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Benes M, Fulin P, Kachlik D, Al-Redouan A, Tomaides J, Kysilko M, Salavova S, Kunc V. Osseous variations associated with physiological thinning of the glenoid articular cartilage: an osteological study with CT, MRI and arthroscopic correlations. Skeletal Radiol 2023; 52:2435-2449. [PMID: 37227484 PMCID: PMC10581943 DOI: 10.1007/s00256-023-04358-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/20/2023] [Accepted: 04/28/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To investigate the relationship between osseous variations of the glenoid fossa and thinning of the overlaying articular cartilage. MATERIALS AND METHODS In total, 360 dry scapulae, comprising adult, children and fetal specimens, were observed for potential presence of osseous variants inside the glenoid fossa. Subsequently, the appearance of the observed variants was evaluated using CT and MRI (each 300 scans), and in-time arthroscopic findings (20 procedures). New terminology of the observed variants was proposed by an expert panel formed by orthopaedic surgeons, anatomists and radiologists. RESULTS Tubercle of Assaky was observed in 140 (46.7%) adult scapulae, and an innominate osseous depression was identified in 27 (9.0%) adult scapulae. Upon radiological imaging, the tubercle of Assaky was found in 128 (42.7%) CTs and 118 (39.3%) MRIs, while the depression was identified in 12 (4.0%) CTs and 14 (4.7%) MRIs. Articular cartilage above the osseous variations appeared relatively thinner and in several young individuals was found completely absent. Moreover, the tubercle of Assaky featured an increasing prevalence with aging, while the osseous depression develops in the second decade. Macroscopic articular cartilage thinning was identified in 11 (55.0%) arthroscopies. Consequently, four new terms were invented to describe the presented findings. CONCLUSION Physiological articular cartilage thinning occurs due to the presence of the intraglenoid tubercle or the glenoid fovea. In teenagers, the cartilage above the glenoid fovea may be naturally absent. Screening for these variations increases the diagnostic accuracy of glenoid defects. In addition, implementing the proposed terminological updates would optimize communication accuracy.
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Affiliation(s)
- Michal Benes
- Department of Anatomy, Second Faculty of Medicine, Charles University, Plzenska 130/221, 150 06, Prague 5, Czech Republic
- Center for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Fulin
- 1st Department of Orthopaedics, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - David Kachlik
- Department of Anatomy, Second Faculty of Medicine, Charles University, Plzenska 130/221, 150 06, Prague 5, Czech Republic
- Center for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Health Care Studies, College of Polytechnics, Jihlava, Czech Republic
| | - Azzat Al-Redouan
- Department of Anatomy, Second Faculty of Medicine, Charles University, Plzenska 130/221, 150 06, Prague 5, Czech Republic
- Center for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Tomaides
- 1st Department of Orthopaedics, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Martin Kysilko
- Department of Radiology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Sarka Salavova
- Department of Anatomy, Second Faculty of Medicine, Charles University, Plzenska 130/221, 150 06, Prague 5, Czech Republic
- Center for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vojtech Kunc
- Department of Anatomy, Second Faculty of Medicine, Charles University, Plzenska 130/221, 150 06, Prague 5, Czech Republic.
- Center for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czech Republic.
- Clinic of Trauma Surgery, Masaryk Hospital, Usti Nad Labem, Czech Republic.
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Glenoid bone loss in anterior shoulder dislocation: a multicentric study to assess the most reliable imaging method. LA RADIOLOGIA MEDICA 2023; 128:93-102. [PMID: 36562906 DOI: 10.1007/s11547-022-01577-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this multicentric study was to assess which imaging method has the best inter-reader agreement for glenoid bone loss quantification in anterior shoulder instability. A further aim was to calculate the inter-method agreement comparing bilateral CT with unilateral CT and MR arthrography (MRA) with CT measurements. Finally, calculations were carried out to find the least time-consuming method. METHOD A retrospective evaluation was performed by 9 readers (or pairs of readers) on a consecutive series of 110 patients with MRA and bilateral shoulder CT. Each reader was asked to calculate the glenoid bone loss of all patients using the following methods: best fit circle area on both MRA and CT images, maximum transverse glenoid width on MRA and CT, CT PICO technique, ratio of the maximum glenoid width to height on MRA and CT, and length of flattening of the anterior glenoid curvature on MRA and CT. Using Pearson's correlation coefficient (PCC), the following agreement values were calculated: the inter-reader for each method, the inter-method for MRA with CT quantifications and the inter-method for CT best-fit circle area and CT PICO. Statistical analysis was carried out to compare the time employed by the readers for each method. RESULTS Inter-reader agreement PCC mean values were the following: 0.70 for MRA and 0.77 for CT using best fit circle diameter, 0.68 for MRA and 0.72 for CT using best fit circle area, 0.75 for CT PICO, 0.64 for MRA and 0.62 for CT anterior straight line and 0.49 for MRA and 0.43 for CT using length-to-width ratio. CT-MRA inter-modality PCC mean values were 0.9 for best fit circle diameter, 0.9 for best fit circle area, 0.62 for anterior straight line and 0.94 for length-to-width methods. PCC mean value comparing unilateral CT with PICO CT methods was 0.8. MRA best fit circle area method was significantly faster than the same method performed on CT (p = 0.031), while no significant difference was seen between CT and MRA for remaining measurements. CONCLUSIONS CT PICO is the most reliable imaging method, but both CT and MRA can be reliably used to assess glenoid bone loss. Best fit circle area CT and MRA methods are valuable alternative measurement techniques.
