the two modalities. CONCLUSIONS The 3D IR-UTE-Cones MRI technique selectively visualizes lamellar bone, produces similar contrast to 2D CT imaging, and compares favorably to measurements made using 2D and 3D CT.
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Affiliation(s)
- Ya-jun Ma
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA 92103,Radiology Service, VA San Diego Healthcare System, San Diego, CA 92161
| | - Justin West
- Department of Orthopedic Surgery and Sports Medicine, Scripps Clinic, La Jolla, CA 92037
| | - Amin Nazaran
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA 92103,Radiology Service, VA San Diego Healthcare System, San Diego, CA 92161
| | - Xin Cheng
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA 92103,Department of Histology & Embryology, Medical College, Jinan University, Guangzhou, China 510632
| | - Heinz Hoenecke
- Department of Orthopedic Surgery and Sports Medicine, Scripps Clinic, La Jolla, CA 92037
| | - Jiang Du
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA 92103
| | - Eric Y. Chang
- Department of Radiology, University of California, San Diego Medical Center, San Diego, CA 92103,Radiology Service, VA San Diego Healthcare System, San Diego, CA 92161
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19
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Plachel F, Korn G, Abdic S, Moroder P. Acute locked superior shoulder dislocation in a patient with cuff tear arthropathy. BMJ Case Rep 2018; 2018:bcr-2018-225237. [PMID: 29930172 DOI: 10.1136/bcr-2018-225237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
In the field of traumatic shoulder dislocations, this report of a 61-year-old female patient discusses the case of an acute locked superior shoulder dislocation in conjunction with a chronic rotator cuff arthropathy resulting from a low-energy fall on the outstretched and abducted arm. Radiological assessment revealed a complex combination of associated bony injuries including a fracture of the upper part of the glenoid and an impaction fracture of the inferior articular surface of the humeral head. Closed reduction and immobilisation were not successful in obtaining joint stability. This unique report highlights the clinical importance of accurate management of bony injuries in traumatic shoulder dislocation.
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Affiliation(s)
- Fabian Plachel
- Center for Musculoskeletal Surgery, Charite Universitatsmedizin Berlin Campus Virchow-Klinikum, Berlin, Germany.,Department of Orthopedics and Traumatology, Landeskrankenhaus Salzburg - Universitatsklinikum der Paracelsus Medizinischen Privatuniversitat, Salzburg, Austria
| | - Gundobert Korn
- Department of Orthopedics and Traumatology, Landeskrankenhaus Salzburg - Universitatsklinikum der Paracelsus Medizinischen Privatuniversitat, Salzburg, Austria
| | - Sejla Abdic
- Department of Orthopedics and Traumatology, Landeskrankenhaus Salzburg - Universitatsklinikum der Paracelsus Medizinischen Privatuniversitat, Salzburg, Austria
| | - Philipp Moroder
- Center for Musculoskeletal Surgery, Charite Universitatsmedizin Berlin Campus Virchow-Klinikum, Berlin, Germany
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20
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Kraeutler MJ, McCarty EC, Belk JW, Wolf BR, Hettrich CM, Ortiz SF, Bravman JT, Baumgarten KM, Bishop JY, Bollier MJ, Brophy RH, Carey JL, Carpenter JE, Cox CL, Feeley BT, Grant JA, Jones GL, Kuhn JE, Kelly JD, Ma CB, Marx RG, Miller BS, Sennett BJ, Smith MV, Wright RW, Zhang AL. Descriptive Epidemiology of the MOON Shoulder Instability Cohort. Am J Sports Med 2018; 46:1064-1069. [PMID: 29505730 DOI: 10.1177/0363546518755752] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Shoulder instability is a common diagnosis among patients undergoing shoulder surgery. PURPOSE To perform a descriptive analysis of patients undergoing surgery for shoulder instability through a large multicenter consortium. STUDY DESIGN Case series; Level of evidence, 4. METHODS All patients undergoing surgery for shoulder instability who were enrolled in the MOON Shoulder Instability Study were included. Baseline demographics included age, sex, body mass index, and race. Baseline patient-reported outcomes (PROs) included the American Shoulder and Elbow Surgeons (ASES) score, Shoulder Activity Score, Western Ontario Shoulder Instability Index (WOSI), 36-Item Health Survey (RAND-36), and Single Assessment Numeric Evaluation (SANE). The preoperative physician examination included active range of motion (ROM) and strength testing. Preoperative imaging assessments with plain radiography, magnetic resonance imaging (MRI), and computed tomography were also included and analyzed. RESULTS Twenty-six surgeons had enrolled 863 patients (709 male, 154 female) across 10 clinical sites. The mean age for the cohort was 24 years (range, 12-63 years). Male patients represented 82% of the cohort. The primary direction of instability was anterior for both male (74%) and female (73%) patients. Football (24%) and basketball (13%) were the most common sports in which the primary shoulder injury occurred. No clinically significant differences were found in preoperative ROM between the affected and unaffected sides for any measurement taken. Preoperative MRI scans were obtained in 798 patients (92%). An anterior labral tear was the most common injury found on preoperative MRI, seen in 66% of patients, followed by a Hill-Sachs lesion in 41%. Poor PRO scores were recorded preoperatively (mean: ASES, 72.4; WOSI, 43.3; SANE, 46.6). CONCLUSION The MOON Shoulder Instability Study has enrolled the largest cohort of patients undergoing shoulder stabilization to date. Anterior instability is most common among shoulder instability patients, and most patients undergoing shoulder stabilization are in their early 20s or younger. The results of this study provide important epidemiological information for patients undergoing shoulder stabilization surgery.
