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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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Secci G, Lazzarini F, Distefano M, Porciatti T, Tonelli F, Mugnaini M, Zanna L. Impact of size and fragmentation of the anteroinferior glenoid rim on clinical and functional outcomes of non-operatively treated Bony Bankart lesions in middle-aged population. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05466-4. [PMID: 39105843 DOI: 10.1007/s00402-024-05466-4] [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] [Received: 10/13/2023] [Accepted: 07/16/2024] [Indexed: 08/07/2024]
Abstract
INTRODUCTION The optimal treatment approach for Bony Bankart remains a subject of considerable debate among shoulder surgeons. Existing literature highlights low recurrence rates and high patient satisfaction with nonoperative treatment, particularly in the middle-aged population. This study aimed to evaluate the recurrence rate of dislocation, as well as the clinical and functional outcomes in middle-aged individuals treated nonoperatively following an acute bony Bankart fracture. Additionally, the impact of glenoid rim size and fragmentation on the treatment outcome was investigated. MATERIAL AND METHODS A prospective analysis was conducted on 20 patients aged over 50 with nonoperatively treated bony Bankart fractures, ensuring a minimum follow-up of 24 months. The study population was categorized based on fragment size (small and medium) according to Kim classification and glenoid rim fragmentation (type 1b and 1c) according to Scheibel classification. Data including UCLA score, Rowe score, recurrence rate, clinical instability, and range of motion (ROM) were collected and analyzed. RESULTS The average UCLA and Rowe scores were 32.15 ± 2.85 and 93.85 ± 2.19, respectively, with no instances of dislocation recurrence. The affected shoulder exhibited no significant reductions in ROM compared to the contralateral side, except for a loss of external rotation (ER) (13.08° ± 7.51; p = 0.005). No differences were observed based on fragment size, although patients with multifragmented glenoid rims showed a greater loss of ER compared to those with a solitary fragment, albeit not reaching statistical significance. CONCLUSION Nonoperative treatment appears to be a viable and effective option for middle-aged individuals with bony Bankart fractures, resulting in favorable functional outcomes and a low risk of recurrence. Additionally, a notable loss of external rotation was observed in fractures with glenoid rim fragmentation. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Gregorio Secci
- Department of Orthopedic Surgery, Santa Maria Annunziata Hospital, ASL Toscana Centro - Via Antella 58, 50012, Bagno a Ripoli, Italy.
- Department of Shoulder Surgery, AOU Careggi, University Hospital of Florence, Florence, Italy.
- University of Florence, Florence, Italy.
| | - Francesco Lazzarini
- Department of Orthopedic Surgery, Santa Maria Annunziata Hospital, ASL Toscana Centro - Via Antella 58, 50012, Bagno a Ripoli, Italy
| | - Marco Distefano
- Department of Orthopedic Surgery, Santa Maria Annunziata Hospital, ASL Toscana Centro - Via Antella 58, 50012, Bagno a Ripoli, Italy
| | - Tommaso Porciatti
- Department of Orthopedic Surgery, Santa Maria Annunziata Hospital, ASL Toscana Centro - Via Antella 58, 50012, Bagno a Ripoli, Italy
| | - Filippo Tonelli
- Department of Orthopedic Surgery, Santa Maria Annunziata Hospital, ASL Toscana Centro - Via Antella 58, 50012, Bagno a Ripoli, Italy
| | - Marco Mugnaini
- Department of Orthopedic Surgery, Santa Maria Annunziata Hospital, ASL Toscana Centro - Via Antella 58, 50012, Bagno a Ripoli, Italy
| | - Luigi Zanna
- Department of Orthopedic Surgery, Santa Maria Annunziata Hospital, ASL Toscana Centro - Via Antella 58, 50012, Bagno a Ripoli, Italy
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Kim SC, Kim HG, Na SW, Jung JS, Yoo JC. Knotless Bioabsorbable Anchors Placed on the Glenoid Face for Arthroscopic Bankart Repair. Am J Sports Med 2024; 52:613-623. [PMID: 38284285 DOI: 10.1177/03635465231221723] [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: 01/30/2024]
Abstract
