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Khan S, Shanmugaraj A, Faisal H, Prada C, Munir S, Leroux T, Khan M. Variability in quantifying the Hill-Sachs lesion: A scoping review. Shoulder Elbow 2023; 15:465-483. [PMID: 37811393 PMCID: PMC10557928 DOI: 10.1177/17585732221123313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/07/2022] [Accepted: 08/15/2022] [Indexed: 10/10/2023]
Abstract
Background Currently, is there no consensus on a widely accepted measurement technique for calculating the Hill-Sachs lesion (HSL). The purpose of this review is to provide an overview of the techniques and imaging modalities to assess the HSL pre-operatively. Methods Four online databases (PubMed, Embase, MEDLINE, and COCHRANE) were searched for literature on the various modalities and measurement techniques used for quantifying HSLs, from data inception to 20 November 2021. The Methodological Index for Non-Randomized Studies tool was used to assess study quality. Results Forty-five studies encompassing 3413 patients were included in this review. MRA and MRI showed the highest sensitivity, specificity, and accuracy values. Intrarater and interrater agreement was shown to be the highest amongst MRA. The most common reference tests for measuring the HSL were arthroscopy, radiography, arthro-CT, and surgical techniques. Conclusion MRA and MRI are reliable imaging modalities with good test diagnostic properties for assessment of HSLs. There is a wide variety of measurement techniques and imaging modalities for HSL assessment, however a lack of comparative studies exists. Thus, it is not possible to comment on the superiority of one technique over another. Future studies comparing imaging modalities and measurement techniques are needed that incorporate a cost-benefit analysis.
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Affiliation(s)
- Shahrukh Khan
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | | | - Haseeb Faisal
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Carlos Prada
- Division of Orthopaedic Surgery, McMaster University, Ontario, Canada
| | - Sohaib Munir
- Department of Radiology, McMaster University, Ontario, Canada
| | - Timothy Leroux
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, McMaster University, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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Bonnevialle N, Mattési L, Martinel V, Letartre R, Barret H, Mansat P. Outcomes at Long-term Follow-up After Open Latarjet Versus Open Bankart Repair in Rugby Players. Orthop J Sports Med 2023; 11:23259671231184394. [PMID: 37564951 PMCID: PMC10411275 DOI: 10.1177/23259671231184394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/13/2023] [Indexed: 08/12/2023] Open
Abstract
Background Because rugby is a collision sport, it exposes players to a high risk of recurrence after anterior shoulder stabilization. Therefore, the choice of surgical procedure warrants close attention in order to optimize the time to return to sport and the stability of the shoulder throughout the player's career. Hypothesis The open Latarjet procedure would allow for a faster return to play and provide a lower rate of recurrence than the open Bankart repair at long-term follow-up. Study Design Cohort study; Level of evidence, 3. Methods The study retrospectively enrolled 62 competitive rugby players who had undergone an anterior shoulder instability procedure and had at least 5 years of follow-up data. A total of 32 players treated with an open Bankart repair (BK group) were compared with 30 players (31 shoulders) treated with an open Latarjet procedure (LT group). Outcomes between groups were compared with the Rowe score, Walch-Duplay score, recurrence rate, and osteoarthritis evaluation on plain radiograph (Samilson classification). Results The recurrence rate was significantly higher at 18.8% for the BK group (mean follow-up, 6.9 ± 1.7 years) compared with 3.3% for the LT group (mean follow-up, 6.2 ± 1.4 years) (P = .04). No postoperative complications occurred in the BK group, whereas 1 infection and 1 hematoma required a second surgery in the LT group (P = .14). In the BK and LT groups, 97% and 90% of players, respectively, were able to return to rugby at the same level or higher (P = .27), at a mean time of 8 and 6.3 months, respectively (P = .03). The mean Rowe and Walch-Duplay scores were not significantly different between the groups; however, the osteoarthritis rate was significantly higher in the BK versus the LT group (68% vs 38%, respectively; P = .03); 23% of patients, all in the BK group, had Samilson grade 2 osteoarthritis. Conclusion The open Latarjet procedure outperformed the open Bankart procedure in terms of stability, time to return to play, and radiological outcomes at long-term follow-up in competitive rugby players.