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Affiliation(s)
- Matthew J Kraeutler
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Eric C McCarty
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - John W Belk
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Brian R Wolf
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Carolyn M Hettrich
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Shannon F Ortiz
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
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- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Jonathan T Bravman
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Keith M Baumgarten
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Julie Y Bishop
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Matthew J Bollier
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Robert H Brophy
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - James L Carey
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - James E Carpenter
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Charlie L Cox
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Brian T Feeley
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - John A Grant
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Grant L Jones
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - John E Kuhn
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - John D Kelly
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - C Benjamin Ma
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Robert G Marx
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Bruce S Miller
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Brian J Sennett
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Matthew V Smith
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Rick W Wright
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Alan L Zhang
- Investigation performed at CU Sports Medicine and Performance Center, Department of Orthopedics, University of Colorado School of Medicine, Boulder, Colorado, USA
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21
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Moroder P, Böhm E, Scheibel M. The Arthroscopic Bankart-Plus Procedure for Treatment of Anterior Shoulder Instability With Small to Intermediate Glenoid Defects. Arthrosc Tech 2018; 7:e379-e384. [PMID: 29868408 PMCID: PMC5982609 DOI: 10.1016/j.eats.2017.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/31/2017] [Indexed: 02/03/2023] Open
Abstract
To date, specific surgical procedures are available for the treatment of anterior shoulder instability with substantial bony glenoid defects, as well as for patients without osseous lesions. However, specific treatment options are lacking for the frequently observed small to intermediate glenoid defects, which may not necessitate glenoid reconstruction surgery according to current guidelines but can still jeopardize the outcome after mere soft-tissue stabilization procedures. This article describes the so-called arthroscopic Bankart-Plus procedure for the treatment of anterior shoulder instability with small to intermediate bony glenoid defects. In addition to the conventional capsulolabral repair, an allogeneic demineralized spongy bone matrix is inserted between the glenoid neck and the labrum with the aim of compensating for the glenoid bone loss by increasing the volume of the labrum and thus its stabilizing effect.
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Affiliation(s)
- Philipp Moroder
- Address correspondence to Philipp Moroder, M.D., Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
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22
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Koh E, Walton ER, Watson P. VIBE MRI: an alternative to CT in the imaging of sports-related osseous pathology? Br J Radiol 2018; 91:20170815. [PMID: 29474097 DOI: 10.1259/bjr.20170815] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
MRI is an excellent diagnostic tool in the imaging of sports-related musculoskeletal pathology; however, standard slice thickness acquisitions can lack the spatial resolution to accurately define and characterise osseous abnormalities. Standard MRI sequences may be supplemented with CT to reduce diagnostic uncertainty. We provide a clinical perspective, in the form of pictorial review, on the potential applications of 3D MRI sequences, specifically using volumetric interpolated breath-hold examination in the characterisation of various musculoskeletal osseous pathologies. The potential to negate the requirement for CT in a young radiation sensitive cohort is a clinically significant concept and suggests the requirement for further studies comparing the performance of volumetric MRI to CT.