BACKGROUND Quantitative analysis of the glenoid face knotless-type anchor placement for arthroscopic Bankart repair has not been reported. PURPOSE To evaluate the clinical and radiologic outcomes after arthroscopic Bankart repair using knotless bioabsorbable anchors depending on the anchor location. STUDY DESIGN Case series, Level of evidence, 4. METHODS A total of 124 patients (113 men and 11 women; age, 25.6 ± 7.5 years; follow-up time, 46.5 ± 18.2 months [range, 6.2-75.5 months]) who underwent arthroscopic Bankart repair with the bioabsorbable knotless anchor between 2017 and 2021 were included in this study. Among them, 118 patients were observed for >2 years (mean, 48.2 ± 16.8 months [range, 24-75.5 months]) and were analyzed for final clinical and radiologic outcomes. Using postoperative 6-month magnetic resonance imaging, remnant glenoid (%) and labral height were measured. Shoulder range of motion (ROM), radiographic osteoarthritic change, dislocation, apprehension test, and return to sports were recorded. Three groups were established based on the remnant glenoid, which represented the percentage of the exposed glenoid anteroposterior diameter to the original diameter using the best-fit circle method-group A: lower quartile; group B: interquartile; and group C: upper quartile-and variables were analyzed. RESULTS Overall, the remnant glenoid was 57% ± 6.4% (range, 41.5%-75%) after the surgery. Osteoarthritic change, dislocations, and positive apprehension tests were observed in 5 (4.2%), 4 (3.4%), and 12 (10.2%) patients, respectively. A total of 34 (28.8%) and 64 (54.2%) patients could return to sports without and with restrictions, respectively. Comparing groups A, B, and C, postoperative labral height (7 ± 1, 7 ± 2, and 7 ± 1 mm; P = .623), final osteoarthritic change (1, 4, and 0; P = .440), positive apprehension tests (5, 5, and 2; P = .387), and return to sports (complete/restricted/unable, 6/18/5, 19/29/11, 9/17/4; P = .769) were not different. All ROM were similar across the groups (all P > .054), except for external rotation (ER) at postoperative 6 months (41.3°± 12.8°; 50.2°± 18.5°; and 49.8°± 15.2°; P = .050). However, ER after 1 year was similar across the groups (all P > .544). In further analysis, patients with positive apprehension tests had lower labral height compared with others (5 [4-6] mm and 7 [6-8] mm; P < .001). CONCLUSION In arthroscopic Bankart repair, the placement of knotless bioabsorbable anchors on the glenoid face, combined with the remplissage procedure or rotator interval closure, resulted in a low recurrence rate and moderate return to sports. However, most patients had some restrictions in returning to sports. Moreover, this technique was not associated with postoperative arthritis and shoulder stiffness, including ER deficit, which was not affected by the position of the anchor on the glenoid face for a minimum 2-year follow-up.
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Affiliation(s)
- Su Cheol Kim
- Samsung Medical Center, Seoul, Republic of Korea
| | - Hyun Gon Kim
- Samsung Medical Center, Seoul, Republic of Korea
| | - Sang Woon Na
- Samsung Medical Center, Seoul, Republic of Korea
| | - Joo Sam Jung
- Samsung Medical Center, Seoul, Republic of Korea
| | - Jae Chul Yoo
- Samsung Medical Center, Seoul, Republic of Korea
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Maiotti M, De Nigris S, Tardioli S, Cavaliere M, Barillà S, Angelini A, Torre G, Gauci MO. IODA-shoulder®, a 3-dimensional automated software for glenoid bone loss quantification in shoulder instability. A validation study. Orthop Traumatol Surg Res 2023:103745. [PMID: 37918692 DOI: 10.1016/j.otsr.2023.103745] [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: 03/04/2023] [Revised: 06/09/2023] [Accepted: 07/05/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Glenoid bone loss (GBL) calculation in patients with shoulder instability has a wide variability in methods and their reliability. The purpose of this study was to describe and validate a new semi-automated software developed to improve GBL calculation using a 3D imaging modeling (IODA-shoulder) and to compare the method to the PICO area method. PATIENTS AND METHODS A semi-automated software to assess GBL was preliminarily developed and validated on 7 fresh frozen specimens (scapulae with artificially created glenoid defect), using water displacement method. Afterwards, the software was retrospectively used on CT images of 20 patients affected by recurrent shoulder dislocation. Inclusion criteria were: unilateral dislocation, minimum 2 dislocation episodes. Exclusion criteria were bone reconstruction of the glenoid, failed shoulder stabilization, bilateral dislocation, shoulder arthritis. Three-dimensional computed