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Canella C, Ávila de Almeida C, Forster BB, Aguiar R. Shoulder instability. Br J Sports Med 2024; 58:805-806. [PMID: 38811062 DOI: 10.1136/bjsports-2024-108333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/18/2024] [Indexed: 05/31/2024]
Affiliation(s)
- Clarissa Canella
- Department of Radiology, Federal Fluminense University Faculty of Medicine, Niteroi, Rio de Janeiro, Brazil
- Department of Radiology, Diagnósticos da América, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carolina Ávila de Almeida
- Department of Radiology, Diagnósticos da América, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bruce B Forster
- Department of Radiology, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Rodrigo Aguiar
- Department of Radiology, Federal University of Parana, Curitiba, Parana, Brazil
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Rutgers C, Verweij LP, van den Bekerom MP, van der Woude HJ. Substantial variability in what is considered important in the radiological report for anterior shoulder instability: a Delphi study with Dutch musculoskeletal radiologists and orthopedic surgeons. JSES Int 2024; 8:746-750. [PMID: 39035655 PMCID: PMC11258832 DOI: 10.1016/j.jseint.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Background Standardized consensus-based radiological reports for shoulder instability may improve clinical quality, reduce heterogeneity, and reduce workload. Therefore, the aim of this study was to determine important elements for the x-ray, magnetic resonance imaging (MRI) arthrography (MRA), and computed tomography (CT) report, the extent of variability, and important MRI views and settings. Methods An expert panel of musculoskeletal radiologists and orthopedic surgeons was recruited in a three-round Delphi design. Important elements were identified for the x-ray, MRA, and CT report and important MRI views and setting. These were rated on a 0-9 Likert scale. High variability was defined as at least one score between 1-3 and 7-9. Consensus was reached when ≥80% scored an element 1-3 or 7-9. Results The expert panel consisted of 21 musculoskeletal radiologists and 15 orthopedic surgeons. The number of elements identified in the first round was seventeen for the x-ray report, 52 for MRA, 21 for CT, and 23 for the MRI protocol. The number of elements that reached consensus was five for x-ray, twenty for MRA, nine for CT, and two for the MRI protocol. High variability was observed in 76.5% (n = 13) x-ray elements, 85.0% (n = 45) MRA, 76.2% (n = 16) CT, and 85.7% (n = 18) MRI protocol. Conclusion Substantial variability was observed in the scoring of important elements in the radiological for the evaluation of anterior shoulder instability, regardless of modality. Consensus was reached for five elements in the x-ray report, twenty in the MRA report, and nine in the CT report. Finally, consensus was reached on two elements regarding MRA views and settings.
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Affiliation(s)
- Cain Rutgers
- Faculty of Behavioural and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, the Netherlands
- Shoulder and Elbow Unit, Joint Research, Department of Orthopedic Surgery, OLVG, Amsterdam, the Netherlands
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), Amsterdam, the Netherlands
| | - Lukas P.E. Verweij
- Faculty of Behavioural and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Shoulder and Elbow Unit, Joint Research, Department of Orthopedic Surgery, OLVG, Amsterdam, the Netherlands
- Amsterdam UMC, Location AMC, Department of Orthopaedic Surgery and Sports Medicine, University of Amsterdam, Amsterdam, the Netherlands
| | - Michel P.J. van den Bekerom
- Faculty of Behavioural and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, the Netherlands
- Shoulder and Elbow Unit, Joint Research, Department of Orthopedic Surgery, OLVG, Amsterdam, the Netherlands
- Amsterdam Shoulder and Elbow Center of Expertise (ASECE), Amsterdam, the Netherlands
- Department of Orthopaedic Surgery, Medical Center Jan van Goyen, Amsterdam, the Netherlands
| | - Henk-Jan van der Woude
- Shoulder and Elbow Unit, Joint Research, Department of Radiology, OLVG, Amsterdam, the Netherlands
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Dowe JN, Bradley MW, LeClere LE, Dickens JF. Creating a Three-Dimensional Reconstruction of the Glenohumeral Joint From Magnetic Resonance Imaging to Assist in Surgical Decision-Making. Arthrosc Tech 2024; 13:102972. [PMID: 39036394 PMCID: PMC11258833 DOI: 10.1016/j.eats.2024.102972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/01/2024] [Indexed: 07/23/2024] Open