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Affiliation(s)
- Eamon Koh
- 1 MRI, Envision Medical Imaging , Wembley, Perth, WA , Australia
| | - Edward Rj Walton
- 2 Radiology, Fiona Stanley and Fremantle Hospitals , Murdoch and Fremantle, WA , Australia
| | - Phil Watson
- 3 MRI, Envision Medical Imaging , Wembley, Perth, WA , Australia
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23
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Moroder P, Plachel F, Huettner A, Ernstbrunner L, Minkus M, Boehm E, Gerhardt C, Scheibel M. The Effect of Scapula Tilt and Best-Fit Circle Placement When Measuring Glenoid Bone Loss in Shoulder Instability Patients. Arthroscopy 2018; 34:398-404. [PMID: 29100772 DOI: 10.1016/j.arthro.2017.08.234] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 07/30/2017] [Accepted: 08/02/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze the effect of lack of standardization on the reliability of current measurement techniques for glenoid bone loss in clinical practice. METHODS Ten consecutive patients with anterior glenoid bone loss due to recurrent anterior shoulder instability and available computed tomographic (CT) scans of the affected shoulder were included in this study. One hundred seventy 3-dimensional en-face view images of the 10 glenoids with up to 20° degrees of tilt in the anterior, posterior, superior, and inferior direction were rendered. Three independent observers first identified the en-face view images and subsequently performed measurements of the defect surface and diameter as well as the glenoid surface and diameter on all 170 images. Measurements were completed based on the conventional best-fit circle technique using the edge of the visible glenoid bone as reference and additionally based on the so-called spoon technique, which places the best-fit circle on the edge of the visible glenoid concavity. RESULTS The overall agreement regarding en-face view image selection between the observers was 30% (K-alpha = 0.10, 95% confidence interval 0.02-0.22). Tilt of the en-face view in any direction resulted in significant alterations of all 4 measurement parameters as well as the relative defect area and diameter (P < .05). The conventional and the spoon techniques rendered significantly different results regarding all 4 measurement parameters as well as the relative defect area (P < .05). CONCLUSION Impreciseness of scapula positioning for creation of an en-face view of the glenoid as well as varying best-fit circle placement significantly alter glenoid defect size measurement results. CLINICAL RELEVANCE Because the glenoid defect size plays an important role in the choice of treatment for anterior shoulder instability, measurement techniques need to be as precise as possible.
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Affiliation(s)
- Philipp Moroder
- Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany; Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria.
| | - Fabian Plachel
- Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany; Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - Anna Huettner
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - Lukas Ernstbrunner
- Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria; Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Marvin Minkus
- Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Elisabeth Boehm
- Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Christian Gerhardt
- Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Markus Scheibel
- Center for Musculoskeletal Surgery, Campus Virchow, Charité-Universitaetsmedizin Berlin, Berlin, Germany
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Shin SJ, Jun BJ, Koh YW, McGarry MH, Lee TQ. Estimation of anterior glenoid bone loss area using the ratio of bone defect length to the distance from posterior glenoid rim to the centre of the glenoid. Knee Surg Sports Traumatol Arthrosc 2018; 26:48-55. [PMID: 27671285 DOI: 10.1007/s00167-016-4312-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 08/31/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Estimation of anterior glenoid bone loss is important for surgical decision-making. The purpose of this study was to describe a method for estimating anterior glenoid bone loss. METHODS Thirty-nine cadaveric glenoids were digitized to obtain glenoid geometry. Glenoid bare spot centre, arthroscopic centre, and centre of the inferior glenoid circle relative to the geometric centre were measured. To simulate anterior glenoid bone loss, imaginary sequential osteotomies were created 0°, 22.5°, and 45° to the superior-inferior line in a 3D digitizing programme. Per cent of anterior glenoid bone loss area was calculated as the percentage of defect area relative to the entire area of the glenoid. The relationship between area loss and ratio of bone defect length to the distance from posterior glenoid to various centres was determined. RESULTS As the ratio of bone defect length to the distance from posterior glenoid to all three centres increased, the per cent area of bone loss increased exponentially. The ratio using the inferior circle centre and arthroscopic centre was highly correlated to the actual glenoid bone loss in all osteotomies (R 2 > 0.90). The ratio using the centre of bare area had the lowest correlation. The ratio of defect length to distance from posterior glenoid to arthroscopic centre greater than 2.4 for 0° and 2.0 for 45° osteotomies results in bone loss area greater than 25 %. The bare area centre had the largest variation. Average bone loss was overestimated when the centre of bare spot was used compared to other centre locations. CONCLUSION Per cent of anterior glenoid bone loss can be estimated using the ratio of bone defect length to the distance from posterior glenoid rim to the centre of inferior glenoid circle or arthroscopic centre either preoperatively using 3D CT or arthroscopically which can be useful for determining surgical treatment.
