1
|
Ren Z, Wang F, Huang X, Wang J, Zhang Y, Yu T. A formula for instability-related bone loss: estimating glenoid width and redefining bare spot. INTERNATIONAL ORTHOPAEDICS 2024; 48:1057-1063. [PMID: 38302596 PMCID: PMC10933210 DOI: 10.1007/s00264-024-06095-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/17/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE The aim of the study reveals a new intuitive method for preoperatively assessing defect ratio in glenoid deficiency based on the native glenoid width and the bare spot. METHODS A linear relationship, i.e. the rh formula, between the native glenoid width (2r) and height (h) was revealed by a cadaver cohort (n = 204). To validate the reliability of the rh formula, 280 3D-CT images of intact glenoids were recruited. To evaluate the accuracy of rh formula in estimating glenoid defect, the 65 anterior-inferior defect models were artificially established based on the 3D-CT images of intact glenoids. Moreover, a clinically common anterior-posterior (AP) method was compared with the rh formula, to verify the technical superiority of rh formula. RESULTS The regression analysis indicated a linear relationship between the width and height of intact glenoid: 2r = 0.768 × h - 1.222 mm (R2 = 0.820, p < 0.001). An excellent reliability was found between the formula prediction and model width (ICC = 0.911, p = 0.266). An excellent agreement was found between the predicted values and model parameters (glenoid width, ICCrh = 0.967, prh = 0.778; defect ratio, prh = 0.572, ICCrh = 0.997). And, it is of higher accuracy compared to the AP method (glenoid width, ICCAP = 0.933, pAP = 0.001; defect ratio, ICCAP = 0.911, pAP = 0.033). CONCLUSION Applying the cadaver-based formula on 3D-CT scans accurately predicts native glenoid width and redefines bare spot for preoperatively determining glenoid bone loss.
Collapse
Affiliation(s)
- Zhongkai Ren
- Department of Sports Medicine, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Fengkun Wang
- School of Medicine, Nankai University, Tianjing, China
| | - Xiaohong Huang
- Medical Research Center, Shandong Institute of Traumatic Orthopedics, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jian Wang
- Department of Hand and Foot Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yingze Zhang
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, Qingdao, China.
| | - Tengbo Yu
- Department of Orthopedic Surgery, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao HospitalQingdao, China.
- Institute of Sports Medicine and Health, Qingdao University, Qingdao, China.
| |
Collapse
|
2
|
LaVigne CA, Griffith TB, Hanson ZC, Davis DD, Kercher JS, Duralde XA. Beyond guesswork: how accurate are surgeons at determining the degree of glenoid bone loss in instability surgery? JSES Int 2024; 8:268-273. [PMID: 38464449 PMCID: PMC10920134 DOI: 10.1016/j.jseint.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Background Accurate measurement of glenoid bone loss (GBL) is critical to preoperative planning in cases of recurrent shoulder instability. The concept of critical bone loss has been established with a value of GBL >13.5% being associated with higher failure rate following arthroscopic Bankart Repair. Advanced imaging, such as magnetic resonance imaging (MRI) scans, can be used to quantify GBL prior to surgery using the best-fit circle technique. Surgeons have traditionally relied on visual inspection of the MRI scan preoperatively or on visual inspection of the glenoid at the time of arthroscopy to determine whether GBL is present. The purpose of this study is to determine if 3 fellowship-trained shoulder surgeons could adequately quantify GBL without using best-fit circle measurements on MRI. Methods A retrospective review was performed which included 122 patients over an 8-year period that had an arthroscopic Bankart repair performed by 3 fellowship-trained surgeons. In all patients, preoperative MRI scans were retrospectively measured using best-fit circle technique to determine true GBL and compare that to the surgeons' preoperative and intraoperative estimation of GBL. Results GBL was correctly identified in only 36% (18/50) of patients when the preoperative best-fit circle measurements were not made. Critical bone loss was missed in 9.8% (12/122) of patients in the study group. The estimated mean bone loss in that group by visual inspection was 11.3% compared to 16% true bone loss measured on MRI. Even in the 18 patients with some identified bone loss prior to surgery, critical bone loss was missed in 6 patients when using visual inspection of the MRI or intraoperative inspection alone. Conclusion Simple visual inspection of glenoid images on MRI scan and visual inspection of the glenoid at the time of surgery are inaccurate in determining the true extent of GBL especially in cases of subtle bone deficiency. Preoperative planning is dependent on the exact degree of bone deficiency and measurement on the MRI scan using the best-fit circle technique is recommended in all cases of instability surgery.
Collapse
Affiliation(s)
- Caleb A. LaVigne
- Department of Orthopedic Surgery, Wellstar Health Systems, Marietta, GA, USA
| | | | - Zachary C. Hanson
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | | | | |
Collapse
|
3
|
Albano D, Basile M, Gitto S, Messina C, Longo S, Fusco S, Snoj Z, Gianola S, Bargeri S, Castellini G, Sconfienza LM. Shear-wave elastography for the evaluation of tendinopathies: a systematic review and meta-analysis. LA RADIOLOGIA MEDICA 2024; 129:107-117. [PMID: 37907673 DOI: 10.1007/s11547-023-01732-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/28/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE To compare pathologic and healthy tendons using shear-wave elastography (SWE). METHODS A systematic review with meta-analysis was done searching Pubmed and EMBASE up to September 2022. Prospective, retrospective and cross-sectional studies that used SWE in the assessment of pathologic tendons versus control were included. Our primary outcome were SWE velocity (m/s) and stiffness (kPa). Methodological quality was assessed by the methodological index for non-randomized studies (MINORS). We used the mean difference (MD) with corresponding 95% confidence intervals (CIs) to quantify effects between groups. We performed sensitivity analysis in case of high heterogeneity, after excluding poor quality studies according to MINORS assessment. We used Grades of Recommendation, Assessment, Development and Evaluation to evaluate the certainty of evidence (CoE). RESULTS Overall, 16 studies with 676 pathologic tendons (188 Achilles, 142 patellar, 96 supraspinatus, 250 mixed) and 723 control tendons (484 healthy; 239 contralateral tendon) were included. Five studies (31.3%) were judged as poor methodological quality. Shear-wave velocity and stiffness meta-analyses showed high heterogeneity. According to a sensitivity analysis, pathologic tendons had a lower shear wave velocity (MD of - 1.69 m/s; 95% CI 1.85; - 1.52; n = 274; I2 50%) compared to healthy tendons with very low CoE. Sensitivity analysis on stiffness still showed high heterogeneity. CONCLUSION Pathological tendons may have reduced SWE velocity compared to controls, but the evidence is very uncertain. Future robust high-quality longitudinal studies and clear technical indications on the use of this tool are needed. PROTOCOL PROSPERO identifier: CRD42023405410 CLINICAL RELEVANCE STATEMENT: SWE is a relatively recent modality that may increase sensitivity and diagnostic accuracy of conventional ultrasound imaging promoting early detection of tendinopathy. Non-negligible heterogeneity has been observed in included studies, so our findings may encourage the conduct of future high-quality longitudinal studies which can provide clear technical indications on the use of this promising tool in tendon imaging.
Collapse
Affiliation(s)
- Domenico Albano
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy.
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milano, Italy.
| | - Mariachiara Basile
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milan, Italy
| | - Salvatore Gitto
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
| | - Carmelo Messina
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
| | - Stefano Longo
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
| | - Stefano Fusco
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milan, Italy
| | - Ziga Snoj
- Clinical Radiology Institute, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine - Department of Radiology, University of Ljubljana, Ljubljana, Slovenia
| | - Silvia Gianola
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, 20157, Milan, Italy
| | - Silvia Bargeri
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, 20157, Milan, Italy
| | - Greta Castellini
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, 20157, Milan, Italy
| | - Luca Maria Sconfienza
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Cristina Belgioioso 173, 20157, Milan, Italy
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
| |
Collapse
|