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Affiliation(s)
| | - Lucas Mattési
- Clinique Universitaire du Sport, CHU de Toulouse, Toulouse, France
| | | | | | - Hugo Barret
- Clinique Universitaire du Sport, CHU de Toulouse, Toulouse, France
| | - Pierre Mansat
- Clinique Universitaire du Sport, CHU de Toulouse, Toulouse, France
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Recurrence of glenohumeral instability in patients with isolated rotator cuff repair after a traumatic shoulder dislocation. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04628-6. [PMID: 36149486 DOI: 10.1007/s00402-022-04628-6] [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] [Received: 06/23/2022] [Accepted: 09/18/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION The primary objective of this study was to assess the incidence of recurrent glenohumeral instability in patients over 40 years with isolated rotator cuff (RC) repair for traumatic shoulder dislocation. The secondary objectives were to identify risk factors for glenohumeral recurrence after RC repair and to describe the causes and incidences of re-intervention. MATERIALS AND METHODS In this retrospective cohort study, data of consecutive patients at a single trauma center between January 2014 and July 2019 were reviewed, and 84 patients with a mean age of 57 (range: 40-75) years and follow-up duration of 3.9 (2-6) years were included. The inclusion criteria were as follows: first traumatic anterior shoulder dislocation, reparable RC tear, primary arthroscopic RC repair, no labral or bony Bankart lesion repair, and at least 2 years of follow-up. Patients less than 40 years of age were excluded. Shoulder instability recurrences and surgical reinterventions were reviewed with medical records. Statistical analysis was performed for qualitative variables using the Chi-squared test. Statistical significance was set at P ≤ 0.05. RESULTS There was one patient with a redislocation episode (1.2%) at 2.5 years after surgery, who was surgically treated. Age, subscapular tears, bony Bankart injuries, humeral defects, and associated neurological injuries were not risk factors for recurrence in this study. Ten patients (11.9%) required reintervention. Nine patients (10.7%) re-tore their RCs. CONCLUSIONS Recurrent glenohumeral instability in active patients over 40 years with isolated RC repair after traumatic shoulder dislocation was infrequent, despite the incidence of significant Hill-Sachs defects, anterior glenoid defects, bipolar bone defects, size of the RC injury, and tendon re-tears. The incidence of re-interventions was 11.9%, with symptomatic RC retear as the main cause.
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Gouveia K, Rizvi SFH, Dagher D, Leroux T, Bedi A, Khan M. Assessing Bone Loss in the Unstable Shoulder: a Scoping Review. Curr Rev Musculoskelet Med 2022; 15:369-376. [PMID: 35788508 DOI: 10.1007/s12178-022-09773-4] [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: 06/10/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW The aim of this scoping review is to identify and summarize findings published in the literature over the past 5 years related to methods for assessment of bone loss in anterior shoulder instability. RECENT FINDINGS Of the 113 clinical studies included in this review, 76 reported a cutoff for glenoid bone loss when determining the patients indicated for one of the many stabilization procedures investigated. Bone loss on the glenoid side was evaluated most commonly with three-dimensional computed tomography (3D CT), and either linear or surface area-based methods were employed with the use of a best-fit circle. When combined with plain CT, the two methods comprise up to 70% of the reported measurement techniques for glenoid bone loss (79 of 113 studies). On the humeral side, Hill-Sachs lesions were assessed more heterogeneously, though plain CT or 3D CT remained the methods of choice in the majority of studies (43 of 68, 63.2%). Lastly, the glenoid track was assessed by 27 of 113 studies (23.9%), again most commonly with 3D CT (13 studies) and plain CT (seven studies). The assessment of glenoid and humeral bone loss is essential to treatment decisions for patient with recurrent anterior shoulder instability. Glenoid bone loss is most commonly assessed using cross-sectional imaging, most often 3D CT, and some variation of a best-fit circle applied to the inferior portion of the glenoid. Hill-Sachs lesion assessment was also commonly done using three-dimensional imaging; however, there was more variability in assessment methods across studies and there is an obvious need to unify the approach to humeral bone loss assessment for the purposes of improving treatment decisions and to better assess on-track and off-track lesions.