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Affiliation(s)
- Sang-Jin Shin
- Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System (09/151), 5901 East 7th. Street , Long Beach, CA, 90822, USA.,Ewha Womans University, Seoul, Korea
| | - Bong Jae Jun
- Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System (09/151), 5901 East 7th. Street , Long Beach, CA, 90822, USA
| | | | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System (09/151), 5901 East 7th. Street , Long Beach, CA, 90822, USA
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System (09/151), 5901 East 7th. Street , Long Beach, CA, 90822, USA. .,Department of Orthopaedic Surgery, University of California, Irvine, CA, USA. .,Department of Biomedical Engineering, University of California, Irvine, CA, USA.
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Brown M, Wallace A, Lachlan A, Alexander S. Arthroscopic Soft Tissue Procedures for Anterior Shoulder Instability. Open Orthop J 2017; 11:979-988. [PMID: 29114337 PMCID: PMC5646175 DOI: 10.2174/1874325001711010979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 10/26/2016] [Accepted: 10/28/2016] [Indexed: 12/24/2022] Open
Abstract
Background: Arthroscopy has rapidly transformed the treatment of anterior shoulder instability over the past 30 years. Development of arthroscopic equipment has permitted the investigation and diagnosis of the unstable shoulder, and fixation methods have evolved to promote arthroscopy from an experimental procedure to one of first-line mainstream treatment. Methods: Key research papers were reviewed to identify the fundamental principles in patient diagnosis and appropriate selection for arthroscopic treatment. The evolution of arthroscopy is described in this article to facilitate the understanding of current treatment. Results: Accurate diagnosis of the shoulder instability subtype is essential prior to selection for surgery. Different surgical techniques are described to address different pathology within the glenohumeral joint related to instability and the appropriate method should be selected accordingly to optimise outcome. Conclusion: Anterior shoulder instability can be treated successfully using arthroscopic surgery, but the surgeon must treat each patient as an individual case and recognise the different subtypes of instability, the associated pathological lesions and the limitations of arthroscopy. The article concludes with a suggested algorithm for the treatment of anterior shoulder instability.
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Affiliation(s)
- Mathew Brown
- Fortius Clinic Central 17 Fitzhardinge Street London W1H 6EQ UK
| | - Andrew Wallace
- Fortius Clinic Central 17 Fitzhardinge Street London W1H 6EQ UK
| | - Andrew Lachlan
- Fortius Clinic Central 17 Fitzhardinge Street London W1H 6EQ UK
| | - Susan Alexander
- Fortius Clinic Central 17 Fitzhardinge Street London W1H 6EQ UK
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26
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Provencher MT, Ferrari MB, Sanchez G, Anavian J, Akamefula R, LeBus GF. Current Treatment Options for Glenohumeral Instability and Bone Loss. JBJS Rev 2017; 5:e6. [DOI: 10.2106/jbjs.rvw.16.00091] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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27
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Abstract
Radiography remains pivotal to the workup of instability lesions of the shoulder, both in the acute as well as the chronic settings. The goal of radiography is to detect osseous abnormalities and locate them in order to determine the direction of instability. In antero-inferior instability, Hill-Sachs lesions are often visible at radiography and should not be confused with various differential diagnoses, which are usually more laterally located. Bankart lesions are more difficult to detect on conventional radiography, but there are less false positives than for Hill-Sachs lesions. The Garth view represents an excellent radiographic view to detect antero-inferior instability impaction fractures at both the humeral and glenoid sides. Accurate quantification of bony abnormalities and detection of lesions to the soft-tissue stabilizers of the shoulder however require advanced cross-sectional imaging techniques.