tomography images of bilateral shoulder were retrieved for each patient. Two methods to determine GBL were compared. The PICO surface area method and the new IODA method. We assessed the intra- and inter-rater reliability of the two methods with the Intraclass Correlation Coefficient (ICC), the Bland-Alman analysis, and Lin's concordance correlation coefficient (CCC). RESULTS We did not find a statistically significant difference between the mean volumes calculated with PICO and IODA methods, respectively 914 vs. 815 mm3, p=0.155. The analysis carried out by using the traditional PICO method showed a lower concordance rate among four observers than the higher concordance found using IODA method, regardless of the size and the location of the defect. The ICC agreement with PICO was significantly lower than with IODA (0.76 vs. 0.97). We found a poor CCC with PICO (from 0.65 to 0.81) and a substantial one with IODA (from 0.96 to 0.98). DISCUSSION The intra- and inter-rater reliability using IODA method is significantly better than PICO method. The assessment of GBL using IODA method is time saving, avoiding significant inter- and intra-observer variation, mainly due to individual skill and experience in the method. LEVEL OF EVIDENCE IV, experimental study.
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Affiliation(s)
- Marco Maiotti
- Villa Stuart Sport Clinic of Rome, Rome, Italy; Mediterranea Hospital, Naples, Italy.
| | - Saverio De Nigris
- Head of Information Technology Department, Military Order of Malta Hospital, Rome, Italy
| | | | | | - Santo Barillà
- Radiology Department Assunzione di Maria SSma Hospital of Rome, Rome, Italy
| | | | - Guglielmo Torre
- Villa Stuart Sport Clinic of Rome, Rome, Italy; Orthopaedic and Trauma Surgery Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Marc Olivier Gauci
- Orthopedic Surgery, Institut Universitaire Locomoteur et du Sport, Nice, France; Head of the Shoulder Unit - IULS - Shoulder & Elbow, Nice, France; Universitary Hospital of Nice Pasteur II, 30, voie Romaine, 06000 Nice, France; Unité de Recherche Clinique Côte d'Azur (UR2CA), Nice, France
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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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Tennent D, Antonios T, Arnander M, Ejindu V, Papadakos N, Rastogi A, Pearse Y. CT methods for measuring glenoid bone loss are inaccurate, and not reproducible or interchangeable. Bone Jt Open 2023; 4:478-489. [PMID: 37399100 DOI: 10.1302/2633-1462.47.bjo-2023-0066.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
Aims Glenoid bone loss is a significant problem in the management of shoulder instability. The threshold at which the bone loss is considered "critical" requiring bony reconstruction has steadily dropped and is now approximately 15%. This necessitates accurate measurement in order that the correct operation is performed. CT scanning is the most commonly used modality and there are a number of techniques described to measure the bone loss however few have been validated. The aim of this study was to assess the accuracy of the most commonly used techniques for measuring glenoid bone loss on CT. Methods Anatomically accurate models with known glenoid diameter and degree of bone loss were used to determine the mathematical and statistical accuracy of six of the most commonly described techniques (relative diameter, linear ipsilateral circle of best fit (COBF), linear contralateral COBF, Pico, Sugaya, and circle line methods). The models were prepared at 13.8%, 17.6%, and 22.9% bone loss. Sequential CT scans were taken and randomized. Blinded reviewers made repeated measurements using the different techniques with a threshold for theoretical bone grafting set at 15%. Results At 13.8%, only the Pico technique measured under the threshold. At 17.6% and 22.9% bone loss all techniques measured above the threshold. The Pico technique was 97.1% accurate, but had a high false-negative rate and poor sensitivity underestimating the need for grafting. The Sugaya technique had 100% specificity but 25% of the measurements were incorrectly above the threshold. A contralateral COBF underestimates the area by 16% and the diameter by 5 to 7%. Conclusion No one method stands out as being truly accurate and clinicians need to be aware of the limitations of their chosen technique. They are not interchangeable, and caution must be used when reading the literature as comparisons are not reliable.