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Affiliation(s)
- Kyle Gouveia
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Syed Fayyaz H Rizvi
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Danielle Dagher
- Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Timothy Leroux
- Division of Orthopedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Asheesh Bedi
- Northshore Orthopedic and Spine Institute, Chicago, IL, USA
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
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Guity MR, Sobhani Eraghi A. Mid-term results of arthroscopic Bankart repair and remplissage for recurrent anterior shoulder instability in patients with a history of seizures. BMC Musculoskelet Disord 2022; 23:12. [PMID: 34980078 PMCID: PMC8725295 DOI: 10.1186/s12891-021-04960-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/13/2021] [Indexed: 11/24/2022] Open
Abstract
Background Seizure predisposes patients to shoulder dislocation. However, there is no consensus regarding the best management approach for recurrent shoulder dislocation in patients who have a history of seizures. In this study, we report the outcome of arthroscopic Bankart repair augmented by Remplissage for the recurrent anterior shoulder dislocation in a series of patients with a history of seizures. Methods In this retrospective study, 27 patients with 29 recurrent anterior shoulder dislocations who were treated with the arthroscopic Bankart repair were included. All cases had deep Hill-Sachs lesions according to Hardy classification that was managed with a Remplissage technique. Patients with a glenoid defect of more than 20% in the CT scan were excluded. Twenty-two patients had an epileptic seizure, while the remaining five patients had convulsions due to other causes. The mean age of the patients was 28.3 ± 6.2 years. The mean follow-up of the patients was 3.1 ± 1.2 years. Outcome measures included the shoulder range of motion that was compared with the non-injured side in the unilateral subjects and the shoulder function that was evaluated by the Rowe score and the Walch-Duplay score. Results The mean forward flexion, abduction, external rotation, and internal rotation were not significantly different between injured and non-injured shoulder (p = 0.34, p = 0.41, p = 0.11, p = 0.23). The mean Rowe score was 49.1 ± 7.8 before the surgery and 92.1 ± 6.4 at the last visit (p < 0.001). According to the Walch-Duplay score, the shoulders were categorized as excellent, good, and fair in 17 (58.7%), 11 (37.9%), and 1 (3.4%) shoulder, respectively. The overall rate of instability recurrence was 17.2% (n = 5). Conclusion In patients with a history of seizures, arthroscopic Bankart repair augmented by Remplissage could be regarded as a safe and efficient method for the treatment of recurrent anterior shoulder dislocation with glenoid defect < 20%.
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Affiliation(s)
- Mohammad Reza Guity
- Orthopaedics Department, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Sobhani Eraghi
- Orthopaedics Department, Rasool Akram Medical Complex, Iran University of Medical Sciences, Tehran, Iran.
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Itoi E. Editorial Commentary: It Is Not the Size, But the Location of Hill-Sachs Lesion That Matters. Arthroscopy 2021; 37:3262-3265. [PMID: 34740405 DOI: 10.1016/j.arthro.2021.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 02/02/2023]
Abstract
The risk of a Hill-Sachs lesion (HSL) to engage the anterior glenoid rim depends on the location of the medial margin of the HSL relative to the anterior rim of the glenoid. The same-sized HSL can be engaging or nonengaging depending upon the size of the glenoid. In order to assess these bony lesions (bipolar lesion) together, the glenoid track concept has been introduced: an on-track lesion (stable) and an off-track lesion (unstable). Three-dimensional computed tomography (3D-CT) confirms that more medialized HSLs have larger volume, greater width, more surface area loss, and higher lesion angles (HS angle), and are more inferior in the humeral head. We know that medialization of the HSL is a definitive risk factor to make it off track, whereas the volume, surface area, and width are all subordinate risk factors dependent on the medialization. On the other hand, while we know very little about the orientation of the HSL, recent research shows a significant association between the medialization and orientation of the HSL. However, we do not know whether the orientation is an independent risk factor or dependent on the medialization. There are two things I emphasize when I look at a HSL: 1) do not look at the HSL alone, but look at the glenoid as well, and 2) the risk of the HSL depends on the location of the medial margin of the HSL relative to the glenoid, not on the volume, depth, or length.