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RAMOS MAXROGÉRIOFREITAS, HIDALGO PEDROFILGUEIRAS, FAGUNDES DIOGO, SAN JUNIOR YONDERARCHANJOCHING. BARE SPOT LOCATION IN GLENOID CAVITY: COMPARISON BETWEEN ARTHROSCOPY AND CT SCAN. ACTA ORTOPEDICA BRASILEIRA 2020; 28:243-246. [PMID: 33144840 PMCID: PMC7580293 DOI: 10.1590/1413-785220202805232045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To assess whether Bare Spot is previously displaced by proportion (MEASURE BP-A × 1.25/MEASURE BP-P = 1). METHODS 35 patients with surgical indication for rotator cuff injury repair were evaluated. The distances from the Bare Spot to the anterior edge of the glenoid cavity (BS-A) and to the posterior edge (BS-P) were measured by arthroscopy and computed tomography with three-dimensional reconstruction of the scapula. RESULTS The distance from the Bare Spot to the anterior border (BS-A tc) was 11.6 mm with a median 12 mm; The distance to the posterior border (BS-P tc) was on average 15.5 mm with a median 15 mm. The distances from BS to anterior cavity edge measured by arthroscopy were on average (BS-A video) 12.25 mm with a median of 12 mm, and from BS to posterior edge (BS-P video) 16.25 mm on average with median 16 mm (p < 0.005). CONCLUSION Bare Spot is displaced anteriorly at a proportion of 40% of the anterior margin and 60% of the posterior margin. Level of Evidence II - Development of diagnostic criteria on consecutive patients (with universally applied reference "gold standard").
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Affiliation(s)
| | | | - DIOGO FAGUNDES
- Universidade Federal do Estado do Rio de Janeiro, Brazil
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Pan Z, Huang F, Li J, Tang X. [Current concepts of diagnostic techniques and measurement methods for bone defect in patient with anterior shoulder instability]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:762-767. [PMID: 31198007 DOI: 10.7507/1002-1892.201812078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To summarize the diagnosis and measurement methods of bone defect in anterior shoulder instability (glenoid bone defect and Hill-Sachs lesion). Methods The related literature on the diagnosis and measurement of the bone defect in anterior shoulder instability was reviewed and summarized. Results The commonly used techniques for the diagnosis of anterior glenoid bone defect and Hill-Sachs lesion of humeral head include X-ray, CT, MRI, arthroscopy, arthrography. The methods for measuring the degree of anterior glenoid bone defect include Griffith method, glenoid index method, Pico method, and best-fit circle method. The indexes for measuring the Hill-Sachs lesion include the length, width, depth, and volume. X-ray is mainly used for primary screening. Best-fit circle method on three-dimensional (3D) CT reconstruction is commonly used to measure the glenoid bone defect currently. Glenoid track theory on 3D CT reconstruction is popular in recent years. Reliability of measuring the glenoid bone defect and Hill-Sachs lesion with MRI and arthroscopy is still debatable. Arthrography is more and more used in the diagnosis of shoulder joint instability of bone defect and concomitant soft tissue injury. Conclusion How to improve the accuracy of evaluating glenoid bone defect and Hill-Sachs lesion before surgery still need further study.
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Affiliation(s)
- Zhengfeng Pan
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Fuguo Huang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Jian Li
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Xin Tang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
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Ramos MRF, San Junior YAC, Alves LHP, Cruz FC, Mansur H. Is the Bare Spot reliable for the bone loss measurement? Shoulder Elbow 2019; 11:106-112. [PMID: 30936949 PMCID: PMC6434960 DOI: 10.1177/1758573218760265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 01/26/2018] [Accepted: 01/28/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND To evaluate the reliability of the Bare Spot (BS) as an anatomical landmark for the intra-operative definition of bone loss in anterior shoulder instability. METHODS The distances from the BS to the anterior (BS-A), posterior (BS-P) and inferior margins of the glenoid cavity were determined both under arthroscopic visualization and by an open approach in 20 shoulders. RESULTS The BS did not coincide with the centre of the glenoid cavity of the studied shoulders because the BS-P distance was greater than the BS-A distance (p < 0.05) and was located 40% closer to the anterior margin. The authors suggest a correction factor: BP-A × 1.25/BP-P = 1. CONCLUSIONS The BS is located at a mean distance of 40% of the joint diameter, relative to the anterior margin of the glenoid. This point may be used as a landmark, using a correction factor of its mostly anterior positioning. Arthroscopy was reliable for bone measurements of the shoulder joint.
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Affiliation(s)
- Max Rogerio Freitas Ramos
- Department of Orthopaedic Surgery, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Yonder Archanjo Ching San Junior
- Department of Orthopaedic Surgery, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil,Yonder Archanjo Ching San Junior, Universidade Federal do Rio de Janeiro (UNIRIO), R. Mariz e Barros 775, Maracanã, Rio de Janeiro, RJ 20270-001, Brazil.
| | - Luiz Henrique Pereira Alves
- Department of Anatomy, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Flavio Carvalho Cruz
- Department of Orthopaedic Surgery, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Henrique Mansur
- Department of Orthopaedic Surgery, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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