Abstract
Understanding the anatomical structure of a patient's shoulder joint is essential in surgical decision-making, especially regarding glenohumeral bone loss. The use of various imaging techniques, such as magnetic resonance imaging (MRI) and computed tomography (CT), bring certain advantages and disadvantages in assessing joint structure. Before a surgical procedure, bone loss can be observed and measured using these imaging techniques in both 2-dimensional and 3-dimensional (3D) views. The ability to visualize the shoulder joint in a 3D manner, as commonly done with CT scans, is helpful in assessing bone loss; however, CT involves exposure to radiation, additional time, and greater costs. The process of obtaining a 3D view of the shoulder joint from an MRI, although less common, can be completed effectively to assess bone loss while also solving some issues surrounding CT scans. By loading MRI datasets into an image-reformation program, such as 3D Slicer, the anatomical structures can be segmented to create realistic 3D models of the shoulder joint. Surgical direction can be determined after bone loss measurements and structural assessment of these models, without the need for CT scans. This technique can also be applied to other skeletal joints, in addition to the shoulder.
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Affiliation(s)
- Jacob N. Dowe
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
- The Geneva Foundation, Tacoma, Washington, U.S.A
- Department of Orthopaedic Surgery, Naval Health Clinic Annapolis, United States Naval Academy, Annapolis, Maryland, U.S.A
| | - Matthew W. Bradley
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
- The Geneva Foundation, Tacoma, Washington, U.S.A
| | - Lance E. LeClere
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
- Department of Orthopaedic Surgery, Naval Health Clinic Annapolis, United States Naval Academy, Annapolis, Maryland, U.S.A
| | - Jonathan F. Dickens
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
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Liu G, Huang C, Li Y, Jiang S, Lu W, Yacoub Hassan MH, Essien AE, Pavel V, Xiao W. Accuracy and Consistency of 3-Dimensional Magnetic Resonance Imaging Is Comparable With 3-Dimensional Computed Tomography in Assessing Glenohumeral Instability: A Systematic Review. Arthroscopy 2024:S0749-8063(24)00266-4. [PMID: 38599537 DOI: 10.1016/j.arthro.2024.03.043] [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: 11/20/2023] [Revised: 03/23/2024] [Accepted: 03/24/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE To compare the accuracy of 3-dimensional (3D) magnetic resonance imaging (MRI) with that of 3D computed tomography (CT) in evaluating glenoid bone loss (GBL). METHODS This review aligned with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. PubMed, the Cochrane Library, Embase, and Web of Science were obtained from data inception to August 28, 2023. The search term "glenoid bone loss" was extracted and analyzed via stringent inclusion and exclusion criteria. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 combined with the QUADAS-Comparative to assess the heterogeneity of included studies. RESULTS A total of 1,589 related studies were retrieved, and 10 studies were finally included, of which a total of 143 shoulders were evaluated. The index test in QUADAS-Comparative was low risk in 9 studies. 3D MRI measurements of GBL were primarily best-fit circles (n = 9). In both clinical and cadaveric studies, the mean percentages of GBL measured by 3D MRI were 0.38% to 2.19% and 0.25% to 6.1% when compared with 3D CT and standard reference values, respectively. Intraclass correlation coefficient agreement greater than 0.9 between GBL percentages measured by 3D CT and 3D MRI. 3D MRI also could accurately measure glenoid width, glenoid height, humeral head width, and height. 3D MRI reconstruction time was similar to that of 3D CT, which was mainly 10 to 15 minutes. CONCLUSIONS In both clinical and cadaveric studies, compared with 3D CT, 3D MRI is accurate and consistent in assessing glenohumeral bone, especially in measuring GBL, and the reconstruction time of 3D MRI is similar to 3D CT. LEVEL OF EVIDENCE Level Ⅲ, systematic review of Level Ⅱ-Ⅲ studies.