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Affiliation(s)
- Eiji Itoi
- Tohoku University, Tohoku Rosai Hospital
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7
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Long-term results of arthroscopic Bankart repairs for anterior instability of the shoulder in patients aged thirty years or older. INTERNATIONAL ORTHOPAEDICS 2021; 45:1583-1589. [PMID: 33768339 DOI: 10.1007/s00264-021-05014-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 03/17/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Bankart repair is a popular treatment for anterior shoulder instability. However, long-term failure rates of arthroscopic Bankart repair remain higher than Latarjet procedures. The purpose of this study was to report long-term results of arthroscopic Bankart repair in patients greater than 30 years old and analyze risk factors of failure following arthroscopic Bankart repair that are independent of younger age. MATERIALS AND METHODS Between January 1999 and December 2003, 41 patients aged 30 years or older treated with arthroscopic Bankart repair for anterior shoulder instability were evaluated. Outcome measures included pain (VAS), range of motion, post-operative Walch-Duplay, WOSII scores, complications, failure rate, and risk factors of failure. Failure was defined as recurrent dislocation or subluxation. RESULTS At a mean 12-year follow-up (range; 10-15 years), the failure rate of arthroscopic Bankart repair in patients aged 30 years and older was 37%. The mean post-operative Walch-Duplay score was significantly higher in patients who had no recurrence compared to those who had had recurrence of instability (100 versus 90, p=0.02). An ISIS score≥3 (p=0.02), a glenoid bone lesion (p=0.06), and a Hill-Sachs lesion>15% defect (p=0.001) were risk factors for recurrent instability. When considering a modified ISIS score that accounted for bony defects on the glenoid and humeral side, patients with an ISIS score <3 + no glenoid lesion + Hill-Sachs ≤ 15% had a recurrence rate of 0%. CONCLUSION The failure rate of arthroscopic Bankart repairs in patients over 30 was higher than previously reported. Specifically, patients with an ISIS >3 and bony glenoid defects and/or Hill-Sachs lesions > 15% may be at higher risk for recurrent instability following an isolated arthroscopic Bankart repair. Alternative stabilization techniques may need to be considered for this subset of patients.
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Gowd AK, Liu JN, Cabarcas BC, Garcia GH, Cvetanovich GL, Provencher MT, Verma NN. Management of Recurrent Anterior Shoulder Instability With Bipolar Bone Loss: A Systematic Review to Assess Critical Bone Loss Amounts. Am J Sports Med 2019; 47:2484-2493. [PMID: 30148653 DOI: 10.1177/0363546518791555] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is increasing evidence to suggest that the amount of glenoid bone loss to indicate bone block procedures may be lower than previously thought, particularly in the presence of a Hill-Sachs defect. PURPOSE To better establish treatment recommendations for anterior shoulder instability among patients with bipolar bone lesions. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS A systematic review of the literature was performed with PubMed, EMBASE, Cochrane Library, and Scopus databases according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Studies evaluating outcomes of operative management in anterior shoulder instability that also reported glenoid bone loss in the presence of Hill-Sachs defects were included. Recurrence rates, glenoid bone loss, and humeral bone loss were pooled and analyzed with forest plots stratified by surgical procedure. Methods of quantification were analyzed for each article qualitatively. RESULTS Thirteen articles were included in the final analysis, with a total of 778 patients. The mean ± SD age was 24.9 ± 8.6 years. The mean follow-up was 30.1 months (range, 11-240 months). Only 13 of 408 (3.2%) reviewed bipolar bone loss articles quantified humeral and/or glenoid bone loss. Latarjet procedures had the greatest glenoid bone loss (21.7%; 95% CI, 14.8%-28.6%), followed by Bankart repairs (13.1%; 95% CI, 9.0%-17.2%), and remplissage (11.7%; 95% CI, 5.5%-18.0%). Humeral bone loss was primarily reported as percentage bone loss (22.2%; 95% CI, 13.1%-31.3% in Bankart repairs and 31.7%; 95% CI, 21.6%-41.1% in Latarjet) or as volumetric defects (439.1 mm3; 95% CI, 336.3-541.9 mm3 in Bankart repairs and 366.0 mm3; 95% CI, 258.4-475.4 mm3 in remplissage). Recurrence rates were as follows: Bankart repairs, 19.5% (95% CI, 14.5%-25.8%); remplissage, 4.4% (95% CI, 1.3%-14.0%); and Latarjet, 8.7% (95% CI, 5.0%-14.7%). Bankart repairs were associated with significantly greater recurrence of instability in included articles (P = .013). CONCLUSION There exists a need for universal and consistent preoperative measurement of humeral-sided bone loss. The presence of concomitant Hill-Sachs defects with glenoid pathology should warrant more aggressive operative management through use of bone block procedures. Previously established values of critical glenoid bone loss are not equally relevant in the presence of bipolar bone loss.