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Affiliation(s)
| | - Tony Antonios
- Trauma & Orthopaedics, St Peter's Hospital, Surrey, UK
| | | | - Vivian Ejindu
- St. George's Hospital and Medical School, London, UK
| | - Nik Papadakos
- St. George's Hospital and Medical School, London, UK
| | | | - Yemi Pearse
- St. George's Hospital and Medical School, London, UK
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Sheean AJ. Editorial Commentary: High Variability Exists Among Different Techniques for Measuring Glenoid Bone Loss. Arthroscopy 2023; 39:1403-1404. [PMID: 37147071 DOI: 10.1016/j.arthro.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 05/07/2023]
Abstract
Glenoid bone loss is a predominant factor in determining proper surgical management for glenohumeral instability. Precise measurements of glenoid (and humeral) bone defects are fundamental, and millimeters matter. Three-dimensional computed tomography scans may provide the highest interobserver reliability for making these measurements. Yet, because imprecision in the range of millimeters is observed with even the most precise glenoid bone loss measurement techniques, it could be a mistake to over-rely, let alone solely rely, on glenoid bone loss measurement as the primary determinant for selecting one surgical procedure over another. Surgeons must measure glenoid bone loss but also thoughtfully consider patient age, associated soft-tissue injuries, and activity level, including throwing and participation in collision sports. When choosing the proper surgical procedure for a shoulder instability patient, we should not focus on only one variably measured parameter but, instead, on a comprehensive assessment of the patient.
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Do WS, Kim JH, Lim JR, Yoon TH, Chun YM. Disagreement Between the Accepted Best-Fit Circle Method to Calculate Bone Loss Between Injured and Uninjured Shoulders. Am J Sports Med 2023; 51:885-892. [PMID: 36786198 DOI: 10.1177/03635465221149743] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND No study has evaluated whether best-fit circles based on glenoids with defects accurately represent normal inferior glenoids before injury. PURPOSE To investigate whether the best-fit circles on the affected side with a glenoid defect can accurately represent native glenoids before injury. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS This retrospective study included 58 patients with unilateral recurrent anterior shoulder instability. First, we compared the diameter of best-fit circles based on affected and unaffected glenoids. Glenoid defect sizes based on each best-fit circle were then calculated and compared. Second, we created serial virtual glenoid defects (10%, 15%, 20%, 25%) on unaffected glenoids and compared diameters of best-fit circles on the glenoids before and after virtual defects. We also analyzed and compared the size of virtual and calculated glenoid defects. Bland-Altman plots and intraclass coefficients (ICCs) were used to compare and analyze agreement of measurements. After categorization of glenoid defects based on clinical cutoff values, Cohen κ and percentage agreement were calculated. RESULTS The diameter of 55.2% (32/58) of best-fit circles from affected glenoids over- or underestimated the diameter on the unaffected side by >5%. In 28 of the 32 patients, the diameter of the affected side circle was overestimated. Consequently, 41.4% (24/58) of glenoid defects were over- or underestimated by >5%. In 19 of the 24 patients, the glenoid defect from the affected side was >5% larger. ICCs between sides for best-fit circle diameters and defect sizes were 0.632 and 0.800, respectively. Agreement of glenoid defect size between sides was 58.6% (34/58) overall, but when the defect was ≥10%, agreement decreased to 32.3% (10/31). Among 232 glenoids with virtual defects created from 58 normal glenoids, the diameter of 31.0% (72/232) of best-fit circles and the size of 11.6% (27/232) of defects were over- or underestimated by >5%. CONCLUSION When assessing glenoid defects in anterior shoulder instability, best-fit circles based on affected glenoids do not always represent the native glenoid and may thus lead to inaccurate circle sizes and defect estimates.
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Affiliation(s)
- Woo-Sung Do
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joo-Hyung Kim
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joon-Ryul Lim
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Hwan Yoon
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Min Chun
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Kim SC, Kim KH, Park JH, Bukhary H, Kim IS, Lee SM, Yoo JC. Microinstability characterised by small and easily overlooked anterior labral or Hill-Sachs lesions can be managed with arthroscopic anterior labral repair. Knee Surg Sports Traumatol Arthrosc 2022; 30:3818-3826. [PMID: 35344057 DOI: 10.1007/s00167-022-06941-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/10/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Some young individuals present with shoulder pain without a definite history or complaint of instability. However, careful history taking, physical examination, and high-quality magnetic resonance imaging may reveal evidence of instability of which the patient is unaware. Therefore, a clearer definition of these ambiguous patients is needed. This study aimed to report the characteristics and surgical outcomes of patients with microinstability compared to those of patients with classic recurrent anterior shoulder instability. METHODS From 2005 to 2018, 35 patients with microinstability (group M) underwent arthroscopic anterior labral repair (AALR) and were compared to 35 sex- and age-matched patients with classic recurrent anterior shoulder instability (group C) who also underwent AALR. Baseline characteristics, preoperative apprehension test findings, preoperative imaging for the presence of anterior labral and Hill-Sachs lesions, preoperative and postoperative (over 2 years) range of motion (ROM) and functional scores, final complications, and patient satisfaction were analysed. RESULTS The most common chief complaints in groups M and C were pain (29/35) and both pain and instability (27/35), respectively. Only pain during the apprehension test was predominant in group M (M vs. C, 27 vs. 1, p < 0.001). High incidence of chronic repetitive injuries (26/35) and acute trauma (28/35) were observed in groups M and C, respectively. Over half of the patients in group M showed anterior labral lesions on magnetic resonance arthrography (MRA, 18/35), and 21 patients had Hill-Sachs lesions on MRA/three-dimensional computed tomography. Finally, 29 patients showed either anterior labral or Hill-Sachs lesions on preoperative imaging. The lesion severity was higher in group C than that in group M. All patients underwent AALR with/without the remplissage procedure, with no significant differences in final clinical outcomes, complications, and patient satisfaction between the groups. CONCLUSIONS Microinstability is diagnostically challenging and can be diagnosed in young patients with ambiguous shoulder pain during motion, without instability. Pain on anterior apprehension test and subtle labral and/or Hill-Sachs lesion on imaging study could be diagnostic clues. This condition can be managed with arthroscopic anterior labral repair with or without the remplissage procedure. The possibility of microinstability in young patients with shoulder pain should always be considered, and small anterior labral or Hill-Sachs lesions should be closely monitored. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Su Cheol Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Kyoung Ho Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jong Hun Park
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Hashem Bukhary
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Il Su Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Sang Min Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jae Chul Yoo
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
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Green GL, Arnander M, Pearse E, Tennent D. CT estimation of glenoid bone loss in anterior glenohumeral instability. Bone Jt Open 2022; 3:114-122. [PMID: 35109662 PMCID: PMC8886323 DOI: 10.1302/2633-1462.32.bjo-2021-0163.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims Recurrent dislocation is both a cause and consequence of glenoid bone loss, and the extent of the bony defect is an indicator guiding operative intervention. Literature suggests that loss greater than 25% requires glenoid reconstruction. Measuring bone loss is controversial; studies use different methods to determine this, with no clear evidence of reproducibility. A systematic review was performed to identify existing CT-based methods of quantifying glenoid bone loss and establish their reliability and reproducibility Methods A Preferred Reporting Items for Systematic reviews and Meta-Analyses-compliant systematic review of conventional and grey literature was performed. Results A total of 25 studies were initially eligible. Following screening, nine papers were included for review. Main themes identified compared 2D and 3D imaging, as well as linear- compared with area-based techniques. Heterogenous data were acquired, and therefore no meta-analysis was performed. Conclusion No ideal CT-based method is demonstrated in the current literature, however evidence suggests that surface area methods are more reproducible and lead to fewer over-estimations of bone loss, provided the views used are standardized. A prospective imaging trial is required to provide a more definitive answer to this research question. Cite this article: Bone Jt Open 2022;3(2):114–122.