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28
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Bornes TD, Jaremko JL, Beaupre LA, Bouliane MJ. Radiographic sclerotic contour loss in the identification of glenoid bone loss. Knee Surg Sports Traumatol Arthrosc 2016; 24:2167-73. [PMID: 25246175 DOI: 10.1007/s00167-014-3328-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 09/12/2014] [Indexed: 12/01/2022]
Abstract
PURPOSE Quantification of glenoid bone loss guides surgical management in the setting of anterior shoulder instability. Glenoid defects resulting in ≥20 % articular area loss require bony reconstruction. The objective of this study was to evaluate the utility of sclerotic glenoid contour loss on true anteroposterior radiography in the detection of varying quantities of simulated glenoid bone loss using a cadaveric model. METHODS Eight cadaveric scapulae with full radiographic sclerotic contour were osteotomized to produce glenoid surface area reductions of 10-50 %. Radiography was performed initially and following each osteotomy, and assessed by an orthopedic surgeon and radiologist twice. Quantity of glenoid loss was compared using Fisher's exact test. Sensitivity, specificity, and reliability analyses were performed. RESULTS On the first radiographic review, sclerotic contour loss was detected in 6 out of 8 scapulae with 50 % area loss, but only 1 out of 8 scapulae with 20 % area loss. There was a significantly higher proportion of radiographs containing sclerotic contour loss for defects with 50 % area loss compared to those with 0-25 % loss (p ≤ 0.02). In the detection of ≥20 % area loss, sclerotic contour loss had a sensitivity of 33-43 % and specificity of 88-100 %. Moderate inter-observer reliability (Cohen's kappa value of 0.42-0.53) and intra-observer reliability (kappa value of 0.46-0.58) were found. CONCLUSION Radiographic sclerotic contour loss is commonly observed in radiographs of scapulae with 40-50 % glenoid area loss and less often with smaller lesions. However, this finding lacks utility in discerning specific quantifications of glenoid bone loss. In a clinical setting, sclerotic contour loss suggests the presence of a large glenoid defect that may require bony reconstruction. However, an intact sclerotic contour does not rule out significant bone loss.
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Affiliation(s)
- Troy D Bornes
- Division of Orthopaedic Surgery, University of Alberta, 6-110B Clinical Sciences Building, 8440-112 Street NW, Edmonton, AB, T6G-2B7, Canada
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2A2.41 Walter Mackenzie Centre, 8440-112 Street NW, Edmonton, AB, T6G-2B7, Canada
| | - Lauren A Beaupre
- Division of Orthopaedic Surgery, University of Alberta, 6-110B Clinical Sciences Building, 8440-112 Street NW, Edmonton, AB, T6G-2B7, Canada.,Department of Physical Therapy, University of Alberta, 3-48 Corbett Hall, 8205-114 Street NW, Edmonton, AB, T6G-2G4, Canada
| | - Martin J Bouliane
- Division of Orthopaedic Surgery, University of Alberta, 6-110B Clinical Sciences Building, 8440-112 Street NW, Edmonton, AB, T6G-2B7, Canada.
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Ramhamadany E, Modi CS. Current concepts in the management of recurrent anterior gleno-humeral joint instability with bone loss. World J Orthop 2016; 7:343-354. [PMID: 27335809 PMCID: PMC4911517 DOI: 10.5312/wjo.v7.i6.343] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 02/16/2016] [Accepted: 04/11/2016] [Indexed: 02/06/2023] Open
Abstract
The management of recurrent anterior gleno-humeral joint instability is challenging in the presence of bone loss. It is often seen in young athletic patients and dislocations related to epileptic seizures and may involve glenoid bone deficiency, humeral bone deficiency or combined bipolar lesions. It is critical to accurately identify and assess the amount and position of bone loss in order to select the most appropriate treatment and reduce the risk of recurrent instability after surgery. The current literature suggests that coracoid and iliac crest bone block transfers are reliable for treating glenoid defects. The treatment of humeral defects is more controversial, however, although good early results have been reported after arthroscopic Remplissage for small defects. Larger humeral defects may require complex reconstruction or partial resurfacing. There is currently very limited evidence to support treatment strategies when dealing with bipolar lesions. The aim of this review is to summarise the current evidence regarding the best imaging modalities and treatment strategies in managing this complex problem relating particularly to contact athletes and dislocations related to epileptic seizures.
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Knöcherne Glenoidverletzungen. ARTHROSKOPIE 2015. [DOI: 10.1007/s00142-015-0036-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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31
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Davis DE, Abboud JA. Operative Management Options for Traumatic Anterior Shoulder Instability in Patients Younger Than 30 Years. Orthopedics 2015; 38:570-6. [PMID: 26375529 DOI: 10.3928/01477447-20150902-07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 11/03/2014] [Indexed: 02/03/2023]
Abstract
Anterior instability of the glenohumeral joint is a relatively common problem in the young population. Identification and treatment is essential to reduce the risk of recurrent instability, whether that is re-dislocation or subluxation events. Non-operative treatment for first-time dislocations was the classic option; however, a relatively high rate of recurrent dislocations has led to earlier operative management in some cases. Surgical treatment through either an open or arthroscopic approach has continued to be an area of research and debate. The decision depends partly on the exact etiology of the instability and the extent of soft tissue or bony deficiency. As arthroscopic techniques and experience improve, surgical procedures for arthroscopic anterior shoulder instability continue to evolve. This review serves as an in-depth overview of the treatment options for traumatic anterior shoulder instability in the patient younger than 30 years, generally focusing on non-rotator cuff-associated etiologies for recurrent instability.
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Imaging methods for quantifying glenoid and Hill-Sachs bone loss in traumatic instability of the shoulder: a scoping review. BMC Musculoskelet Disord 2015; 16:164. [PMID: 26187270 PMCID: PMC4506419 DOI: 10.1186/s12891-015-0607-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 05/28/2015] [Indexed: 01/01/2023] Open
Abstract
Background Glenohumeral instability is a common problem following traumatic anterior shoulder dislocation. Two major risk factors of recurrent instability are glenoid and Hill-Sachs bone loss. Higher failure rates of arthroscopic Bankart repairs are associated with larger degrees of bone loss; therefore it is important to accurately and reliably quantify glenohumeral bone loss pre-operatively. This may be done with radiography, CT, or MRI; however no gold standard modality or method has been determined. A scoping review of the literature was performed to identify imaging methods for quantifying glenohumeral bone loss. Methods The scoping review was systematic in approach using a comprehensive search strategy and standardized study selection and evaluation. MEDLINE, EMBASE, Scopus, and Web of Science were searched. Initial selection included articles from January 2000 until July 2013, and was based on the review of titles and abstracts. Articles were carried forward if either reviewer thought that the study was appropriate. Final study selection was based on full text review based on pre-specified criteria. Consensus was reached for final article inclusion through discussion amongst the investigators. One reviewer extracted data while a second reviewer independently assessed data extraction for discrepancies. Results Forty-one studies evaluating glenoid and/or Hill-Sachs bone loss were included: 32 studies evaluated glenoid bone loss while 11 studies evaluated humeral head bone loss. Radiography was useful as a screening tool but not to quantify glenoid bone loss. CT was most accurate but necessitates radiation exposure. The Pico Method and Glenoid Index method were the most accurate and reliable methods for quantifying glenoid bone loss, particularly when using three-dimensional CT (3DCT). Radiography and CT have been used to quantify Hill-Sachs bone loss, but have not been studied as extensively as glenoid bone loss. Conclusions Radiography can be used for screening patients for significant glenoid bone loss. CT imaging, using the Glenoid Index or Pico Method, has good evidence for accurate quantification of glenoid bone loss. There is limited evidence to guide imaging of Hill-Sachs bone loss. As a consensus has not been reached, further study will help to clarify the best imaging modality and method for quantifying glenohumeral bone loss. Electronic supplementary material The online version of this article (doi:10.1186/s12891-015-0607-1) contains supplementary material, which is available to authorized users.
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Vivanco JF, Burgers TA, García-Rodríguez S, Crookshank M, Kunz M, MacIntyre NJ, Harrison MM, Bryant JT, Sellens RW, Ploeg HL. Estimating the density of femoral head trabecular bone from hip fracture patients using computed tomography scan data. Proc Inst Mech Eng H 2014; 228:616-626. [DOI: 10.1177/0954411914540285] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to compare computed tomography density ( ρCT) obtained using typical clinical computed tomography scan parameters to ash density ( ρash), for the prediction of densities of femoral head trabecular bone from hip fracture patients. An experimental study was conducted to investigate the relationships between ρash and ρCT and between each of these densities and ρbulk and ρdry. Seven human femoral heads from hip fracture patients were computed tomography–scanned ex vivo, and 76 cylindrical trabecular bone specimens were collected. Computed tomography density was computed from computed tomography images by using a calibration Hounsfield units–based equation, whereas ρbulk, ρdry and ρash were determined experimentally. A large variation was found in the mean Hounsfield units of the bone cores (HUcore) with a constant bias from ρCT to ρash of 42.5 mg/cm3. Computed tomography and ash densities were linearly correlated ( R2 = 0.55, p < 0.001). It was demonstrated that ρash provided a good estimate of ρbulk ( R2 = 0.78, p < 0.001) and is a strong predictor of ρdry ( R2 = 0.99, p < 0.001). In addition, the ρCT was linearly related to ρbulk ( R2 = 0.43, p < 0.001) and ρdry ( R2 = 0.56, p < 0.001). In conclusion, mineral density was an appropriate predictor of ρbulk and ρdry, and ρCT was not a surrogate for ρash. There were linear relationships between ρCT and physical densities; however, following the experimental protocols of this study to determine ρCT, considerable scatter was present in the ρCT relationships.
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Affiliation(s)
- Juan F Vivanco
- Department of Mechanical Engineering, University of Wisconsin–Madison, Madison, WI, USA
- Facultad de Ingeniería y Ciencias, Universidad Adolfo Ibáñez, Viña del Mar, Chile
| | | | | | - Meghan Crookshank
- Department of Mechanical and Materials Engineering, Queen’s University, Kingston, ON, Canada
- Human Mobility Research Centre, Kingston General Hospital, Queen’s University, Kingston, ON, Canada
| | - Manuela Kunz
- Human Mobility Research Centre, Kingston General Hospital, Queen’s University, Kingston, ON, Canada
| | - Norma J MacIntyre
- Human Mobility Research Centre, Kingston General Hospital, Queen’s University, Kingston, ON, Canada
| | - Mark M Harrison
- Human Mobility Research Centre, Kingston General Hospital, Queen’s University, Kingston, ON, Canada
- Department of Surgery, Queen’s University, Kingston, ON, Canada
| | - J Tim Bryant
- Department of Mechanical and Materials Engineering, Queen’s University, Kingston, ON, Canada
- Human Mobility Research Centre, Kingston General Hospital, Queen’s University, Kingston, ON, Canada
| | - Rick W Sellens
- Department of Mechanical and Materials Engineering, Queen’s University, Kingston, ON, Canada
- Human Mobility Research Centre, Kingston General Hospital, Queen’s University, Kingston, ON, Canada
| | - Heidi-Lynn Ploeg
- Department of Mechanical Engineering, University of Wisconsin–Madison, Madison, WI, USA
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Markenstein JE, Jaspars KCCJ, van der Hulst VPM, Willems WJ. The quantification of glenoid bone loss in anterior shoulder instability; MR-arthro compared to 3D-CT. Skeletal Radiol 2014; 43:475-83. [PMID: 24442561 DOI: 10.1007/s00256-013-1780-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 11/04/2013] [Accepted: 11/08/2013] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of this study is to investigate if magnetic resonance imaging with intra-articular contrast (MR-arthro) is as reliable as three-dimensionally reconstructed computed tomography imaging (3D-CT) in quantifying the glenoid bone loss in patients with anterior shoulder instability. MATERIALS AND METHODS Thirty-five patients were included. Sagittal MR-arthro and 3D-CT images of the glenoid surface were obtained pre-operatively. Two observers measured these images twice with OsiriX software in a randomized and blinded way. The intraclass correlations (ICC) of the intra- and inter-observer reliability within one method and an additional Bland-Altman plot for calculating agreement between the two methods were obtained. RESULTS The joint estimates of the intra-observer reliability, taking into account the data from both observer A and B, for 3D-CT and MR-arthro were good to excellent. The intra-observer reliability was 0.938 (95% CI: 0.879, 0.968) for 3D-CT and 0.799 (95% CI: 0.639, 0.837) for MR-arthro. The inter-observer reliability between the two observers within one method (3D-CT or MR-arthro) was moderate to good. 3D-CT: 0.724 (95% CI: 0.236, 0.886) and MR-arthro: 0.534 (95% CI: 0.128, 0.762). Comparing both the 3D-CT and MR-arthro method, a Bland-Altman plot showed satisfying differences with the majority of outcomes (89%) within 1 SD. CONCLUSIONS Good to excellent intra- and moderate to good inter-observer correlations and a satisfying Bland-Altman plot when compared to 3D-CT show tendencies that MR-arthro is reliable and valid for measuring bony defects of the glenoid.
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Affiliation(s)
- Jeroen E Markenstein
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Postbox 95500, 1090 HM, Amsterdam, The Netherlands,
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Petterson SC, Plancher KD. The Surgeons’ Dilemma: Revision Instability in the Athlete. OPER TECHN SPORT MED 2014. [DOI: 10.1053/j.otsm.2014.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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