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Affiliation(s)
- Anirudh K Gowd
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Joseph N Liu
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Brandon C Cabarcas
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Grant H Garcia
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Gregory L Cvetanovich
- Department of Orthopaedics, the Ohio State University, Wexner Medical Center, Columbus, Ohio, USA
| | | | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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França FDO, Godinho AC, Carneiro Leal DPC, Mantovani MM, Frazão RR, Mariz RF. Clinical and Image Outcomes of the Hill-Sachs Injury Approach by the Remplissage Technique on the Anterior Shoulder Instability. Rev Bras Ortop 2019; 54:13-19. [PMID: 31363237 PMCID: PMC6424803 DOI: 10.1016/j.rbo.2017.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 10/24/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To evaluate the functional outcome of the remplissage technique, the healing of the capsulotenodesis of the infraspinatus tendon in Hill-Sachs lesion, and the degree of fatty infiltration of the infraspinatus muscle and its postoperative strength. METHODS Twenty-five patients with recurrent anterior dislocation of the shoulder and Hill-Sachs lesion with a Hardy index > 20% who underwent the remplissage arthroscopic technique were evaluated with a minimum follow-up of 1 year. Patients underwent a clinical evaluation (Carter-Rowe and Walch-Duplay functional scores, measurement of range of motion and strength) and a magnetic resonance imaging (MRI) exam on the operated shoulder. RESULTS Eighty-eight percent and 92% of the patients had good or excellent scores in the functional assessments of the Carter-Rowe and Walch-Duplay scores, respectively. A mean difference of - 1 kg in the strength of the operated limb was observed when compared with the contralateral limb ( p < 0.001), as well as a mean difference of 10° in external rotation 1 and 2 ( p < 0.001), also compared with the contralateral side. All of the patients who underwent an MRI exam presented high-grade filling of the Hill-Sachs lesion by capsulotenodesis, as well as absence of or minimal fatty infiltration in the infraspinatus muscle. CONCLUSION The remplissage technique had good/excellent functional score results, despite the discrete, albeit statistically significant, loss of strength and of external rotation amplitude. Successful capsulotenodesis healing and filling of the Hill-Sachs defect were demonstrated.
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Affiliation(s)
| | - André Couto Godinho
- Hospital Ortopédico, Belo Horizonte, MG, Brasil
- Hospital Belvedere, Belo Horizonte, MG, Brasil
- Hospital Belo Horizonte, Belo Horizonte, MG, Brasil
| | | | - Mateus Matos Mantovani
- Hospital Ortopédico, Belo Horizonte, MG, Brasil
- Hospital Belvedere, Belo Horizonte, MG, Brasil
| | - Rafael Rodrigues Frazão
- Hospital Ortopédico, Belo Horizonte, MG, Brasil
- Hospital Belvedere, Belo Horizonte, MG, Brasil
| | - Ricardo Ferreira Mariz
- Hospital Ortopédico, Belo Horizonte, MG, Brasil
- Hospital Belvedere, Belo Horizonte, MG, Brasil
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França FDO, Godinho A, Ribeiro E, Ranzzi A, Bittencourt BLL, Barreto BB. New quantitative method to measure the Hill-Sachs lesion: validation of Hardy's radiographic method for MRI/AMRI. Rev Bras Ortop 2018; 53:589-594. [PMID: 30258824 PMCID: PMC6148711 DOI: 10.1016/j.rboe.2018.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/06/2017] [Indexed: 01/31/2023] Open
Abstract
Objective To validate Hardy's radiographic method for magnetic resonance imaging/magnetic resonance arthrography (MRI/MRA) in the assessment of Hill-Sachs lesion (HSL) involvement in patients with a history of anterior shoulder instability. Methods This study retrospectively evaluated 53 shoulder radiographs and MRI/MRA to compare the measurements of HSL through Hardy's radiographic method. Imaging exams used in the study were conducted between the March 2013 AND September 2015. The data obtained from these exams were carried out during 2015. Inclusion criteria were previous history of anterior instability of the shoulder, presence of LHS, and radiographs at 70° medial rotation. Results MRI/MRA had a sensitivity of 100% and specificity of 100% when using the Hardy's radiographic method 20% cutoff point to measure the HSL. Conclusion MRI/MRA can be used to assess the degree of HSL involvement with the same reliability as Hardy's radiographic method.