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Affiliation(s)
- Gaoming Liu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Cheng Huang
- Department of Orthopaedics, China-Japan Friendship Hospital, Beijing, China
| | - Yusheng Li
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Shide Jiang
- Department of Orthopedics, The Central Hospital of Yongzhou, Yongzhou, China
| | - Wenhao Lu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | | | - Anko Elijah Essien
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Volotovski Pavel
- Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk, Belarus
| | - Wenfeng Xiao
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
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Mouchantaf M, Bastard C, Corsia S, Métais P, Nourissat G. High Rates of Return to Play and Low Recurrence Rate After Arthroscopic Latarjet Procedure for Anterior Shoulder Instability in Rugby Players. Arthrosc Sports Med Rehabil 2024; 6:100912. [PMID: 38590787 PMCID: PMC10999816 DOI: 10.1016/j.asmr.2024.100912] [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: 08/25/2023] [Accepted: 02/09/2024] [Indexed: 04/10/2024] Open
Abstract
Purpose To analyze the rate of return to play, changes in athletic level, and recurrence rate and to report subjective outcomes in a series of rugby players with anterior shoulder instability who underwent an arthroscopic Latarjet procedure. Methods A multicenter retrospective study done in 2 centers on rugby players who were operated on between January 2011 and December 2020 was performed. Rugby players who underwent arthroscopic Latarjet procedure for anterior shoulder stabilization with a minimum follow-up period of 2 years were included. Rugby players were grouped according to their competitive level in their country (recreational, regional, national, and international). Data collected included return to sport after surgery, time to return to rugby, athletic level before and after surgery, patient satisfaction, and subjective scores. Recurrence and apprehension rates were also evaluated. Results A total of 73 subjects were included. Mean age at time of surgery was 23 ± 5 years. Mean duration of follow-up was 5 ± 2.6 years. Eighty-four percent of rugby players returned to rugby within a mean period of 6.6 months. Initial athletic level was a significant factor (P = .012) for not returning to sport, with 67% of patients who initially played at a recreational level not returning to rugby and 33% of patients who initially played at a regional league level not returning. All national and international players returned to play. Of the 12 non-returning rugby players, only 30% did not return because of their shoulder. Mean Subjective Shoulder Value was 90 ± 9%. Recurrence rate was 7%. Conclusions Arthroscopic Latarjet procedure proved its efficacy in managing recurrent anterior shoulder instability in rugby players. Return to play was achieved in almost all cases, with low recurrence rates. Despite high global return to the same level of sport, the higher the level of competition, the harder it is for rugby players to resume sport at the same level. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Mark Mouchantaf
- Clinique de l’épaule–Paris, Clinique Maussins-Nollet, Ramsay Sante, Paris, France
| | - Claire Bastard
- Service de Chirurgie Orthopedique–Hôpital Saint-Antoine, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Simon Corsia
- Service de Chirurgie Orthopédique–Hôpital Cochin, Assistance Publique–Hôpitaux de Paris, Paris, France
| | | | - Geoffroy Nourissat
- Clinique de l’épaule–Paris, Clinique Maussins-Nollet, Ramsay Sante, Paris, France
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Testa EJ, van der List JP, Waterman BR, Caldwell PE, Parada SA, Owens BD. Management of Bone Loss in Posterior Glenohumeral Shoulder Instability: Current Concepts. JBJS Rev 2024; 12:01874474-202404000-00005. [PMID: 38619382 DOI: 10.2106/jbjs.rvw.23.00243] [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: 04/16/2024]
Abstract
» Posterior glenohumeral instability is relatively uncommon compared with anterior instability, but is becoming an increasingly recognized and surgically managed shoulder pathology.» