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Boileau P, Ranieri R, Lavoué V, Saliken D. Results of combined all-arthroscopic Latarjet with Hill-Sachs remplissage for significant bipolar glenohumeral bone loss. J Shoulder Elbow Surg 2024:S1058-2746(24)00622-0. [PMID: 39245258 DOI: 10.1016/j.jse.2024.07.030] [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: 03/15/2024] [Revised: 07/26/2024] [Accepted: 07/30/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Arthroscopic Latarjet using suture-button fixation has shown good clinical results and low recurrent instability in patients with significant glenoid bone loss. However, the presence of an associated Hill-Sachs lesion (HSL) is a risk factor for recurrent instability after isolated Latarjet. The aim of the study was to report clinical and radiologic results following all-arthroscopic Latarjet combined with Hill-Sachs remplissage (HSR). METHODS Monocentric prospective study including 41 patients (mean age 28 ± 7 years) who underwent the combined procedure between 2014 and 2019 with minimum 2 years' follow-up (mean 40 ± 13 months). Indications were glenoid bone loss >10% (mean 23.9% ± 7.5%) and large, deep HSL (Calandra 3). Five (13%) patients had signs of osteoarthrosis stage I preoperatively, 4 (10%) had previous stabilization surgery (3 cases isolated Bankart and 1 case Bankart combined with HSR), and 4 (13%) were epileptic. The HSR was performed first followed by guided Latarjet procedure. Primary outcome measures included shoulder stability and function represented by Walch-Duplay and Rowe scores, and Subjective Shoulder Value (SSV) for daily life/sports. Secondary outcome measures included coracoid graft position and union, and glenohumeral osteoarthritis using radiographs and computed tomography. RESULTS Three patients (7%) had recurrent instability: 1 due to seizure, 1 following fall, and 1 related to graft osteolysis. Two patients were revised because of recurrence with arthroscopic distal clavicle autograft. There were no infections, neurologic complications, or hardware failures. The Walch-Duplay score was 90 (95% CI 76.8-93.2), and the Rowe score 95 (95% CI 77.2-92.2). The median SSV averaged 96% (95% CI 87.5-97.0) for daily life and 90% (95% CI 75.7-90.2) for sports. Mean external rotation with the arm at the side was 60° (95% CI 59°-70°) with a median loss 10° (95% CI 3°-17°) compared to the contralateral side. Among patients playing sport preoperatively, 36 (95%) were able to return to sport: 25 (67%) at the same level and 7 (18%) at a lower level, whereas 4 had to change sport. The coracoid graft was flush with the glenoid surface in 96% of cases and subequatorial in 89%. The graft developed nonunion in 11% and fractured in 5%. Seven patients (18%) had radiographic signs of grade I osteoarthritis. CONCLUSION Combined arthroscopic Latarjet and HSR is an efficient solution for dealing with significant bipolar glenohumeral bone loss. The combined procedure deserves consideration in high-risk patients including combined bone loss, recurrent anterior instability after failed stabilization procedures and/or seizure.
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Affiliation(s)
- Pascal Boileau
- ICR-Institute for Sports and Reconstructive Bone & Joint Surgery, Clinique Kantys Centre, Groupe Kantys, Nice, France.
| | - Riccardo Ranieri
- ICR-Institute for Sports and Reconstructive Bone & Joint Surgery, Clinique Kantys Centre, Groupe Kantys, Nice, France
| | - Vincent Lavoué
- ICR-Institute for Sports and Reconstructive Bone & Joint Surgery, Clinique Kantys Centre, Groupe Kantys, Nice, France
| | - David Saliken
- RebalanceMD Clinic, Victoria, Canada; Department of Orthopaedics, University of British Columbia, Vancouver, BC Canada
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Verweij LPE, Yamamoto N, Arino A, Kawakami J, Kerkhoffs GMMJ, van Deurzen DFP, van den Bekerom MPJ, Aizawa T. Statistical shape models that predict native glenoid width based on glenoid height are inaccurate in their current form: a cross-sectional study. J Shoulder Elbow Surg 2024; 33:2057-2063. [PMID: 38467182 DOI: 10.1016/j.jse.2024.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/26/2023] [Accepted: 01/18/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND The extent of measurement errors of statistical shape models that predict native glenoid width based on glenoid height to subsequently determine the amount of anterior glenoid bone loss is unclear. Therefore, the aim of this study was to (1) create a statistical shape model based on glenoid height and width measured on 3-dimensional computed tomography (3D-CT) and determine the accuracy through measurement errors and (2) determine measurement errors of existing 3D-CT statistical shape models. MATERIALS AND METHODS A retrospective cross-sectional study included all consecutive patients who underwent CT imaging before undergoing primary surgical treatment of traumatic anterior shoulder dislocation between 2007 and 2022 at the Tohoku University Hospital and affiliated hospitals. Patients were included when instability was unilateral and CT scans of both the injured and contralateral uninjured shoulder were available. 3D segmentations were created and glenoid height and width of the injured and contralateral uninjured side (gold standard) were measured. Accuracy was determined through measurement errors, which were defined as a percentage error deviation from native glenoid width (contralateral uninjured glenoid), calculated as follows: measurement error = [(estimated glenoid width with a statistical shape model - native glenoid width) / native glenoid width] × 100%. A linear regression analysis was performed to create a statistical shape model based on glenoid height according to the formula: native glenoid width = a × glenoid height + b. RESULTS The diagnosis and procedure codes identified 105 patients, of which 69 (66%) were eligible for inclusion. Glenoid height demonstrated a very strong correlation (r = 0.80) with native glenoid width. The linear regression formula based on this cohort was as follows: native glenoid width = 0.75 × glenoid height - 0.61, and it demonstrated an absolute average measurement error of 5% ± 4%. The formulas by Giles et al, Chen et al and Rayes et al demonstrated absolute average measurement errors of 10% ± 7%, 6% ± 5%, and 9% ± 6%, respectively. CONCLUSION Statistical shape models that estimate native glenoid width based on glenoid height demonstrate unacceptable measurement errors, despite a high correlation. Therefore, great caution is advised when using these models to determine glenoid bone loss percentage. To minimize errors caused by morphologic differences, preference goes to methods that use the contralateral side as reference.
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Affiliation(s)
- Lukas P E Verweij
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan; Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, the Netherlands; Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands.
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Atsushi Arino
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Jun Kawakami
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, the Netherlands
| | - Derek F P van Deurzen
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands; Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, the Netherlands
| | - Michel P J van den Bekerom
- Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, the Netherlands; Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands; Department of Orthopedic Surgery, Shoulder and Elbow Unit, OLVG, Amsterdam, the Netherlands; Faculty of Behavioural and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
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Milano G, Colosio A, Agosti M, Bergomi A, Saccomanno MF. Arthroscopic humeral head defect filling with osteochondral autografts transplantation for near-track Hill-Sachs lesions. JSES Int 2024; 8:686-691. [PMID: 39035648 PMCID: PMC11258713 DOI: 10.1016/j.jseint.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Affiliation(s)
- Giuseppe Milano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
| | - Alessandro Colosio
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Monica Agosti
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Bergomi
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Maristella F. Saccomanno
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
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Moroder P, Akguen D, Paksoy A, Gebauer H, Barthod-Tonnot N, Lupetti M, Markova V, Zettinig O, Parada S, Karpinski K. The Global Track Concept for Assessment of Engaging Hill-Sachs Defects in Anterior Shoulder Instability. Am J Sports Med 2024; 52:1292-1298. [PMID: 38506922 DOI: 10.1177/03635465241232089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND The glenoid track concept is used to determine preoperatively whether a Hill-Sachs defect is engaging or not. Currently, the glenoid track concept relies on measurements of bony structures as well as on the confines and elasticity of the rotator cuff as a reference point, which varies extensively among individuals and therefore limits the reliability and accuracy of this concept. PURPOSE To evaluate the reliability of the global track concept, which determines the angular distance of the Hill-Sachs defect from the center of the articular surface of the humeral head as a new reference point with the help of an automated image analysis software and 3-dimensional analysis of the humeral head. STUDY DESIGN Controlled laboratory study. METHODS Computed tomography scans of 100 patients treated for anterior shoulder instability with different sizes of Hill-Sachs defects were evaluated manually by 2 orthopaedic surgeons independently using the software OsiriX as well as automatically by using a dedicated prototype software (ImFusion). Obtained manual and automated measurements included the Hill-Sachs length, Hill-Sachs width, and Hill-Sachs depth of the defect; the Hill-Sachs interval (HSI); and the glenoid width for the glenoid track concept, as well as the angular distance of the Hill-Sachs defect from the center of the articular surface of the humeral head (global track concept). The reliability of the different measurement techniques was compared by calculating intraclass correlation coefficients (ICCs). RESULTS There was a significant difference for all obtained parameters comparing manual and automatic measurements. For manually obtained parameters, measurements referring to bony boundaries (glenoid width, Hill-Sachs length, and Hill-Sachs width) showed good to excellent agreement (ICC, 0.86, 0.82, and 0.62, respectively), while measurements referring to soft tissue boundaries (HSI and glenoid track; ICC, 0.56 and 0.53, respectively) or not directly identifiable reference points (center of articular surface and global track) only showed fair reliability (ICC middle excursion, 0.42). When the same parameters were measured with the help of an automated software, good reliability for the glenoid track concept and excellent reliability for the global track concept in the middle excursion were achieved. CONCLUSION The present study showed that the more complex global track measurements of humeral defects are more reliable than the current standard HSI and glenoid track measurements. However, this is only true when automated software is used to perform the measurements. CLINICAL RELEVANCE Future studies using the new proposed method in combination with an automated software need to be conducted to determine critical threshold values for defects prone to engagement.
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Affiliation(s)
| | - Doruk Akguen
- Charite Universitätsmedizin Berlin, Berlin, Germany
| | - Alp Paksoy
- Charite Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | | | | | - Stephen Parada
- Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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Rashid MS, Tsuchiya S, More KD, LeBlanc J, Bois AJ, Kwong CA, Lo IKY. Validating the Glenoid Track Concept Using Dynamic Arthroscopic Assessment. Orthop J Sports Med 2024; 12:23259671241226943. [PMID: 38390400 PMCID: PMC10883128 DOI: 10.1177/23259671241226943] [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: 07/11/2023] [Accepted: 08/10/2023] [Indexed: 02/24/2024] Open
Abstract
Background Failure after isolated Bankart repair has led surgeons to consider when to address the Hill-Sachs lesion, which is thought to be a contributor to recurrent instability. One approach utilizes the glenoid track concept to determine whether a Hill-Sachs lesion is classified as "off-track," suggesting that the addition of a remplissage procedure may aid stability. However, the accuracy and reliability of using this approach require validation using an appropriate reference. Purpose To determine the accuracy and reliability of using the glenoid track concept against dynamic arthroscopic assessment of Hill-Sachs lesion engagement. Study Design Cohort study (diagnosis); Level of evidence, 3. Methods A total of 49 patients undergoing arthroscopic Bankart repair surgery for recurrent traumatic anterior shoulder instability were enrolled in this diagnostic validation study. Shoulders were classified as on-track or off-track using 3-dimensional computed tomography (3DCT) and static arthroscopic measurements. These classifications were compared with dynamic arthroscopic assessment (engagement of the Hill-Sachs lesion on the anterior glenoid rim in the 'athletic position') to determine their accuracy and reliability. Results The 3DCT-based measurements to determine glenoid track status had a higher positive predictive value (66% vs 42%), higher specificity (47% vs 42%), and higher accuracy (65% vs 59%) compared with static arthroscopic measurements. Static arthroscopic measurements to determine glenoid track status had a higher negative predictive value (96% vs 64%) and higher sensitivity (96% vs 81%) compared with 3DCT-based measurements. Interrater reliability (Krippendorff α) was 'fair' for determining the glenoid track status using 3DCT (0.368; 95% CI, 0.217-0.519) and 'moderate' for static arthroscopic measurements (0.523; 95% CI, 0.364-0.666). Intrarater reliability (intraclass correlation coefficient [ICC] 3,k) was 'moderate' for 3DCT measurements (0.660; 95% CI, 0.444-0.798) and 'good' for static arthroscopic measurements (0.769; 95% CI, 0.629-0.862). Conclusion Determining glenoid track status using either 3DCT or static arthroscopic measurements yielded moderate accuracy and reliability. Surgeons using the glenoid track concept to aid surgical decision-making in traumatic recurrent anterior shoulder instability should utilize 3DCT or static arthroscopic measurements with caution.
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Affiliation(s)
- Mustafa S Rashid
- Department of Surgery, Section of Orthopedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Saho Tsuchiya
- Department of Surgery, Section of Orthopedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Kristie D More
- University of Calgary Sport Medicine Centre, Calgary, Alberta, Canada
| | - Justin LeBlanc
- Department of Surgery, Section of Orthopedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Aaron J Bois
- Department of Surgery, Section of Orthopedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Cory A Kwong
- Department of Surgery, Section of Orthopedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Ian K Y Lo
- Department of Surgery, Section of Orthopedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
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Bhatia DN, Malviya P. How does dynamic arthroscopic tracking compare with radiologic glenoid track for identification of on- and off-track lesions in anterior shoulder instability? J Shoulder Elbow Surg 2024; 33:23-31. [PMID: 37339701 DOI: 10.1016/j.jse.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/14/2023] [Accepted: 05/06/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Current treatment paradigms for anterior shoulder instability are based on radiologic measurements of glenohumeral bone defects, and mathematical calculation of the glenoid track (GT) is used to classify lesions into on-track and off-track morphology. However, radiologic measurements have shown high variability, and GT widths under dynamic conditions have been reported to be significantly smaller than those under static radiologic conditions. The purpose of this study was to assess the reliability, reproducibility, and diagnostic validity of dynamic arthroscopic standardized tracking (DAST) in comparison to the gold-standard radiologic track measurement method for the identification of on- and off-track bony lesions in patients with anteroinferior shoulder instability. METHODS Between January 2018 and August 2022, 114 patients with traumatic anterior shoulder instability were evaluated using 3-T magnetic resonance imaging or computed tomography scans; glenoid bone loss, Hill-Sachs interval, GT, and Hill-Sachs occupancy ratio (HSO) were measured, and defects were classified as on-track or off-track defects and peripheral-track defects (based on HSO percentage) by 2 independent researchers. During arthroscopy, a standardized method (DAST method) was used by 2 independent observers to classify defects into on-track defects (central and peripheral) and off-track defects. Interobserver reliability of the DAST and radiologic methods was calculated using the κ statistic and reported as percentage agreement. Diagnostic validity (sensitivity, specificity, positive predictive value, and negative predictive value) of the DAST method was calculated using the radiologic track (HSO percentage) as the gold standard. RESULTS The radiologically measured mean glenoid bone loss percentage, Hill-Sachs interval, and HSO in off-track lesions were lower with the arthroscopic method (DAST) as compared with the radiologic method. The DAST method showed nearly perfect agreement between the 2 observers for the on-track/off-track classification (κ = 0.96, P < .001) and the on-track central or peripheral /off-track classification (κ = 0.88, P < .001). The radiologic method showed greater interobserver variability (κ = 0.31 and κ = 0.24, respectively) with only fair agreement for both classifications. Inter-method agreement varied between 71% and 79% (95% confidence interval, 62%-86%) between the 2 observers, and reliability was assessed as slight (κ = 0.16) to fair (κ = 0.38). Overall, for identification of an off-track lesion, the DAST method showed maximum specificity (81% and 78%) when radiologic peripheral-track lesions (HSO percentage of 75%-100%) were considered off-track and showed maximum sensitivity when arthroscopic peripheral-track lesions were classified as off-track. CONCLUSION Although inter-method agreement was low, a standardized arthroscopic tracking method (DAST method) showed superior interobserver agreement and reliability for lesion classification in comparison to the radiologic track method. Incorporating DAST into current algorithms may help reduce variability in surgical decision making.
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Affiliation(s)
- Deepak N Bhatia
- Shoulder and Upper Limb Surgery, SportsDocs, Mumbai, India; Department of Orthopaedic Surgery, Sir H.N. Reliance Foundation Hospital and Research Center, Mumbai, India.
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Ruiz Ibán MA, Pérez Expósito R, Vicente Bártulos A, Vega Rodriguez R, Ruiz Díaz R, Diaz Heredia J. The size of the Hill Sachs defect increases during reduction of a first time shoulder dislocation in older adults: a pilot study in 20 cases. J Exp Orthop 2023; 10:143. [PMID: 38133843 PMCID: PMC10746632 DOI: 10.1186/s40634-023-00667-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/29/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To evaluate if the size of Humeral Hill-Sachs Defects (HSDs) increases during reduction in the emergency department (ED) in subjects that have a first-time anterior shoulder dislocation. METHODS Subjects more than 18 years old presenting to the ED a first-time anterior shoulder dislocation were included. A computed tomography was performed prior to any reduction attempt (Pre-CT). The shoulder was reduced in the emergency room with intraarticular lidocaine; if two attempts failed, the shoulder was reduced under anaesthesia. A second CT was performed after reduction of the shoulder (Post-CT). CT were evaluated using the Osirix software. A 3-dimensional reconstruction of the humeral head was performed and the maximum width of the humeral defect, maximum depth of the humeral defect and total volume of the humeral defect were measured. The relative increase in size was calculated. RESULTS Twenty subjects were included in the study. All subjects presented HSDs in the Pre-CT that had a width of a median of 9.9(interquartile range:2.9)mm, a depth of 7.0(3.0]mm and a volume of 355(333)mm2. The HSD in the Post-CT had a width of 10.9(3.0)mm (an increase of 7.23[8.5]%, significant differences, p = 0.0001) a depth of 7.2(2.7)mm (an increase of 9.93[20.7]%, significant differences, p < 0.0001) and a volume of 469(271) mm2 (an increase of 27.5[26.9]%, significant differences, p < 0.0001). There were size increases larger than 25% in 15/20 (75%) of subjects. CONCLUSION Standard reduction manoeuvres performed in a first-time anterior shoulder dislocation increase the size of the HSD. This increase in size is larger than 25% in four out of five cases. LEVEL OF EVIDENCE IV, prospective cases series study.
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Affiliation(s)
- Miguel Angel Ruiz Ibán
- Shoulder and Elbow Unit, Orthopaedic Surgery and Trauma Service, Hospital Universitario Ramón y Cajal, Cta. Colmenar Km 9,100, 28046, Madrid, Spain.
- Departamento de Cirugía, Ciencias Sanitarias Y Medicosociales, Universidad de Alcalá de Henares, Madrid, Spain.
- Área De Traumatología y Ortopedia, Universidad CEU San Pablo, Madrid, Spain.
| | - Roque Pérez Expósito
- Shoulder and Elbow Unit, Orthopaedic Surgery and Trauma Service, Hospital Universitario Ramón y Cajal, Cta. Colmenar Km 9,100, 28046, Madrid, Spain
| | | | - Rosa Vega Rodriguez
- Shoulder and Elbow Unit, Orthopaedic Surgery and Trauma Service, Hospital Universitario Ramón y Cajal, Cta. Colmenar Km 9,100, 28046, Madrid, Spain
| | - Raquel Ruiz Díaz
- Shoulder and Elbow Unit, Orthopaedic Surgery and Trauma Service, Hospital Universitario Ramón y Cajal, Cta. Colmenar Km 9,100, 28046, Madrid, Spain
| | - Jorge Diaz Heredia
- Shoulder and Elbow Unit, Orthopaedic Surgery and Trauma Service, Hospital Universitario Ramón y Cajal, Cta. Colmenar Km 9,100, 28046, Madrid, Spain
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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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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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Aydıngöz Ü, Yıldız AE, Huri G. Glenoid Track Assessment at Imaging in Anterior Shoulder Instability: Rationale and Step-by-Step Guide. Radiographics 2023; 43:e230030. [PMID: 37410625 DOI: 10.1148/rg.230030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Anterior shoulder dislocation is the most common form of joint instability in humans, usually resulting in soft-tissue injury to the glenohumeral capsuloligamentous and labral structures. Bipolar bone lesions in the form of fractures of the anterior glenoid rim and posterolateral humeral head are often associated with anterior shoulder dislocation and can be a cause or result of recurrent dislocations. Glenoid track assessment is an evolving concept that incorporates the pathomechanics of anterior shoulder instability into its management. Currently widely endorsed by orthopedic surgeons, this concept has ramifications for prognostication, treatment planning, and outcome assessment of anterior shoulder dislocation. The glenoid track is the contact zone between the humeral head and glenoid during shoulder motion from the neutral position to abduction and external rotation. Two key determinants of on-track or off-track status of a Hill-Sachs lesion (HSL) are the glenoid track width (GTW) and Hill-Sachs interval (HSI). If the GTW is less than the HSI, an HSL is off track. If the GTW is greater than the HSI, an HSL is on track. The authors focus on the rationale behind the glenoid track concept and explain stepwise assessment of the glenoid track at CT or MRI. Off-track to on-track conversion is a primary goal in stabilizing the shoulder with anterior instability. The key role that imaging plays in glenoid track assessment warrants radiologists' recognition of this concept along with its challenges and pitfalls and the production of relevant and actionable radiology reports for orthopedic surgeons-to the ultimate benefit of patients. ©RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Üstün Aydıngöz
- From the Department of Radiology (Ü.A., A.E.Y.) and Department of Orthopedics and Traumatology (G.H.), Hacettepe University School of Medicine, 06230 Ankara, Turkey
| | - Adalet Elçin Yıldız
- From the Department of Radiology (Ü.A., A.E.Y.) and Department of Orthopedics and Traumatology (G.H.), Hacettepe University School of Medicine, 06230 Ankara, Turkey
| | - Gazi Huri
- From the Department of Radiology (Ü.A., A.E.Y.) and Department of Orthopedics and Traumatology (G.H.), Hacettepe University School of Medicine, 06230 Ankara, Turkey
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11
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Yeo MHX, Lie D, Cheong T, Wonggokusuma E, Mak WK. Anatomic risk factors for arthroscopic Bankart repair failure: A case-control study comparing failure and non-failure groups in an Asian population. J Orthop 2023; 41:73-78. [PMID: 37362959 PMCID: PMC10285502 DOI: 10.1016/j.jor.2023.06.005] [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: 05/02/2023] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Post-arthroscopic Bankart repair failure/re-dislocation rates are influenced by several risk factors, including anatomic defects. There is limited evidence on the role of anatomic defects, especially for Hill-Sachs size in on-track lesions. This study aimed to assess glenoid bone loss, Hill-Sachs lesion and labral tear size and evaluate their contribution to post-operative instability after a primary repair. Material and methods Across 169 patients with on-track Bankart lesions who underwent primary arthroscopic Bankart repair from 2010 to 2015, this study matched 14 failure with 14 non-failure cases based on age/gender. Patient demographics, pre-operative radiological parameters (including size of glenoid bone loss and Hill-Sachs lesion) and labral tear size were compared between the failure and non-failure groups. Result All patients were male with a mean age of 21.01 ± 4.97. Significantly greater glenoid bone loss (p = 0.024) and labral tear size (p = 0.039) were found in the failure group. However, there was no significant difference in mean volume of Hill-Sachs lesion between the two groups (p = 0.739). Conclusion Extensive glenoid bone loss and labral tears are risk factors for post-arthroscopic Bankart failure. However, the size of Hill-Sachs lesion is not a risk factor for failure, in a specific group of on-track Hill-Sachs lesions. Level of evidence Retrospective Study, Level IV.
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Affiliation(s)
- Mark HX Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Denny Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Teddy Cheong
- Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang E Way, 544886, Singapore
| | - Erick Wonggokusuma
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Wai Keong Mak
- Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang E Way, 544886, Singapore
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12
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Verweij LPE, van Iersel TP, van Deurzen DFP, van den Bekerom MPJ, Floor S. "Nearly off-track lesions" or a short distance from the medial edge of the Hill-Sachs lesion to the medial edge of the glenoid track does not seem to be accurate in predicting recurrence after an arthroscopic Bankart repair in a military population: a case-control study. J Shoulder Elbow Surg 2023; 32:e145-e152. [PMID: 36368476 DOI: 10.1016/j.jse.2022.10.003] [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: 07/14/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND On-track lesions with a short distance from the medial edge of the Hill-Sachs lesion to the medial edge of the glenoid track (nearly off-track) may predispose recurrence after arthroscopic Bankart repair (ABR) in the general population. The aim of this study was to determine if a shorter distance between the medial edge of the Hill-Sachs lesion and the medial edge of the glenoid track could accurately predict recurrence after an ABR in a high-demand military population. It was hypothesized that a shorter distance would not accurately predict recurrence. MATERIALS AND METHODS A retrospective monocenter case-control study was performed at the Dutch Central Military Hospital. Patients with an on-track Hill-Sachs lesion who underwent a primary ABR between 2014 and 2019 with a minimal follow-up of 2 years and a preoperative magnetic resonance imaging (MRI) assessment received a questionnaire. The primary outcome was recurrence, defined as a complete dislocation or subluxation. Glenoid bone loss was assessed using a linear-based method on MRI. The distance from the medial edge of the Hill-Sachs lesion to the medial edge of the glenoid track was defined as the distance to dislocation (DTD). A receiver operating characteristic curve was created to determine the predictive value of the DTD for recurrence. Logistic regression was used to determine preoperative risk factors that predispose recurrence. Covariates were selected based on univariable analysis and included gender, body mass index, age at surgery and first dislocation, laterality, smoking habits, overhead shoulder activity during work, preoperative dislocations, sports type and level, bony or labral lesions on MRI, and DTD. RESULTS In total, 80 patients with an average follow-up of 4.8 ± 1.9 years completed the questionnaire and were included in the analyses. Seventeen patients (21%) experienced recurrence at the final follow-up. No difference in DTD was observed among patients who experienced recurrence (9 ± 4 mm) compared with patients who did not (9 ± 5 mm; P = .81). The receiver operating characteristic curve demonstrated no predictive power of DTD for recurrence (area under the curve = 0.49). Smoking at the time of surgery (odds ratio: 3.9; confidence interval: 1.2-12.7; P = .02) and overhead shoulder movement during work (odds ratio: 9.3; confidence interval: 1.1-78.0; P = .04) were associated with recurrence according to the logistic regression analysis. CONCLUSION A shorter DTD demonstrated no accuracy in predicting recurrence in a military population. Smoking at the time of surgery and overhead shoulder activity during work were associated with recurrence; however, these analyses were underpowered to draw valid conclusions.
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Affiliation(s)
- Lukas P E Verweij
- Amsterdam UMC, Location AMC, Department of Orthopedic Surgery and Sports Medicine, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, the Netherlands; Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands.
| | - Theodore P van Iersel
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands; Shoulder and Elbow Unit, Department of Orthopedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Derek F P van Deurzen
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands; Shoulder and Elbow Unit, Department of Orthopedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Michel P J van den Bekerom
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands; Shoulder and Elbow Unit, Department of Orthopedic Surgery, OLVG, Amsterdam, the Netherlands; Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Sebastiaan Floor
- Department of Orthopedic Surgery, Central Military Hospital, Utrecht, the Netherlands
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13
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Maiotti M, De Vita A, De Benedetto M, Cerciello S, Massoni C, Di Giunta A, Raffelini F, Lo Cascio R, Pirani P, Castricini R. Clinical outcomes and recurrence rate of 4 procedures for recurrent anterior shoulder instability: ASA, remplissage, open, and arthroscopic Latarjet: a multicenter study. J Shoulder Elbow Surg 2022; 32:931-938. [PMID: 36470517 DOI: 10.1016/j.jse.2022.10.030] [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: 06/21/2022] [Revised: 10/16/2022] [Accepted: 10/20/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of the present study was to compare the clinical outcomes of 4 surgical techniques in patients with recurrent anterior shoulder dislocation, glenoid bone loss (GBL) <15% and Instability Severity Index (ISI) score >3. METHODS A retrospective multicenter study was conducted on 226 patients who underwent 1 of 4 different techniques (Bankart plus arthroscopic subscapularis augmentation (ASA), Bankart plus remplissage, Latarjet, Arthro-Latarjet). The inclusion criteria were: recurrent dislocation, GBL <15%, and ISI score >3. The exclusion criteria were: GBL >15%, voluntary instability, multidirectional instability, preexisting osteoarthritis, throwing athletes' first dislocation, and ISI score<3. Follow-up ranged from 24 months to 6 years. Hyperlaxity was clinically evaluated according to Neer and Coudane-Walch tests. Clinical outcomes were assessed using the Rowe score and the Western Ontario Shoulder Instability Index (WOSI) for each technique. Before surgery, all patients underwent magnetic resonance imaging and computed tomography scanning. The Pico area method was used to assess the percentage of GBL. The operations were performed by 10 experienced surgeons; the functional outcomes were evaluated by 2 independent observers. RESULTS A total of 226 patients who met the inclusion criteria were included in the present series. A total of 89.2% of patients in the ASA group reported an excellent Rowe score at the final follow-up, and their scores on the WOSI scale, improved from 838 to 235 points. A total of 79.9% of patients in remplissage (R) group reported an excellent Rowe score at the final follow-up, and their scores on the WOSI scale improved from 1146 to 465 points. A total of 98.5% of patients in the Latarjet (L) group reported an excellent Rowe score at the final follow-up, and their scores on the WOSI scale improved from 1456 to 319 points. A total of 81.6% of patients in the Arthro-Latarjet (AL) group reported an excellent Rowe score at the final follow-up, and their scores on the WOSI scale improved from 1250 to 221 points. The recurrence rates were as follows: ASA group (7%), remplissage group (6.1%), L group (1.5%), Arthro-Latarjet group (0%). Patients in the open L group had 15.5% (10/66) more complications. CONCLUSION The use of ASA and remplissage to augment the Bankart repair have been demonstrated to be effective for restoring joint stability, yielding good clinical outcomes similar to the L procedure in patients affected by recurrent anterior dislocation with GBL <15% and an ISI score score >3. Soft tissues augmentations of the Bankart repair have been demonstrated to be effective for addressing anterior soft tissue deficiency dysfunction and critical Hill-Sachs lesions.
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Affiliation(s)
- Marco Maiotti
- Villa Stuart Hospital, Rome, Italy; Mediterranea Hospital, Naples, Italy.
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14
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Wu C, Wang Y, Wang C, Chen J, Xu J, Yu W, Huang K, Ye Z, Jiang J, Tsai TY, Zhao J, Xie G. Glenoid Track Width Is Smaller Under Dynamic Conditions: An In Vivo Dual-Fluoroscopy Imaging Study. Am J Sports Med 2022; 50:3881-3888. [PMID: 36300554 DOI: 10.1177/03635465221126650] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND The glenoid track concept has been widely used to assess the risk of instability due to bipolar bone loss. The glenoid track width was commonly used as 83% of the glenoid width to determine if a lesion was on-track or off-track. However, the value was obtained under static conditions, and it may not be able to reflect the actual mechanism of traumatic dislocation during motion. PURPOSE To compare the glenoid track width under dynamic and static conditions using a dual-fluoroscopic imaging system. STUDY DESIGN Controlled laboratory study. METHODS In total, 40 shoulders of 20 healthy volunteers were examined for both dynamic and static tests within a dual-fluoroscopic imaging system at 5 different arm positions: 30°, 60°, 90°, 120°, and 150° of abduction, keeping the shoulder at 90° of external rotation. The participants performed a fast horizontal arm backswing for dynamic tests while keeping their arm in maximum horizontal extension for static tests. Computed tomography scans were used to create 3-dimensional models of the humerus and scapula for 2-dimensional to 3-dimensional image registration. Magnetic resonance imaging scans were obtained to delineate the medial margin of the rotator cuff insertion. The glenoid track width was measured as the distance from the anterior rim of the glenoid to the medial margin of the rotator cuff insertion and compared between static and dynamic conditions. RESULTS The mean glenoid track widths at 30°, 60°, 90°, 120°, and 150° of abduction were significantly smaller under dynamic conditions (88%, 81%, 72%, 69%, and 68% of the glenoid width) than those under static conditions (101%, 92%, 84%, 78%, and 77% of the glenoid width) (all P < .001). The glenoid track width significantly decreased with the increasing abduction angles in the range of 30° to 120° under static conditions (all P < .003) and 30° to 90° under dynamic conditions (all P < .001). CONCLUSION A smaller dynamic-based value should be considered for the glenoid track width when distinguishing on-track/off-track lesions. Clinical evidence is needed to establish the superiority of the dynamic-based value over the static-based value as an indicator for augmentation procedures. CLINICAL RELEVANCE Some off-track lesions might be misclassified as on-track lesions when the original commonly used static-based value of 83% is used as the glenoid track width.
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Affiliation(s)
- Chenliang Wu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yufan Wang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cong Wang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiebo Chen
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wanxin Yu
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kai Huang
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zipeng Ye
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Jiang
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,TaoImage Medical Technologies Corporation, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guoming Xie
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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15
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Asghar E, Burks R. Is 13.5% the Right Number for Critical Bone Loss? Arthroscopy 2022; 38:2773-2775. [PMID: 36192039 DOI: 10.1016/j.arthro.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/02/2022] [Indexed: 02/02/2023]
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16
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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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Gracitelli MEC, Lobo FL, Malavolta EA, Assunção JH, Andrade-Silva FBD, Ferreira Neto AA. Validação clínica do conceito de glenoid track na instabilidade glenoumeral anterior. Rev Bras Ortop 2022; 57:612-618. [PMID: 35966420 PMCID: PMC9365485 DOI: 10.1055/s-0041-1741022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/09/2021] [Indexed: 11/25/2022] Open
Abstract
Objective
To evaluate the correlation of the glenoid track and glenoidal bone loss with the recurrence dislocation rate and the Rowe score.
Methods
Retrospective study that assessed the glenoid track and glenoidal bone loss through preoperative magnetic resonance imaging. Patients undergoing primary arthroscopic repair of anterior Bankart were included. Patients with glenoidal bone loss greater than 21%, rotator cuff tear, scapular waist fracture, and posterior or multidirectional instability were not included. Rowe score were the primary outcome, and the recurrence rate was the secondary outcome.
Results
One hundred and two patients were included. Postoperative recurrent instability was reported by 8 patients (7.8%). Four patients (50%) in the group with recurrence presented glenoidal bone loss greater than 13.5% against 24 (25.5%) in the group without recurrence (
p
= 0.210), with a negative predictive value of 94.6%. Three patients (37.5%) in the recurrence group were considered off-track, against 13 (13.8%) in the group without recurrence (
p
= 0.109), with a negative predictive value of 94.2%. Patients with absolute glenoid track value ≤ 1.5 mm had worse results in relation to the recurrence group, with 6 patients (75%) presenting recurrence (
p
= 0.003).
Conclusion
Off-track injury and glenoidal bone loss greater than the subcritical are not related to the recurrence rate and Rowe score, despite the high negative predictive value. The cut of the absolute value of the glenoid track at 1.5 mm had a significant relationship with the recurrence rate.
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Affiliation(s)
- Mauro Emilio Conforto Gracitelli
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Frederico Lafraia Lobo
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Eduardo Angeli Malavolta
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Jorge Henrique Assunção
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Fernando Brandão de Andrade-Silva
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Arnaldo Amado Ferreira Neto
- Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Rutgers C, Verweij LPE, Priester-Vink S, van Deurzen DFP, Maas M, van den Bekerom MPJ. Recurrence in traumatic anterior shoulder dislocations increases the prevalence of Hill-Sachs and Bankart lesions: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:2130-2140. [PMID: 34988633 PMCID: PMC9165262 DOI: 10.1007/s00167-021-06847-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/13/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The extent of shoulder instability and the indication for surgery may be determined by the prevalence or size of associated lesions. However, a varying prevalence is reported and the actual values are therefore unclear. In addition, it is unclear whether these lesions are present after the first dislocation and whether or not these lesions increase in size after recurrence. The aim of this systematic review was (1) to determine the prevalence of lesions associated with traumatic anterior shoulder dislocations, (2) to determine if the prevalence is higher following recurrent dislocations compared to first-time dislocations and (3) to determine if the prevalence is higher following complete dislocations compared to subluxations. METHODS PubMed, EMBASE, Cochrane and Web of Science were searched. Studies examining shoulders after traumatic anterior dislocations during arthroscopy or with MRI/MRA or CT published after 1999 were included. A total of 22 studies (1920 shoulders) were included. RESULTS The proportion of Hill-Sachs and Bankart lesions was higher in recurrent dislocations (85%; 66%) compared to first-time dislocations (71%; 59%) and this was statistically significant (P < 0.01; P = 0.05). No significant difference between recurrent and first-time dislocations was observed for SLAP lesions, rotator-cuff tears, bony Bankart lesions, HAGL lesions and ALPSA lesions. The proportion of Hill-Sachs lesions was significantly higher in complete dislocations (82%) compared to subluxations (54%; P < 0.01). CONCLUSION Higher proportions of Hill-Sachs and Bankart were observed in recurrent dislocations compared to first-time dislocations. No difference was observed for bony Bankart, HAGL, SLAP, rotator-cuff tear and ALPSA. Especially when a Hill-Sachs or Bankart is present after first-time dislocation, early surgical stabilization may need to be considered as other lesions may not be expected after recurrence and to limit lesion growth. However, results should be interpreted with caution due to substantial heterogeneity and large variance. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Cain Rutgers
- Vrije Universiteit Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands.
| | - Lukas. P. E. Verweij
- Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands
| | - Simone Priester-Vink
- Medical Library, Department of Research and Epidemiology, OLVG, Amsterdam, The Netherlands
| | - Derek F. P. van Deurzen
- Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands
| | - Mario Maas
- Division of Musculoskeletal Radiology, Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
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Vopat ML, Hermanns CA, Midtgaard KS, Baker J, Coda RG, Cheema SG, Tarakemeh A, Peebles L, Vopat BG, Provencher MT. Imaging Modalities for the Glenoid Track in Recurrent Shoulder Instability: A Systematic Review. Orthop J Sports Med 2021; 9:23259671211006750. [PMID: 34159209 PMCID: PMC8182199 DOI: 10.1177/23259671211006750] [Citation(s) in RCA: 3] [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] [Received: 02/17/2021] [Accepted: 02/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background: The glenoid track (GT) concept illustrates how the degree of glenoid bone
loss and humeral bone loss in the glenohumeral joint can guide further
treatment in a patient with anterior instability. The importance of
determining which lesions are at risk for recurrent instability involves
imaging of the glenohumeral joint, but no studies have determined which type
of imaging is the most appropriate. Purpose/Hypothesis: The purpose of this study was to determine the validity and accuracy of
different imaging modalities for measuring the GT in shoulders with
recurrent anterior instability. We hypothesized that 3-dimensional computed
tomography (3D-CT) would be the most accurate imaging technique. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed according to the PRISMA (Preferred
Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using
PubMed, Scopus, Medline, and Cochrane libraries between database inception
and July 2019. We included all clinical trials or cadaveric studies that
evaluated imaging modalities for assessing the GT. Results: A total of 13 studies were included in this review: 1 study using
2-dimensional CT, 6 studies using 3D-CT, 4 studies using magnetic resonance
imaging (MRI), 1 study using magnetic resonance arthrography (MRA)/MRI, and
1 study combining CT and MRI. The mean sensitivity, specificity, and
accuracy for 2D-CT was 92%, 100%, and 96%, respectively. For MRI, the means
were 72.2%, 87.9%, and 84.2%, respectively. No papers included 3D-CT
metrics. The mean intraclass correlation coefficients (ICCs) for
intraobserver reliability were 0.9046 for 3D-CT and 0.867 for MRI. ICCs for
interobserver reliability were 0.8164, 0.8845, and 0.43 for 3D-CT, MRI, and
MRA/MRI, respectively. Conclusion: There is evidence to support the use of both CT and MRI imaging modalities in
assessing the GT. In addition, few studies have compared radiographic
measurements with a gold standard, and even fewer have looked at the GT
concept as a predictor of outcomes. Thus, future studies are needed to
further evaluate which imaging modality is the most accurate to assess the
GT.
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Affiliation(s)
- Matthew L Vopat
- University of Kansas School of Medicine--Wichita, Wichita, Kansas, USA
| | | | - Kaare S Midtgaard
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA.,Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Jordan Baker
- University of Kansas School of Medicine--Kansas City, Kansas City, Kansas, USA
| | - Reed G Coda
- University of Kansas School of Medicine--Kansas City, Kansas City, Kansas, USA
| | - Sana G Cheema
- University of Kansas School of Medicine--Kansas City, Kansas City, Kansas, USA
| | - Armin Tarakemeh
- University of Kansas School of Medicine--Kansas City, Kansas City, Kansas, USA
| | - Liam Peebles
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Bryan G Vopat
- University of Kansas School of Medicine--Kansas City, Kansas City, Kansas, USA
| | - Matthew T Provencher
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
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20
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Rossi LA, Frank RM, Wilke D, Provencher CMT, Millet PJ, Romeo A, Walch G, Lo I, Yamamoto N, Bokor D, Di Giacomo G, Tokish J, Lech O, Itoi E, Garrigues G, Scheibel M, Boileau P, Calvo E, Arce G, Toro F, Sugaya H, Ranalletta M, Parada S, Savoie F, Verma NN, Chahla J. Evaluation and Management of Glenohumeral Instability With Associated Bone Loss: An Expert Consensus Statement Using the Modified Delphi Technique. Arthroscopy 2021; 37:1719-1728. [PMID: 33453347 DOI: 10.1016/j.arthro.2020.12.237] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To establish an international expert consensus, using the modified Delphi technique, on the evaluation and management of glenohumeral instability with associated bone loss. METHODS A working group of 6 individuals generated a list of statements related to history and physical examination, imaging and specialized diagnostic tests, bone loss quantification and classification, treatment outcomes and complications, and rehabilitation for the management of glenohumeral instability associated with bone loss to form the basis of an initial survey for rating by a group of experts. The expert group (composed of 22 high-volume glenohumeral instability experts) was surveyed on 3 occasions to establish a consensus on the statements. Items with over 70% agreement and less than 10% disagreement achieved consensus. RESULTS After a total of 3 rounds, 31 statements achieved consensus. Eighty-six percent of the experts agreed that a history of multiple dislocations and failed soft-tissue surgery should raise suspicion about the possibility of an associated bone deficit. Ninety-five percent of the experts agreed that 3-dimensional (3D) computed tomography (CT) is the most accurate diagnostic method to evaluate and quantify bone loss. Eighty-six percent of the experts agreed that any of the available methods to measure glenoid bone deficiency is adequate; however, 91% of the experts thought that an en face view of the glenoid using 3D CT provides the most accurate method. Ninety-five percent of the experts agreed that Hill-Sachs lesions are poorly quantified and classified by current imaging systems. Ninety percent of the experts agreed that in cases with a glenoid bone deficit greater than 20%, glenoid bone graft reconstruction should be performed and any of the available options is valid. There was no consensus among experts on how Hill-Sachs injuries should be managed or on how postoperative rehabilitation should be carried out. CONCLUSIONS The essential statements on which the experts reached consensus included the following: A history of multiple dislocations and failed soft-tissue surgery should make surgeons consider the possibility of an associated bone deficit. Three-dimensional CT is the most accurate diagnostic method to evaluate and quantify bone loss. Although any of the available methods to measure glenoid bone deficiency is adequate, an en face view of the glenoid using 3D CT provides the most accurate method. Hill-Sachs lesions are poorly quantified and classified by current imaging systems. Finally, in cases with a glenoid bone deficit greater than 20%, glenoid bone graft reconstruction should be performed. LEVEL OF EVIDENCE Level V, consensus statement.
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Affiliation(s)
| | - Rachel M Frank
- Rush University Medical Center, Chicago, Illinois, U.S.A
| | | | | | | | | | | | - Ian Lo
- The Steadman Clinic, Vail, Colorado, U.S.A
| | | | | | | | | | | | - Eiji Itoi
- The Steadman Clinic, Vail, Colorado, U.S.A
| | | | | | | | | | | | | | | | | | | | | | | | - Jorge Chahla
- Rush University Medical Center, Chicago, Illinois, U.S.A
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21
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Pougès C, Hardy A, Vervoort T, Amouyel T, Duriez P, Lalanne C, Szymanski C, Deken V, Chantelot C, Upex P, Maynou C. Arthroscopic Bankart Repair Versus Immobilization for First Episode of Anterior Shoulder Dislocation Before the Age of 25: A Randomized Controlled Trial. Am J Sports Med 2021; 49:1166-1174. [PMID: 33705240 DOI: 10.1177/0363546521996381] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The risk of recurrence after the first episode of anterior shoulder dislocation is high with nonoperative treatment in younger patients. PURPOSE/HYPOTHESIS The aim of this study was to compare the results of arthroscopic Bankart repair and nonoperative treatment for shoulder dislocation in patients younger than 25 years, with a minimum of 2 years of follow-up. The hypothesis was that surgery would decrease the risk of recurrence. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS We included patients aged between 18 and 25 years after a first episode of anterior shoulder dislocation and divided them into 2 groups. The first group was treated surgically with an arthroscopic Bankart repair within 2 weeks after the dislocation; the second group was treated nonoperatively. Both groups were immobilized for 3 weeks in internal rotation and followed the same physical therapy protocol. Standard radiography and computed tomography were performed immediately after reduction of the dislocation, and follow-up was performed at 3, 6, 12, and 24 months. The primary outcome measure was instability recurrence, defined as another anterior shoulder dislocation requiring closed reduction by another person (the patient was unable to reduce the dislocated joint themselves), a subluxation, or a positive apprehension test. Secondary outcome measures included range of motion, return to sport, and functional scores such as the short version of the Disabilities of the Arm, Shoulder and Hand score the Walch-Duplay score, and the Western Ontario Shoulder Instability Index (WOSI). RESULTS A total of 20 patients were included in each group. The mean ± SD age was 21 ± 1.8 years, and there were 33 men (82.5%) and 7 women (17.5%) in the total sample. Recurrence of instability was significantly decreased in the surgical treatment group compared with the nonoperative group (2 [10%] vs 14 [70%], respectively; P = .0001). Fewer patients in the surgical treatment group versus the nonoperative group had another episode of dislocation (0 vs 6 [30%], respectively), subluxation (2 [10%] vs 13 [65%], respectively; P = .003), or a positive apprehension test (1 [5%] vs 11 [58%], respectively; P = .0005). The Walch-Duplay score (88.4 vs 70.3 points; P = .046) and WOSI (11.5 vs 17.7 points; P = .035) were significantly better in the surgical group versus the nonoperative group after a 2-year follow-up. Level of sport was the same or better in 89% of the surgical treatment group vs 53% of the nonoperative treatment group (P = .012). No surgical complication was recorded. We did not find any significant difference in range of motion. CONCLUSION In patients with first-time shoulder dislocations, arthroscopic labral repair (Bankart procedure) reduced the risk of secondary shoulder dislocation and improved functional outcome versus nonoperative treatment after a 2-year follow-up. Surgical treatment after a first episode of shoulder dislocation could be offered as a primary treatment option in a younger population if these results are confirmed by larger studies with a longer follow-up. REGISTRATION NCT03315819 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Cécile Pougès
- Lille-Hauts de France University, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital Salengro, Lille, France
| | - Alexandre Hardy
- Lille-Hauts de France University, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital Salengro, Lille, France
| | - Thomas Vervoort
- Lille-Hauts de France University, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital Salengro, Lille, France.,Arcachon Clinic, La Teste-de-Buch, France
| | - Thomas Amouyel
- Lille-Hauts de France University, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital Salengro, Lille, France
| | - Pauline Duriez
- Lille-Hauts de France University, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital Salengro, Lille, France
| | - Clément Lalanne
- Lille-Hauts de France University, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital Salengro, Lille, France
| | - Christophe Szymanski
- Lille-Hauts de France University, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital Salengro, Lille, France
| | - Valérie Deken
- Lille-Hauts de France University, Lille, France.,Methodology Unit-Biostatistics and Data Management, Lille University, France
| | - Christophe Chantelot
- Lille-Hauts de France University, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital Salengro, Lille, France
| | - Peter Upex
- Orthopedic Department, Saint Joseph Hospital, Paris, France
| | - Carlos Maynou
- Lille-Hauts de France University, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital Salengro, Lille, France
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22
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Mulleneers LIC, Van Rompaey H, Haloui B, Pouliart N. Determining On-/Off-track Lesions in Glenohumeral Dislocation Using Multiplanar Reconstruction Computed Tomography Is Easier and More Reproducible Than Using 3-dimensional Computed Tomography. Am J Sports Med 2021; 49:137-145. [PMID: 33270465 DOI: 10.1177/0363546520971856] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND The glenoid track is a useful tool to predict engagement and therefore the risk of recurrence of dislocation in the presence of Hill-Sachs and/or bony Bankart lesions. To assess the glenoid track preoperatively, only methods using 3-dimensional reconstruction (3DR) have been described, but these lack a standardized, reliable, and easy description. PURPOSE/HYPOTHESIS The purpose was to evaluate a new method for determining the glenoid track using computed tomography (CT) scan with multiplanar reconstruction (MPR) in comparison with using 3DR images. Our hypothesis was that the MPR method would be easier to standardize and more reproducible. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS A total of 52 patients whose arthro-CT scan revealed a Hill-Sachs lesion, whether in combination with a bony Bankart lesion or not, were included. Digital Imaging and Communications in Medicine data from the 52 CT scans were all analyzed using open source image analysis software. Glenoid width, with or without associated bony defect, and the Hill-Sachs interval (HSI) were measured on MPR as well as on 3DR images. All measurements obtained using both methods were directly compared and evaluated for intra- and interobserver reliability. RESULTS In absolute values, only small differences were seen between the MPR and 3DR methods, amounting to a maximal difference of 0.07 cm for the HSI and 0.04 cm for the glenoid width. For glenoid measurements, both methods were similar. For humeral measurements, the MPR method demonstrated higher inter- and intraobserver reliability than did the 3DR method. CONCLUSION The newly described MPR method for the assessment of the glenoid track and HSI is at least as accurate as the published 3DR method, with better intra- and interobserver reliability. Because MPRs are also easier to obtain, this method could be recommended in daily practice.
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Affiliation(s)
| | | | | | - Nicole Pouliart
- Shoulder and Elbow Surgery, Sports Traumatology, and Arthroscopic Surgery, Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel, Free University of Brussels, Brussels, Belgium.,Faculty of Medicine and Pharmacy, Free University of Brussels, Brussels, Belgium
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23
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Vopat ML, Peebles LA, McBride T, Cirone I, Rider D, Provencher CMT. Accuracy and Reliability of Imaging Modalities for the Diagnosis and Quantification of Hill-Sachs Lesions: A Systematic Review. Arthroscopy 2021; 37:391-401. [PMID: 32798670 DOI: 10.1016/j.arthro.2020.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/24/2020] [Accepted: 08/11/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine the reliability and accuracy of different imaging modalities in assessing Hill-Sachs lesions within the setting of anterior shoulder instability. METHODS A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines using the PubMed, Scopus, Embase, and Cochrane Library databases. The inclusion criteria were clinical trials or cadaveric studies that assessed the accuracy of humeral head bone loss imaging or reliability and English-language articles. The exclusion criteria were animal studies; imaging studies without measures of accuracy, reliability, or clinical predictive power; studies of shoulder injuries without humeral head bone loss; editorials; abstracts; reviews; case reports; and surveys. The search terms included "imaging" OR "radiographic" OR "CT" OR "MRI" AND "Hill-Sachs" OR "humeral head bone loss." Assessment of the methodologic quality of the included studies was performed using the original Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. RESULTS Forty studies (2,560 shoulders) met the inclusion criteria and were assessed. For diagnosing the presence of Hill-Sachs lesions, computed tomography (CT) arthrography had the highest reported accuracy (median, 91%; range, 66%-100%). For the same assessment, CT arthrography also had the greatest reported sensitivity (median, 94%; range, 50%-100%). For the quantification of Hill-Sachs lesion parameters, reported intraobserver reliabilities were highest for 3-dimensional (3D) CT (intraclass correlation coefficient [ICC] range, 0.916-0.999), followed by 2-dimensional CT (ICC range, 0.858-0.861) and magnetic resonance imaging (MRI) (ICC range, 0.28-0.97). For the same quantification parameters, interobserver reliabilities were also reported for 3D CT (ICC range, 0.772-0.996), 2-dimensional CT (ICC range, 0.721-0.879), and MRI (κ range, 0.444-0.700). Intraobserver reliabilities for determining glenoid tracking were only reported for 3D CT (κ range, 0.730-1.00; ICC range, 0.803-0.901) and MRI (ICC range, 0.770-0.790). CONCLUSIONS This study shows that the current literature supports a variety of different imaging modalities that provide clinically acceptable accuracy in diagnosing and quantifying Hill-Sachs lesions, as well as determining whether they will cause persistent anterior shoulder instability. Furthermore, this systematic review justifies that further research is needed to help develop a treatment algorithm on the proper imaging modalities needed to help treat patients with anterior shoulder instability that is both reliable and financially acceptable. LEVEL OF EVIDENCE Level IV, systematic review of Level I through IV studies.
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Affiliation(s)
- Matthew L Vopat
- University of Kansas School of Medicine-Wichita, Wichita, Kansas, U.S.A
| | - Liam A Peebles
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Trevor McBride
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania, U.S.A
| | - Isaak Cirone
- Colorado State University, Fort Collins, Colorado, U.S.A
| | - Danielle Rider
- Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Capt Matthew T Provencher
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A..
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24
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Stefaniak J, Lubiatowski P, Kubicka AM, Wawrzyniak A, Wałecka J, Romanowski L. Clinical and radiological examination of bony-mediated shoulder instability. EFORT Open Rev 2020; 5:815-827. [PMID: 33312708 PMCID: PMC7722946 DOI: 10.1302/2058-5241.5.200049] [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] [Indexed: 12/19/2022] Open
Abstract
The coexistence of glenoid and humeral head bone defects may increase the risk of recurrence of instability after soft tissue repair. Revealed factors in medical history such as male gender, younger age of dislocation, an increasing number of dislocations, contact sports, and manual work or epilepsy may increase the recurrence rate of instability. In physical examination, positive bony apprehension test, catching and crepitations in shoulder movement may suggest osseous deficiency. Anteroposterior and axial views allow for the detection of particular bony lesions in patients with recurrent anterior shoulder instability. Computed Tomography (CT) with multiplanar reconstruction (MPR) and various types of 3D rendering in 2D (quasi-3D-CT) and 3D (true-3D-CT) space allows not only detection of glenoid and humeral bone defects but most of all their quantification and relations (engaging/not-engaging and on-track/off-track) in the context of bipolar lesion. Magnetic resonance imaging (MRI) is increasingly developing and can provide an equally accurate measurement tool for bone assessment, avoiding radiation exposure for the patient.
Cite this article: EFORT Open Rev 2020;5:815-827. DOI: 10.1302/2058-5241.5.200049
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Affiliation(s)
- Jakub Stefaniak
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, Poznan, Poland.,Sport Traumatology and Biomechanics Unit, Rehasport Clinic, Poznan University of Medical Sciences, Poznan, Poland
| | - Przemyslaw Lubiatowski
- Sport Traumatology and Biomechanics Unit, Rehasport Clinic, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Maria Kubicka
- Institute of Zoology, Poznan University of Life Sciences, Poznan, Poland
| | - Anna Wawrzyniak
- Sport Traumatology and Biomechanics Unit, Rehasport Clinic, Poznan University of Medical Sciences, Poznan, Poland
| | - Joanna Wałecka
- Sport Traumatology and Biomechanics Unit, Rehasport Clinic, Poznan University of Medical Sciences, Poznan, Poland
| | - Leszek Romanowski
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, Poznan, Poland
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25
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Evaluation of the Glenoid Track Tomographic Method in Magnetic Resonance Imaging/Arthro-MRI. Rev Bras Ortop 2020; 56:733-740. [PMID: 34900101 PMCID: PMC8651453 DOI: 10.1055/s-0040-1716766] [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] [Received: 12/09/2019] [Accepted: 07/06/2020] [Indexed: 11/25/2022] Open
Abstract
Objective
To evaluate and compare the glenoid track method in 3D-reconstructed computed tomography (3D-CT) scans with magnetic resonance imaging (MRI) and/or arthro-MRI.
Methods
Forty-four shoulders with clinical and radiographic diagnosis of traumatic anterior instability were assessed using 3D-CT, MRI, and/or arthro-MRI scans. Glenoid track (GT), Hill-Sachs interval (HSI), and glenoid bone loss (GBL) were determined by a radiologist using 3D-CT images, and classified as on-track/off-track. Three surgeons, blinded to the radiologist's evaluation, performed the same determinations using MRI/arthro-MRI. Descriptive analysis, variance analysis, results disagreement analysis, and receiver operating characteristic (ROC) curves were performed.
Results
Results from the 4 examiners were fully consistent in 61.4% of the cases. Magnetic resonance imaging/arthro-MRI diagnosed off-track injuries with 35 to 65% sensitivity and on-track injuries, with 91.67 to 95.83% specificity. Accuracy ranged from 68.1 to 79.5%. The greatest data divergence occurred for off-track injuries diagnosed by MRI/arthro-MRI. The greatest data variability referred to HSI calculation. Higher HSI and GBL values were associated with greater disagreement among examiners. Hill-Sachs interval values were lower at MRI/arthro-MRI when compared to 3D-CT. Agreement between CT and MRI/arthro-MRI for the GT method was only moderate (kappa value, 0.325–0.579).
Conclusion
Magnetic resonance imaging/arthro-MRI showed low accuracy and moderate agreement for the GT method; as such, it should be used with caution by surgeons.
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26
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Kim SH, Jung W, Rhee SM, Kim JU, Oh JH. Outcomes of arthroscopic capsulolabral reconstruction for anterior instability with greater than 20% glenoid bone defects: are Latarjet procedures absolutely indicated for these patients? Clin Shoulder Elb 2020; 23:62-70. [PMID: 33330236 PMCID: PMC7714330 DOI: 10.5397/cise.2019.00094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/19/2020] [Accepted: 04/22/2020] [Indexed: 11/25/2022] Open
Abstract
Background Recent studies have reported high rates of recurrence of shoulder instability in patients with glenoid bone defects greater than 20% after capsulolabral reconstruction. The purpose of the present study was to evaluate the failure rate of arthroscopic capsulolabral reconstruction for the treatment of anterior instability in the presence of glenoid bone deficits >20%. Methods Retrospective analyses were conducted among cases with anterior shoulder instability and glenoid bone defects of >20% that were treated by arthroscopic capsulolabral reconstruction with a minimum 2-year follow-up (30 cases). We included the following variables: age, bone defect size, instability severity index score (ISIS), on-/off-track assessment, incidence recurrent instability, and return to sports. Results The mean glenoid bone defect size was 25.8%±4.2% (range, 20.4%–37.2%), and 18 cases (60%) had defects of >25%. Bony Bankart lesions were identified in 11 cases (36.7%). Eleven cases (36.7%) had ISIS scores >6 points and 21 cases (70%) had off-track lesions. No cases of recurrent instability were identified over a mean follow-up of 39.9 months (range, 24–86 months), but a sense of subluxation was reported by three patients. Return to sports at the preinjury level was possible in 24 cases (80%), and the average satisfaction rating was 92%. Conclusions Arthroscopic soft tissue reconstruction was successful for treating anterior shoulder instability among patients with glenoid bone defects >20%, even enabling return to sports. Future studies should focus on determining the range of bone defect sizes that can be successfully managed by soft tissue repair.
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Affiliation(s)
- Sae Hoon Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Whanik Jung
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Min Rhee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Un Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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27
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Pandey V, Gangadharaiah L, Madi S, Acharya K, Nayak S, Karegowda LH, Willems WJ. A retrospective cohort analysis of arthroscopic Bankart repair with or without remplissage in patients with off-track Hill-Sachs lesion evaluated for functional outcomes, recurrent instability, and range of motion. J Shoulder Elbow Surg 2020; 29:273-281. [PMID: 31447283 DOI: 10.1016/j.jse.2019.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 05/30/2019] [Accepted: 06/07/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lone Bankart repair is associated with high rates of recurrence, especially in off-track Hill-Sachs (HS) lesion. The objective of the study was to assess the impact of remplissage in off-track HS lesion influencing the rate of redislocation and range of motion (ROM) of the shoulder. MATERIAL AND METHOD We retrospectively reviewed 136 patients for arthroscopic Bankart repair without remplissage (group 1, n = 77) or with remplissage (group 2, n =59) for recurrent anterior dislocation of the shoulder with glenoid bone loss of <25%. Further subgroups of on- and off-track HS lesion were based on computed tomographic assessment. At a minimum follow-up of 2 years; patients were evaluated for functional scores (Rowe, Constant-Murley, Western Ontario Shoulder Instability Index), redislocations, and ROM. RESULTS At a mean follow-up of 54 and 44 months in group 1 and 2, respectively, there was no difference in postoperative functional scores. There were significantly more dislocations in patients with Bankart repair with off-track lesion than in patients with Bankart repair with on-track lesion (P = .02). There were significantly fewer redislocations in patients with off-track lesion who underwent Bankart repair and remplissage than in those who did not undergo remplissage (P = .0007). Compared with group 1 patients, those in group 2 revealed a statistically significant loss of ROM. CONCLUSIONS Although a nonremplissaged off-track HS lesion remains an important risk factor for recurrent instability, remplissage also results in significant loss of shoulder ROM compared with those who do not undergo remplissage.
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Affiliation(s)
- Vivek Pandey
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Lohith Gangadharaiah
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sandesh Madi
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kiran Acharya
- Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shalini Nayak
- School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal Karnataka, India
| | | | - W Jaap Willems
- Shoulder Unit, Lairesse Kliniek, Amsterdam, The Netherlands
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28
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Editorial Commentary: Methodology of Measuring Bone Loss in Recurrent Shoulder Instability Surgery: Traditional Computed Tomography Scan and Magnetic Resonance Imaging Do Not Tell the Full Story. Arthroscopy 2020; 36:20-22. [PMID: 31864577 DOI: 10.1016/j.arthro.2019.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 02/02/2023]
Abstract
When measuring bone loss in recurrent shoulder instability, both computed tomography (CT) scan and magnetic resonance imaging (MRI) are accurate using the circle method. However, measurement of on- versus off-track lesions can be inconsistent, and measuring Hill-Sachs lesions on MRI relative to an extrapolated rotator cuff attachment is difficult. In the end, determination of on- versus off-track treatment is quite difficult, and for this determination, differences between CT scan and MRI may be clinically imperceptible. Thus, for now, we, and we believe, other surgeons will continue to stick with the circle technique when determining individual patient treatment for recurrent shoulder instability.
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29
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Chalmers PN, Christensen G, O'Neill D, Tashjian RZ. Does Bone Loss Imaging Modality, Measurement Methodology, and Interobserver Reliability Alter Treatment in Glenohumeral Instability? Arthroscopy 2020; 36:12-19. [PMID: 31864563 DOI: 10.1016/j.arthro.2019.06.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/07/2019] [Accepted: 06/13/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine, in the context of measuring bone loss in shoulder instability, whether measurement differences between magnetic resonance imaging (MRI) and computed tomography (CT), linear-based and area-based methods, and observers altered the proposed treatment when a standardized algorithm was applied. METHODS This was a retrospective, comparative imaging study of preoperative patients with anterior shoulder instability with both an MRI and CT scan within 1 year of one another. On parasagittal images reoriented en face to the glenoid, 2 attending orthopaedic surgeons measured glenoid width, glenoid area, glenoid defect width, and glenoid defect area. On axial images maximal Hill-Sachs width was measured. From these, linear percent glenoid bone loss (%GBL) and area %GBL were calculated, and on-versus off-track was determined. With these results, a recommended treatment was determined by applying a standardized algorithm, in which the Latarjet procedure was selected for %GBL >20%, arthroscopic labral repair and remplissage for off-track lesions with %GBL <20%, and arthroscopic labral repair on-track shoulders with %GBL <20%. RESULTS In total, 53 patients with mean ± standard deviation 45 ± 83 days between scans were include with a CT linear %GBL of 23.5 ± 9.6% (range 0%-47%). CT lead to larger measurements of %GBL than MRI (linear P = .008, area P = .003), and fewer shoulders being considered on-track (33.0% vs 40.5%), which would alter treatment in 25% to 34%. Linear measurements produced larger values for %GBL (CT, P < .001; MRI, P < .001), which would alter treatment in 25%. For %GBL, inter-rater reliability was good, with intraclass correlation coefficients varying from 0.727 to 0.832 and Kappa varying from 0.57 to 0.62, but these inter-rater differences would alter treatment in 31%. CONCLUSIONS The significant differences in bone loss measurement between imaging modality, measurement method, and observers may lead to differences in treatment in up to 34% of cases. Linear CT measurements resulted in the most aggressive treatment recommendations. LEVEL OF EVIDENCE Retrospective Comparative Study: Diagnostic, Level III.
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Affiliation(s)
- Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A..
| | - Garrett Christensen
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Dillon O'Neill
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
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Flinkkilä T, Knape R, Nevalainen M, Sirniö K, Ohtonen P, Leppilahti J. Previous arthroscopic Bankart repair is an independent risk factor for an inferior outcome after Latarjet procedure. Orthop Traumatol Surg Res 2019; 105:1481-1485. [PMID: 31640915 DOI: 10.1016/j.otsr.2019.06.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/15/2019] [Accepted: 06/27/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND There is limited evidence that the Latarjet procedure has a worse outcome as a revision operation, after a failed stabilization surgery, compared with when it is the primary procedure for posttraumatic anteroinferior instability of the shoulder joint. PURPOSE To compare the results from Latarjet as a primary operation vs. revision surgery after a failed arthroscopic Bankart repair for posttraumatic anteroinferior shoulder instability. In addition, to assess the effect of preoperative bony pathology on outcome. PATIENTS AND METHODS Ninety-nine patients who underwent the Latarjet procedure (47 primary, 52 revision after failed Bankart repair) were analyzed after an average of 3.8 (SD 2.3, range 1-11) years of follow-up. All patients underwent either computed tomography or magnetic resonance imaging preoperatively. Glenoid and humeral bone defects were measured to assess whether the Hill-Sachs lesion was on- or off-track. Clinical outcome measures included the Western Ontario Shoulder Instability Index (WOSI), subjective shoulder value (SSV), and recurrence of instability (dislocation, subluxation, or any perception of instability). RESULTS There were no cases of recurrent dislocation in either group. Four patients in the primary surgery group and 13 in the revision group had at least one subluxation or perception of instability after the Latarjet procedure. Patients with a previous arthroscopic Bankart repair had worse outcomes than those undergoing primary Latarjet when assessed by the WOSI: 76 (SD 22) vs. 85 (SD 15), difference in means -9 (95% CI -17 to -1, p=0.02); SSV: 80 (SD 18) vs. 88 (SD 13), difference in means -8 (95% CI -15 to -2, p=0.01); and the recurrence percentage (25% vs. 9%, p=0.03). A multivariate linear regression model adjusted for the length of follow-up, glenoid bone defect size, Hill-Sachs lesion size, and the frequency of preoperative bipolar bone defects (on/off track Hill-Sachs lesions) further increased the difference in WOSI to -12 (95% CI -21 to -4, p=0.005). DISCUSSION A previous failed arthroscopic Bankart repair was a significant independent risk factor for inferior outcome. Preoperative bony pathology did not explain the worse outcome from the revision vs. primary Latarjet procedure. LEVEL OF EVIDENCE IV, cohort observational study.
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Affiliation(s)
- Tapio Flinkkilä
- Department of Surgery, Division of Orthopedic and Trauma Surgery, Oulu University Hospital and University of Oulu, PL 21, FIN-90029 OYS, Oulu, Finland.
| | - Rony Knape
- Department of Surgery, Division of Orthopedic and Trauma Surgery, Oulu University Hospital and University of Oulu, PL 21, FIN-90029 OYS, Oulu, Finland
| | - Mika Nevalainen
- Department of diagnostic radiology, Medical Research Center Oulu, Oulu, Finland
| | - Kai Sirniö
- Department of Surgery, Division of Orthopedic and Trauma Surgery, Oulu University Hospital and University of Oulu, PL 21, FIN-90029 OYS, Oulu, Finland
| | - Pasi Ohtonen
- Department of Surgery, Division of Orthopedic and Trauma Surgery, Oulu University Hospital and University of Oulu, PL 21, FIN-90029 OYS, Oulu, Finland
| | - Juhana Leppilahti
- Department of Surgery, Division of Orthopedic and Trauma Surgery, Oulu University Hospital and University of Oulu, PL 21, FIN-90029 OYS, Oulu, Finland
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Park I, Kang JS, Jo YG, Kim SW, Shin SJ. Off-track Hill-Sachs lesions do not increase postoperative recurrent instability after arthroscopic Bankart repair with selective Remplissage procedure. Knee Surg Sports Traumatol Arthrosc 2019; 27:3864-3870. [PMID: 30806757 DOI: 10.1007/s00167-019-05441-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 02/22/2019] [Indexed: 01/30/2023]
Abstract
PURPOSE This study aimed to compare clinical outcomes and recurrence rates after arthroscopic Bankart repair with selective Remplissage procedure, between patients with off-track and on-track Hill-Sachs lesions. METHODS Patients who underwent arthroscopic Bankart repair with selective Remplissage procedure for recurrent anterior shoulder instability and were followed up for at least 2 years were included. Patients with a glenoid defect greater than 25% were excluded. According to the glenoid track concept, patients were divided into group I (off-track lesions) and group II (on-track lesions). After Bankart repair, an additional Remplissage procedure was performed selectively in patients who sustained engagement of the humeral head. The clinical outcomes and recurrence rates were evaluated. RESULTS A total of 193 patients (23 in group I and 170 in group II) were enrolled. No significant differences were found in clinical outcomes (n.s.) or recurrence rates (n.s.) between the two groups, despite larger glenoid defects in group I (group I:17.1 ± 6.1%, and group II:13.0 ± 6.4%, P = 0.003). In all patients, the incidence of off-track lesions was not significantly different according to the occurrence of postoperative recurrence (n.s.), whereas the glenoid defect size showed a significant difference (with recurrence: 17.9 ± 3.9%, and without recurrence: 13.2 ± 6.5%, P = 0.002). CONCLUSIONS The presence of an off-track lesion did not alter the clinical outcomes and recurrence rates after arthroscopic Bankart repair with selective Remplissage procedure. The glenoid defect size rather than the presence of an off-track lesion can more reliably predict postoperative recurrence. Arthroscopic Bankart repair with selective Remplissage procedure is considered one surgical option for the treatment of off-track lesions. LEVEL OF EVIDENCE III.
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Affiliation(s)
- In Park
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, 260 Gonghang-daero, Gangseo-gu, Seoul, 07804, Republic of Korea
| | - Jun-Seok Kang
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, 260 Gonghang-daero, Gangseo-gu, Seoul, 07804, Republic of Korea
| | - Yoon-Geol Jo
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, 260 Gonghang-daero, Gangseo-gu, Seoul, 07804, Republic of Korea
| | - Sang-Woo Kim
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, 260 Gonghang-daero, Gangseo-gu, Seoul, 07804, Republic of Korea
| | - Sang-Jin Shin
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, 260 Gonghang-daero, Gangseo-gu, Seoul, 07804, Republic of Korea.
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Russo M, Bolcato M, Sabadin V, Aprile A. The medico-legal assessment of aesthetic damage. A correlation analysis between experts and an operative proposal. Leg Med (Tokyo) 2019; 40:47-53. [PMID: 31352266 DOI: 10.1016/j.legalmed.2019.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/10/2019] [Accepted: 07/21/2019] [Indexed: 10/26/2022]
Abstract
Aesthetic damage, defined as any detrimental modification of the individual morpho-functional exterior attributes, is difficult to assess, since the perception of its entity is rather subjective. This study aims to provide a medico-legal contribution to the assessment of this kind of damage. 60 photographic images, representing stabilized aesthetic damage, were collected and showed to 16 expert evaluators, who were required to exclusively quantify the objective component of the aesthetic impairment. The inter-observer agreement for the assessments was calculated using the Intraclass Correlation Coefficient (ICC). Looking into specific characteristics of both the injury and the damaged subject, the assessors were more consistent in quantifying the damage in male subjects (ICC 0.68) and in subjects aged over 50 years (ICC 0.81) as well as in assessing extensive damages (ICC 0.61) than those of mild severity (ICC 0.41). The assessment of impairments located in the facial area resulted in a high level of concordance (ICC 0.73), while damages located the head and neck regions presented the lowest concordance (ICC 0.35). The evaluators were more consistent in assessing the outcomes of burns (ICC 0.70). Regardless the various reasons underlying the different degree of concordance, these results and the high degree of the overall concordance (ICC 0.63) point out the skillfulness of medicolegal professionals to formulate a complex judgment as more objectively as possible. Finally, an operative proposal was outlined to guide medico-legal professionals or interns in evaluating the aesthetic damage as more objectively as possible.
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Affiliation(s)
- Marianna Russo
- Department of Molecular Medicine - Legal Medicine, University of Padua, Via Falloppio, 50, Padua, Italy.
| | - Matteo Bolcato
- Department of Molecular Medicine - Legal Medicine, University of Padua, Via Falloppio, 50, Padua, Italy.
| | - Valeria Sabadin
- Department of Molecular Medicine - Legal Medicine, University of Padua, Via Falloppio, 50, Padua, Italy.
| | - Anna Aprile
- Department of Molecular Medicine - Legal Medicine, University of Padua, Via Falloppio, 50, Padua, Italy.
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Funakoshi T, Hartzler RU, Stewien E, Burkhart SS. Hill-Sachs Lesion Classification by the Glenoid Track Paradigm in Shoulder Instability: Poor Agreement Between 3-Dimensional Computed Tomographic and Arthroscopic Methods. Arthroscopy 2019; 35:1743-1749. [PMID: 31072719 DOI: 10.1016/j.arthro.2018.12.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 12/03/2018] [Accepted: 12/03/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine the amount of agreement between preoperative 3-dimensional computed tomographic (3D-CT) and intraoperative arthroscopic classification of Hill-Sachs lesions (HSLs) according to the glenoid track (GT) paradigm. METHODS Records for patients treated surgically for anterior shoulder instability from a single surgeon's practice from August 2013 until March 2016 were retrospectively reviewed. Inclusion criteria were presence of an HSL, < 25% glenoid bone loss, bilateral 3D-CT, and arthroscopically recorded bone loss measurements. Records for patients with chronic dislocations or prior operations were excluded. Calculations by 3D-CT and arthroscopy were performed as follows: Hill-Sachs interval (HSI) was the distance from rotator cuff insertion to medial edge of the HSL; GT was 83% of the normal glenoid width minus any glenoid defect; on-track was HSI less than GT; off-track was HSI greater than GT. RESULTS Sixteen shoulders with HSL status determined as on- or off-track demonstrated agreement between the 2 methods in 10 of 16 cases (63%, Cohen's κ = 0.16). All 6 cases with disagreement were calculated as on-track by 3D-CT and off-track by arthroscopic measurement. The GT was larger as determined by 3D-CT measurement (22 ± 1 mm [21-24]) compared with arthroscopy (18 ± 1 mm [17-20], P = .002). CONCLUSIONS Preoperative 3D-CT showed slight agreement compared with intraoperative arthroscopic measurements in classifying HSL as on-track versus off-track in the GT paradigm; larger GT size by 3D-CT versus arthroscopy accounted for all discrepancies. Determination of off-track status based on preoperative 3D-CT versus determination with the arthroscopic method would result in fewer HSLs treated with remplissage if the GT treatment paradigm were followed. Surgeons using the GT paradigm to determine treatment of HSL by remplissage should recognize the potential for discordance between arthroscopic and radiographic measurements.
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Abstract
Quantifying bone loss is important to decide the best treatment for patients with recurrent anterior glenohumeral instability. Currently, there is no standard method available to make a precise evaluation of the Hill–Sachs lesion and predict its engagement before the surgical procedure. This literature review was performed in order to identify existing published imaging methods quantifying humeral head bone loss in Hill–Sachs lesions. Searches were undertaken in Scopus and PubMed databases from January 2008 until February 2018. The search terms were “Hill-Sachs” and “measurement” for the initial search and “Hill–Sachs bone loss” for the second, to be present in the keywords, abstracts and title. All articles that presented a method for quantifying measurement of Hill–Sachs lesions were analysed. Several methods are currently available to evaluate Hill–Sachs lesions. The length, width and depth measurements on CT scans show strong inter and intra-observer correlation coefficients. Three-dimensional CT is helpful for evaluation of bony injuries; however, there were no significant differences between 3D CT and 3D MRI measurements. The on-track off-track method using MRI allows a simultaneous evaluation of the Hill–Sachs and glenoid bone loss and also predicts the engaging lesions with good accuracy.
Cite this article: EFORT Open Rev 2019;4:151-157. DOI: 10.1302/2058-5241.4.180031
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Affiliation(s)
- Marta Maio
- Department of Orthopaedics and Traumatology, Centro Hospitalar de Trás os Montes e Alto Douro, Vila Real, Portugal
| | - Marco Sarmento
- Shoulder and Elbow Unit, Orthopaedics Department, Hospital CUF Descobertas, Lisboa, Portugal
| | - Nuno Moura
- Shoulder and Elbow Unit, Orthopaedics Department, Hospital CUF Descobertas, Lisboa, Portugal
| | - António Cartucho
- Shoulder and Elbow Unit, Orthopaedics Department, Hospital CUF Descobertas, Lisboa, Portugal
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Griffith JF. Measuring glenoid and humeral bone loss in shoulder dislocation. Quant Imaging Med Surg 2019; 9:134-143. [PMID: 30976536 DOI: 10.21037/qims.2019.01.06] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- James F Griffith
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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Arthroscopic Remplissage for Anterior Shoulder Instability: A Systematic Review of Clinical and Biomechanical Studies. Arthroscopy 2019; 35:617-628. [PMID: 30612762 DOI: 10.1016/j.arthro.2018.09.029] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To examine the clinical outcomes and biomechanical data supporting the use of the remplissage procedure. METHODS A query of the Embase, PubMed, Scopus, and Web of Science databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines from 2000 to 2017. Data were extracted from included studies for a qualitative review of both clinical and biomechanical outcomes. RESULTS After review, 18 clinical and 10 biomechanical studies were available for analysis; 10 of 18 clinical studies (55.6%) were Level IV evidence. Within the clinical studies, there were 567 patients (570 shoulders) evaluated with follow-up ranging from 6 to 180 months. Overall, 5.8% of shoulders (33 of 570) displayed recurrent instability after arthroscopic remplissage. Of the shoulders with recurrent instability, 42.4% of shoulders (14 of 33) underwent further surgical management. In all studies evaluating pre- and postoperative patient-reported outcomes, the arthroscopic remplissage procedure improved patient-reported outcomes a statistically significant amount postoperatively. Within individual clinical studies, external rotation with the arm in neutral was the most consistently limited range of motion (ROM) parameter, with deficits compared with the contralateral shoulder ranging from 9° to 14°. Biomechanical analysis appeared to corroborate the clinical results, although significant conclusions were limited by heterogeneity of reporting. CONCLUSIONS Arthroscopic remplissage performed in conjunction with arthroscopic Bankart repair is a safe and effective procedure for patients with engaging Hill-Sachs lesions and subcritical glenoid bone loss. Although both the included clinical and biomechanical studies would suggest minimal changes in glenohumeral ROM following the remplissage procedure, strong conclusions are limited by the heterogeneity in reporting ROM data and lack of comparative studies. LEVEL OF EVIDENCE IV, systematic review.
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Yang TC, Chen KH, Chiang ER, Chang MC, Ma HL. Using the "Hill-Sachs interval to glenoid track width ratio" for prediction of recurrent instability after arthroscopic Bankart repair. Orthop Traumatol Surg Res 2018; 104:797-801. [PMID: 29654932 DOI: 10.1016/j.otsr.2018.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 12/26/2017] [Accepted: 02/27/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The glenoid track concept was used to confirm the engaging Hill-Sachs lesion (HSL) as a risk factor for recurrent instability following arthroscopic Bankart repair (ABR). However, the post-operative condition of soft tissue in vivo was not comparable to that designed in the intact condition in vitro in the original study of the glenoid track concept. Herein, the possibility of engagement may be underestimated. HYPOTHESIS A threshold of the Hill-Sachs interval to glenoid track width ratio (H/G ratio) that is related to recurrent instability after ABR could be found, in order to adjust the original glenoid track concept. PATIENTS AND METHODS Patients who underwent ABR with minimum 24-months follow-up were reviewed retrospectively. The primary outcome was evaluated with the recurrent instability. The H/G ratio of individual patients was used to calculate the sensitivity, specificity, and a receiver operating characteristic (ROC) curve, which aimed to establish a H/G ratio threshold related to recurrent instability after ABR. RESULTS From June 2005 to December 2013, 160 patients with a mean age of 27.7years were enrolled. The mean follow-up period was 77.2 months. The ROC curve indicated that H/G ratio≥0.7 had the sensitivity and specificity of 0.74 and 0.71, respectively, in predicting recurrent instability. On univariate logistic regression analysis, the H/G ratio≥0.7 was a significant predictor of higher risk for recurrent instability (p<0.001). DISCUSSION H/G ratio seems to be a reliable parameter for predicting recurrent instability. H/G ratio≥0.7 may be considered as a positive predictor for recurrent instability after ABR. LEVEL OF EVIDENCE Level IV: retrospective diagnostic study.
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Affiliation(s)
- T-C Yang
- Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - K-H Chen
- Orthopaedic Department School of Medicine, National Yang-Ming University; Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - E-R Chiang
- Orthopaedic Department School of Medicine, National Yang-Ming University; Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - M-C Chang
- Orthopaedic Department School of Medicine, National Yang-Ming University; Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - H-L Ma
- Orthopaedic Department School of Medicine, National Yang-Ming University; Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.
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Yamamoto N, Kawakami J, Nagamoto H, Shiota Y, Itoi E. The relationship between the glenoid track and the range of shoulder motion: A cadaver study. Orthop Traumatol Surg Res 2018; 104:793-796. [PMID: 29292122 DOI: 10.1016/j.otsr.2017.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 11/22/2017] [Accepted: 12/07/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The concept of the glenoid track has been proposed to evaluate the risk of dislocation. The glenoid track width was demonstrated to be 84% of the glenoid width in cadaveric shoulders and 83% in live shoulders. HYPOTHESIS The glenoid track width seems to be affected by the range of motion. PURPOSE The purpose of this study was to determine the relationship between the glenoid track and the range of shoulder motion. METHODS Ten fresh-frozen cadaveric shoulders were used. The specimen was fixed to a shoulder-positioning device. The anterior rim of the glenoid was marked on the humeral head using a Kirschner wire with the arm in 60° of abduction. This marking was repeated with the arm in (1) horizontal flexion/extension and (2) internal/external rotations (0° to max). The distances from the Kirschner wire markings to the footprint of the rotator cuff tendon were measured. RESULTS The greater the angle of the horizontal extension or external rotation, the smaller the glenoid track width, whereas the greater the angle of the horizontal flexion or internal rotation, the greater the glenoid track width. There was a negative relationship between them. The horizontal flexion/extension motion was demonstrated to affect the glenoid track width more than the internal/external rotation motion. CONCLUSION The glenoid track width decreased with the increase of horizontal extension. We should consider the range of horizontal extension angle when applying the glenoid track concept in clinical practice. TYPE OF STUDY Laboratory study.
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Affiliation(s)
- N Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - J Kawakami
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - H Nagamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Y Shiota
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - E Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.
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Duchman KR, Hettrich CM, Glass NA, Westermann RW, Wolf BR, Baumgarten K, Bishop J, Bravman J, Brophy R, Carpenter J, Jones G, Kuhn J, Benjamin Ma C, Marx R, McCarty E, Miller B, Smith M, Eric M, Miller B, Smith M, Wright R, Zhang A. The Incidence of Glenohumeral Bone and Cartilage Lesions at the Time of Anterior Shoulder Stabilization Surgery: A Comparison of Patients Undergoing Primary and Revision Surgery. Am J Sports Med 2018; 46:2449-2456. [PMID: 29985051 DOI: 10.1177/0363546518781331] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Intra-articular glenohumeral joint changes frequently occur after shoulder instability events. PURPOSE (1) To compare demographic characteristics, baseline patient-reported outcomes, and intraoperative findings for patients undergoing primary or revision shoulder stabilization surgery and (2) to determine the incidence of glenohumeral bone and cartilage lesions in this population while identifying factors independently associated with these lesions. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS The Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group shoulder instability database was used to identify all prospectively enrolled patients undergoing shoulder stabilization surgery for anterior instability between October 2012 and September 2016. Any patient who underwent surgery for posterior or multidirectional shoulder instability or concomitant rotator cuff repair surgery was excluded. Patient demographic characteristics, preoperative patient-reported outcomes, and intraoperative findings, including glenohumeral bone and cartilage lesions, were compared for patients undergoing primary and revision shoulder stabilization surgery. Additionally, patients with and without glenohumeral bone and cartilage lesions were compared and independent associations determined using multivariate analysis. RESULTS There were 545 patients available for analysis (461/545 [84.6%] primary; 84/545 [15.4%] revision). Patients undergoing revision surgery were older ( P = .001), were more frequently smokers ( P = .022), had a greater number of instability events before surgery ( P = .047), more frequently required reduction assistance ( P < .001), and had lower Short Form-36 (SF-36) Mental Component Summary ( P = .020) and Western Ontario Shoulder Instability Index (WOSI) ( P = .026) scores preoperatively. Additionally, patients undergoing revision surgery had a higher frequency of bone and cartilage lesions than those undergoing primary surgery (47.6% vs 18.4%, respectively; P < .001). Male sex, revision surgery, black race, increasing body mass index, increasing patient age, and lower preoperative SF-36 Physical Component Summary score were independently associated with the presence of glenohumeral bone and cartilage lesions at the time of shoulder stabilization surgery. Revision surgery was strongly associated with the presence of glenohumeral bone and cartilage lesions (odds ratio [OR], 4.381 [95% CI, 2.591-7.406]) and glenoid bone loss greater than 10% (OR, 9.643 [95% CI, 5.128-18.134]) or 20% (OR, 13.076 [95% CI, 5.113-33.438]) of the glenoid width. CONCLUSION Glenohumeral bone and cartilage lesions are common at the time of shoulder stabilization surgery, occurring more frequently in patients undergoing revision surgery as compared with primary surgery. On the basis of these findings, future prospective studies should aim to compare the clinical outcomes in these 2 groups.
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Affiliation(s)
- Kyle R Duchman
- Investigation performed at the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Carolyn M Hettrich
- Investigation performed at the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Natalie A Glass
- Investigation performed at the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Robert W Westermann
- Investigation performed at the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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- Investigation performed at the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Brian R Wolf
- Investigation performed at the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Keith Baumgarten
- Investigation performed at the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Julie Bishop
- Investigation performed at the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Jonathan Bravman
- Investigation performed at the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Robert Brophy
- Investigation performed at the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - James Carpenter
- Investigation performed at the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Grant Jones
- Investigation performed at the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - John Kuhn
- Investigation performed at the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - C Benjamin Ma
- Investigation performed at the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Robert Marx
- Investigation performed at the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Eric McCarty
- Investigation performed at the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Bruce Miller
- Investigation performed at the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Matthew Smith
- Investigation performed at the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - McCarty Eric
- Investigation performed at the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Bruce Miller
- Investigation performed at the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Matthew Smith
- Investigation performed at the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Rick Wright
- Investigation performed at the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Alan Zhang
- Investigation performed at the Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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40
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Fox JA, Sanchez A, Zajac TJ, Provencher MT. Understanding the Hill-Sachs Lesion in Its Role in Patients with Recurrent Anterior Shoulder Instability. Curr Rev Musculoskelet Med 2017; 10:469-479. [PMID: 29101634 PMCID: PMC5685959 DOI: 10.1007/s12178-017-9437-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE OF REVIEW The purpose of this study is to provide an update to the orthopedic field in regard to treatment of the Hill-Sachs lesion and anterior shoulder instability. The review highlights the most current knowledge of epidemiology, clinical evaluation, and surgical methods used to treat Hill-Sachs lesions. It also details the relevant clinical and surgical findings that have been made throughout the literature in the past couple of years. RECENT FINDINGS The most recent literature covering the Hill-Sachs lesion has focused on the relatively new and unexplored topic of the importance of concomitant injuries while treating a humeral head defect. The glenoid track concept has been clinically validated as a method to predict engagement. 3D-CT has become the "gold standard" for Hill-Sachs imaging; however, it has been noted that 3D-MRI produces results that are not significantly different from CT. Also, it has been found that when the arm is in a position of abduction during the primary injury, there is a higher risk of engagement and subsequent dislocation. Recent studies have demonstrated successful results stemming from purely arthroscopic procedures in treating Hill-Sachs lesions. Anterior shoulder instability, specifically the Hill-Sachs lesion, is an area of orthopedic study that is highly active and constantly producing new studies in an attempt of gaining the best outcomes for patients. The past few years have yielded many excellent discoveries, but there is still much more work to be done in order to fully understand the role of the Hill-Sachs lesion in anterior shoulder instability.
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Affiliation(s)
- Jake A Fox
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO, 81657, USA
| | - Anthony Sanchez
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO, 81657, USA
| | | | - Matthew T Provencher
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO, 81657, USA.
- The Steadman Clinic, Vail, CO, USA.
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41
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Younan Y, Wong PK, Karas S, Umpierrez M, Gonzalez F, Jose J, Singer AD. The glenoid track: a review of the clinical relevance, method of calculation and current evidence behind this method. Skeletal Radiol 2017; 46:1625-1634. [PMID: 28593363 DOI: 10.1007/s00256-017-2687-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/12/2017] [Accepted: 05/24/2017] [Indexed: 02/02/2023]
Abstract
In the setting of bipolar bone injury, orthopedic surgeons are currently making use of the glenoid track method to guide surgical management. Using preoperative CT or MR imaging, this method allows the identification of patients who are more likely to fail a primary capsuloligamentous Bankart repair. As the glenoid track method becomes increasingly used in preoperative planning, it is important for the radiologist to become familiar with its concept and method of calculation. This review article aims to concisely summarize the current literature and the clinical implications of the glenoid track method.
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Affiliation(s)
- Yara Younan
- Department of Radiology and Imaging Sciences, Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA, 30329, USA.
| | - Philip K Wong
- Department of Radiology and Imaging Sciences, Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA, 30329, USA
| | - Spero Karas
- Department of Orthopedic Surgery, Emory University Hospital, Atlanta, GA, USA
| | - Monica Umpierrez
- Department of Radiology and Imaging Sciences, Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA, 30329, USA
| | - Felix Gonzalez
- Department of Radiology and Imaging Sciences, Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA, 30329, USA
| | - Jean Jose
- Department of Radiology, University of Miami, Miami, FL, USA
| | - Adam Daniel Singer
- Department of Radiology and Imaging Sciences, Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor, Suite 4009, Atlanta, GA, 30329, USA
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42
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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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43
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Momaya AM, Tokish JM. Applying the Glenoid Track Concept in the Management of Patients with Anterior Shoulder Instability. Curr Rev Musculoskelet Med 2017; 10:463-468. [PMID: 28994025 DOI: 10.1007/s12178-017-9436-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The purpose of this paper is to evaluate the recent evolution in the treatment of anterior shoulder instability and the dynamic interaction between the glenoid and Hill-Sachs lesion. RECENT FINDINGS Through the glenoid track concept, glenoid- and humeral-sided bone loss are evolving away from being approached as separate entities. Recent cadaveric studies have validated the glenoid track concept. Moreover, a recent clinical study has demonstrated a much higher rate of failure after arthroscopic Bankart repair for shoulders that were off track. The glenoid track concept is a useful tool in evaluating patients with anterior shoulder instability. Shoulders that are off track may require more than a simple arthroscopic Bankart, and the addition of a remplissage or bony transfer may be considered.
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Affiliation(s)
- Amit M Momaya
- Steadman Hawkins Clinic of the Carolinas, 200 Patewood Drive, Suite C100, Greenville, SC, 29615, USA
| | - John M Tokish
- Steadman Hawkins Clinic of the Carolinas, 200 Patewood Drive, Suite C100, Greenville, SC, 29615, USA.
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44
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Lau BC, Conway D, Curran PF, Feeley BT, Pandya NK. Bipolar Bone Loss in Patients With Anterior Shoulder Dislocation: A Comparison of Adolescents Versus Adult Patients. Arthroscopy 2017. [PMID: 28624240 DOI: 10.1016/j.arthro.2017.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare bipolar bone loss by evaluating the degree of glenoid bone loss, Hill-Sachs lesion size, and glenoid track in adolescents and adults with shoulder dislocations. METHODS We performed a retrospective review between 2012 and 2016 of surgical and nonsurgical patients with a history of anterior shoulder dislocations (primary or recurrent) who underwent magnetic resonance imaging of the affected shoulder. The exclusion criteria included multidirectional instability, prior surgery, and posterior dislocation. Patients were grouped into 2 groups: adolescents (aged 10-19 years) and adults (aged ≥20 years). The groups were compared regarding measures of glenoid bone loss (best-fit circle technique) and Hill-Sachs lesion size (medial margin of rotator cuff footprint to medial margin of Hill-Sachs lesion). If the medial margin of a Hill-Sachs lesion was within the glenoid track, it was defined as on track; if it was more medial than the glenoid track, it was defined as off track. RESULTS We identified 45 adolescents (mean age, 16.1 years) and 30 adults (mean age, 28.9 years) with anterior shoulder dislocations. There was no significant difference in percentage of bone loss between adolescents (mean, 8.4%) and adults (mean, 9.9%; P = .23). There was no significant difference in Hill-Sachs lesion size between adolescents (mean, 12.7 mm) and adults (mean, 9.9 mm; P = .12). There were 12 patients with off-track lesions. Off-track lesions were present in 11 of 45 adolescents (24.4%) and 1 of 30 adults (3.3%). Adolescents had an increased risk of having an off-track lesion (odds ratio, 9.38; 95% confidence interval, 1.14-77.1). A subgroup analysis identified multiple dislocations as an independent risk factor for an off-track lesion (odds ratio, 4.15; 95% confidence interval, 0.85-20.23). CONCLUSIONS This study shows that adolescence and a history of multiple dislocations are independent risk factors for a greater likelihood of glenoid off-track lesions. The findings support the use of bipolar assessment of shoulder dislocators, especially in adolescents and multiple dislocators. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Brian C Lau
- Division of Shoulder and Sports Medicine Surgery, Department of Orthopaedic Surgery, University of California San Francisco Medical Center, San Francisco, California, U.S.A..
| | - Devin Conway
- Division of Shoulder and Sports Medicine Surgery, Department of Orthopaedic Surgery, University of California San Francisco Medical Center, San Francisco, California, U.S.A
| | - Patrick F Curran
- Division of Shoulder and Sports Medicine Surgery, Department of Orthopaedic Surgery, University of California San Francisco Medical Center, San Francisco, California, U.S.A
| | - Brian T Feeley
- Division of Shoulder and Sports Medicine Surgery, Department of Orthopaedic Surgery, University of California San Francisco Medical Center, San Francisco, California, U.S.A
| | - Nirav K Pandya
- Division of Shoulder and Sports Medicine Surgery, Department of Orthopaedic Surgery, University of California San Francisco Medical Center, San Francisco, California, U.S.A.; University of California San Francisco Medical Center, Children's Hospital of Oakland, Oakland, California, U.S.A
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