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Affiliation(s)
- Flávio de Oliveira França
- Hospital Ortopédico, Belo Horizonte, MG, Brazil
- Hospital Belvedere, Belo Horizonte, MG, Brazil
- Corresponding author.
| | - André Godinho
- Hospital Ortopédico, Belo Horizonte, MG, Brazil
- Hospital Belvedere, Belo Horizonte, MG, Brazil
- Hospital Belo Horizonte, Belo Horizonte, MG, Brazil
| | | | - Abel Ranzzi
- Hospital Ortopédico, Belo Horizonte, MG, Brazil
- Hospital Belvedere, Belo Horizonte, MG, Brazil
- Hospital Belo Horizonte, Belo Horizonte, MG, Brazil
| | - Brício Lima Lobão Bittencourt
- Hospital Ortopédico, Belo Horizonte, MG, Brazil
- Hospital Belvedere, Belo Horizonte, MG, Brazil
- Hospital Belo Horizonte, Belo Horizonte, MG, Brazil
| | - Bruno Brum Barreto
- Hospital Ortopédico, Belo Horizonte, MG, Brazil
- Hospital Belvedere, Belo Horizonte, MG, Brazil
- Hospital Belo Horizonte, Belo Horizonte, MG, Brazil
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Novo método quantitativo para medida da lesão de Hill‐Sachs: validação do método radiográfico de Hardy para ressonância magnética/artro‐RNM. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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12
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Delage Royle A, Balg F, Bouliane MJ, Canet-Silvestri F, Garant-Saine L, Sheps DM, Lapner P, Rouleau DM. Indication for Computed Tomography Scan in Shoulder Instability: Sensitivity and Specificity of Standard Radiographs to Predict Bone Defects After Traumatic Anterior Glenohumeral Instability. Orthop J Sports Med 2017; 5:2325967117733660. [PMID: 29119123 PMCID: PMC5665105 DOI: 10.1177/2325967117733660] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: Quantifying glenohumeral bone loss is key in preoperative surgical planning for a successful Bankart repair. Hypothesis: Simple radiographs can accurately measure bone defects in cases of recurrent shoulder instability. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A true anteroposterior (AP) view, alone and in combination with an axillary view, was used to evaluate the diagnostic properties of radiographs compared with computed tomography (CT) scan, the current gold standard, to predict significant bone defects in 70 patients. Sensitivity, specificity, and positive and negative predictive values were evaluated and compared. Results: Detection of glenoid bone loss on plain film radiographs, with and without axillary view, had a sensitivity of 86% for both views and a specificity of 73% and 64% with and without the axillary view, respectively. For detection of humeral bone loss, the sensitivity was 8% and 17% and the specificity was 98% and 91% with and without the axillary view, respectively. Regular radiographs would have missed 1 instance of significant bone loss on the glenoid side and 20 on the humeral side. Interobserver reliabilities were moderate for glenoid detection (κ = 0.473-0.503) and poor for the humeral side (κ = 0.278-0.336). Conclusion: Regular radiographs showed suboptimal sensitivity, specificity, and reliability. Therefore, CT scan should be considered in the treatment algorithm for accurate quantification of bone loss to prevent high rates of recurrent instability.