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Affiliation(s)
- Gemma L. Green
- Trauma and Orthopaedics, St George's Hospital, London, UK
| | | | - Eyiyemi Pearse
- Shoulder and Elbow Unit, St George's Hospital, London, UK
| | - Duncan Tennent
- Shoulder and Elbow Unit, St George's Hospital, London, UK
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11
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Calvo E, Itoi E, Landreau P, Arce G, Yamamoto N, Ma J, Sparavalo S, Wong I. Anterior and posterior glenoid bone augmentation options for shoulder instability: state of the art. J ISAKOS 2021; 6:308-317. [PMID: 34145077 DOI: 10.1136/jisakos-2019-000413] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/24/2021] [Accepted: 04/08/2021] [Indexed: 11/04/2022]
Abstract
Bony lesions are highly prevalent in anterior shoulder instability and can be a significant cause of failure of stabilisation procedures if they are not adequately addressed. The glenoid track concept describes the dynamic interaction between the humeral head and glenoid defects in anterior shoulder instability. It has been beneficial for understanding the role played by bone defects in this entity. As a consequence, the popularity of glenoid augmentation procedures aimed to treat anterior glenoid bone defects; reconstructing the anatomy of the glenohumeral joint has risen sharply in the last decade. Although bone defects are less common in posterior instability, posterior bone block procedures can be indicated to treat not only posterior bony lesions, attritional posterior glenoid erosion or dysplasia but also normal or retroverted glenoids to provide an extended glenoid surface to increase the glenohumeral stability. The purpose of this review was to analyse the rationale, current indications and results of surgical techniques aimed to augment the glenoid surface in patients diagnosed of either anterior or posterior instability by assessing a thorough review of modern literature. Classical techniques such as Latarjet or free bone block procedures have proven to be effective in augmenting the glenoid surface and consequently achieving adequate shoulder stability with good clinical outcomes and early return to athletic activity. Innovations in surgical techniques have permitted to perform these procedures arthroscopically. Arthroscopy provides the theoretical advantages of lower morbidity and faster recovery, as well as the identification and treatment of concomitant pathologies.
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Affiliation(s)
- Emilio Calvo
- Department of Orthopaedic Surgery and Traumatology, Instituto de Investigacion Sanitaria de la Fundacion Jimenez Diaz, Universidad Autonoma, Madrid, Spain
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | | | - Guillermo Arce
- Department of Orthopedic Surgery, Instituto Argentino de Diagnostico y Tratamiento (IADT), Buenos Aires, Argentina
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Jie Ma
- Division of Orthopaedic Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sara Sparavalo
- Division of Orthopaedic Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ivan Wong
- Division of Orthopaedic Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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12
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Launay M, Choudhry MN, Green N, Maharaj J, Cutbush K, Pivonka P, Gupta A. Three-Dimensional Quantification of Glenoid Bone Loss in Anterior Shoulder Instability: The Anatomic Concave Surface Area Method. Orthop J Sports Med 2021; 9:23259671211011058. [PMID: 34159213 PMCID: PMC8182205 DOI: 10.1177/23259671211011058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/12/2021] [Indexed: 11/15/2022] Open
Abstract
Background Recurrent shoulder instability may be associated with glenoid erosion and bone loss. Accurate quantification of bone loss significantly influences the contemplation of surgical procedure. In addition, assessment of bone loss is crucial for surgical planning and accurate graft placement during surgery. Purpose To quantify the concave surface area of glenoid bone loss by using 3-dimensional (3D) segmented models of the scapula and to compare this method with the best-fit circle and glenoid height/width methods, which use the glenoid rim for bone loss estimations. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods A total of 36 consecutive preoperative bilateral computed tomography scans of patients eligible for a primary Latarjet procedure were selected from our institutional surgical database (mean patient age, 29 ± 9 years; 31 men and 5 women). The 3D models of both scapulae were generated using medical segmentation software and were used to map the anatomic concave surface area (ACSA) of the inferior glenoid using the diameter of the best-fit circle of the healthy glenoid. Bone loss was calculated as a ratio of the difference between surface areas of both glenoids (healthy and pathological) against the anatomic circular surface area of the healthy glenoid (the ACSA method). These results were compared with bone loss calculations using the best-fit circle and glenoid height/width methods. Inter- and intraobserver reliability were also calculated. Results The mean (± SD) bone loss calculated using the ACSA, the best-fit circle, and glenoid height/width methods was 9.4% ± 6.7%, 14.3% ± 6.8%, and 17.6% ± 7.3%, respectively. The ACSA method showed excellent interobserver reliability, with an intraclass correlation coefficient (ICC) of 0.95 versus those for the best-fit circle (ICC, 0.71) and glenoid height/width (ICC, 0.79) methods. Conclusion Quantification of instability-related glenoid bone loss is reliable using the 3D ACSA method.
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Affiliation(s)
- Marine Launay
- Shoulder Surgery QLD Research Institute, Brisbane, Australia.,Queensland Unit for Advanced Shoulder Research, Queensland University of Technology, Brisbane, Australia
| | - Muhammad Naghman Choudhry
- Queensland Unit for Advanced Shoulder Research, Queensland University of Technology, Brisbane, Australia
| | - Nicholas Green
- Queensland Unit for Advanced Shoulder Research, Queensland University of Technology, Brisbane, Australia
| | - Jashint Maharaj
- Shoulder Surgery QLD Research Institute, Brisbane, Australia.,Queensland Unit for Advanced Shoulder Research, Queensland University of Technology, Brisbane, Australia
| | - Kenneth Cutbush
- Queensland Unit for Advanced Shoulder Research, Queensland University of Technology, Brisbane, Australia.,Brisbane Private Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - Peter Pivonka
- Queensland Unit for Advanced Shoulder Research, Queensland University of Technology, Brisbane, Australia
| | - Ashish Gupta
- Shoulder Surgery QLD Research Institute, Brisbane, Australia.,Queensland Unit for Advanced Shoulder Research, Queensland University of Technology, Brisbane, Australia.,Greenslopes Private Hospital, Brisbane, Australia
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13
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Abstract
Fractures of the anteroinferior aspect of the glenoid rim, known as a bony Bankart lesions, can occur frequently in the setting of traumatic anterior shoulder dislocation. If these lesions are large and are left untreated in active patients, then recurrent glenohumeral instability due to glenoid bone deficiency may occur. Therefore, the clinician must recognize these lesions when they occur and provide appropriate treatment to restore physiological joint stability. This article aims to provide an overview focusing on clinical and technical considerations in the diagnosis and treatment of bony Bankart lesions.
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14
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Weel H, Krekel PR, Willigenburg N, Willems WJ, Randelli P, Compagnoni R, van Deurzen DFP. Dynamic contact area ratio in shoulder instability: an innovative diagnostic technique measuring interplay of bony lesions. Knee Surg Sports Traumatol Arthrosc 2020; 28:2361-2366. [PMID: 31807834 PMCID: PMC7347673 DOI: 10.1007/s00167-019-05816-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 11/27/2019] [Indexed: 12/04/2022]
Abstract
PURPOSE The hypothesis of this study is that Dynamic Contact Area Ratio of the humerus and glenoid, measured with CT scans, is significantly reduced in patients with anterior shoulder instability compared to the Dynamic Contact Area Ratio in a control group of people without shoulder instability. METHODS Preoperative CT scans of patients who underwent surgery for anterior shoulder instability were collected. Additionally, the radiologic database was searched for control subjects. Using a validated software tool (Articulis) the CT scans were converted into 3-dimensional models and the amount the joint contact surface during simulated motion was calculated. RESULTS CT scans of 18 patients and 21 controls were available. The mean Dynamic Contact Area Ratio of patients was 25.2 ± 6.7 compared to 30.1 ± 5.1 in healthy subjects (p = 0.014). CONCLUSION Dynamic Contact Area Ratio was significantly lower in patients with anterior shoulder instability compared to controls, confirming the hypothesis of the study. The findings of this study indicate that calculating the Dynamic Contact Area Ratio based on CT scan images may help surgeons in diagnosing anterior shoulder instability. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hanneke Weel
- Amsterdam University Medical Centres, Amsterdam, The Netherlands.
| | | | | | - W. Jaap Willems
- grid.440209.bOnze Lieve Vrouwe Gasthuis Oost, Amsterdam, The Netherlands ,Clinical Graphics, Delft, The Netherlands ,grid.7177.60000000084992262Amsterdam University Medical Centres, Amsterdam, The Netherlands ,Lairesse Kliniek, Amsterdam, The Netherlands
| | - Pietro Randelli
- grid.4708.b0000 0004 1757 2822Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy ,1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
| | - Riccardo Compagnoni
- grid.4708.b0000 0004 1757 2822Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milan, Italy ,1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy
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