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Affiliation(s)
| | - Frédéric Balg
- Division of Orthopedics, Université de Sherbrooke, Sherbrooke, Québec, Canada.,Research Center of CHUS, Sherbrooke, Québec, Canada
| | - Martin J Bouliane
- University of Alberta, Edmonton, Alberta, Canada.,Glen Sather Sports Medicine Clinic, Edmonton, Alberta, Canada
| | | | | | - David M Sheps
- University of Alberta, Edmonton, Alberta, Canada.,Sturgeon Community Hospital, St Albert, Alberta, Canada
| | - Peter Lapner
- Division of Orthopedics, University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dominique M Rouleau
- Université de Montréal, Montréal, Québec, Canada.,Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada
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Rouleau DM, Garant-Saine L, Canet F, Sandman E, Ménard J, Clément J. Measurement of combined glenoid and Hill-Sachs lesions in anterior shoulder instability. Shoulder Elbow 2017; 9:160-168. [PMID: 28588656 PMCID: PMC5444602 DOI: 10.1177/1758573216681208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 10/28/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recurrent glenohumeral anterior instability (RGAI) frequently induces combined glenoid and Hill-Sachs bone lesions and is a risk factor for soft tissue repair failure. This cohort study describes a simple preoperative quantification method for bone loss, the Clock method, the first that combines glenoid and humeral lesions. METHODS Computed tomography scans of 34 shoulders with RGAI were twice reviewed by three independent observers, who measured bone lesions using the new Clock method and existing validated methods. Intra- and inter-observer reliability of the Clock method was evaluated (intraclass correlation coefficient). Pearson correlation was used to correlate Clock method with existing methods, and with function (Western Ontario Shoulder Instability, Quick-Disabilities of the Arm, Shoulder and Hand). RESULTS Thirty-two patients met the inclusion criteria: three females and 29 males, mean age 28 years. The intra- and inter-observer reliability was excellent, with intraclass correlation coefficient ranging from 0.817 to 0.938 for the novel Clock method. Humeral Clock and Glenoid Clock strongly correlated with Humeral Ratio (r = 0.882, p < 0.001) and Glenoid Surface Area and Glenoid Ratio (r = 0.793 and 0.717, p < 0.001), respectively. The classic threshold of 25% of the glenoid diameter with the Glenoid Ratio method corresponds to 4 hours with the Glenoid Clock method. CONCLUSIONS The Clock method is quick and reliable, with more studies being needed to investigate whether it is correlated with surgical outcomes.
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Affiliation(s)
- Dominique M. Rouleau
- Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada,Dominique M. Rouleau, HSCM, 5400 boul. Gouin Ouest, Local K-3035, Montreal, QC H4J 1C5, Canada.
| | | | - Fanny Canet
- Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
| | - Emilie Sandman
- Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
| | - Jérémie Ménard
- Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
| | - Julien Clément
- Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
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Schneider AK, Hoy GA, Ek ET, Rotstein AH, Tate J, Taylor DM, Evans MC. Interobserver and intraobserver variability of glenoid track measurements. J Shoulder Elbow Surg 2017; 26:573-579. [PMID: 27989718 DOI: 10.1016/j.jse.2016.09.058] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 09/21/2016] [Accepted: 09/27/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND A method of assessing combined glenoid and humeral bone loss in traumatic shoulder instability with an associated treatment protocol was recently published. The aim of this study was to investigate its reliability and reproducibility. METHODS Seventy-one patients with unilateral anteroinferior shoulder instability underwent computed tomography scans, from which 3-dimensional images were derived. En face views of both glenoid fossae and with 3 views of the humeral head were provided to 4 assessors to determine interobserver reliability. From these measurements, the shoulder was assigned a treatment classification. Two observers repeated their assessments 1 month later to determine intraobserver reliability. For each measurement, the mean coefficient of variability was calculated. RESULTS Assessment of glenoid bone loss showed good interobserver (4 observers agreeing in 90.1% of cases) and also good intraobserver agreement (94% and 96%). There was a poor level of interobserver reliability regarding the on-track or off-track classification (72%). Intraobserver reliability for this measurement was less variable (90% and 80%). There was a poor level of agreement between observers (65%) regarding treatment classification. The coefficient of variability for the Hill-Sachs lesion measured 19.2%, indicating a high level of variability for this measurement compared with <4% for all other measures. CONCLUSION Linear bone loss on the glenoid can be measured reliably and reproducibly; however, evaluation of Hill-Sachs lesions demonstrates a high level of variability, and poor interobserver reliability.
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Affiliation(s)
- Adrian K Schneider
- Upper Limb Unit, Melbourne Orthopaedic Group, Windsor, Victoria, Australia; Department of Orthopaedic Surgery and Traumatology, Kantonsspital, St. Gallen, Switzerland
| | - Gregory A Hoy
- Upper Limb Unit, Melbourne Orthopaedic Group, Windsor, Victoria, Australia; Department of Surgery, Monash University, Clayton, Victoria, Australia
| | - Eugene T Ek
- Upper Limb Unit, Melbourne Orthopaedic Group, Windsor, Victoria, Australia; Department of Surgery, Monash University, Clayton, Victoria, Australia
| | | | - Julie Tate
- Victoria House Medical Imaging, Prahran, Victoria, Australia
| | - David McD Taylor
- Austin Health Emergency Department, Heidelberg, Victoria, Australia
| | - Matthew C Evans
- Upper Limb Unit, Melbourne Orthopaedic Group, Windsor, Victoria, Australia; Department of Surgery, Monash University, Clayton, Victoria, Australia.
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Ciais G, Klouche S, Fournier A, Rousseau B, Bauer T, Hardy P. Bony defects in chronic anterior posttraumatic dislocation of the shoulder: Is there a correlation between humeral and glenoidal lesions? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2016; 26:581-6. [DOI: 10.1007/s00590-016-1815-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 06/27/2016] [Indexed: 01/23/2023]
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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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Omori Y, Yamamoto N, Koishi H, Futai K, Goto A, Sugamoto K, Itoi E. Measurement of the Glenoid Track In Vivo as Investigated by 3-Dimensional Motion Analysis Using Open MRI. Am J Sports Med 2014; 42:1290-5. [PMID: 24681398 DOI: 10.1177/0363546514527406] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A Hill-Sachs lesion is a common injury associated with anterior glenohumeral instability, and a Hill-Sachs lesion that engages with the anterior glenoid rim is 1 factor related to recurrent instability. In a cadaveric study in 2007, a new concept, the "glenoid track," was proposed to evaluate the risk of engagement of Hill-Sachs lesions with the glenoid. PURPOSE To investigate the glenoid track in vivo using a custom-developed noninvasive motion analysis system. STUDY DESIGN Descriptive laboratory study. METHODS Using a wide-gantry magnetic resonance imaging (MRI) scanner, the right shoulders of 30 healthy volunteers were examined. The MRI scans were taken of the right arm in 7 static supine positions from 0° to maximum abduction, keeping maximum external rotation and horizontal extension. Using the custom motion analysis system, 3-dimensional models of the scapula and humerus were created from the MRI data. Then, the movement of the humerus and scapula was calculated using voxel-based registration of each model, and the motion of the glenoid on the humeral head was analyzed. RESULTS The models demonstrated that glenoid contact shifted from the inferomedial to the superolateral portion of the humeral head. The mean widths of the glenoid track with the arm at 60°, 90°, 120°, and 150° of abduction were 20.7 ± 4.5 mm, 19.4 ± 3.9 mm, 18.9 ± 2.7 mm, and 18.7 ± 2.5 mm (89%, 83%, 82%, and 81% of the glenoid width), respectively. The width of the glenoid track at 60° of abduction was significantly greater than those at 90°, 120°, and 150° of abduction (P = .0472, .0148, and .0083, respectively). There were no significant differences among widths measured at 90°, 120°, and 150° of abduction. CONCLUSION The existence and widths of the glenoid track were confirmed in vivo.
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Affiliation(s)
- Yasushi Omori
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Suita, Japan
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Hayato Koishi
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazuma Futai
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akira Goto
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazuomi Sugamoto
- Department of Orthopaedic Biomaterial Science, Osaka University Graduate School of Medicine, Suita, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
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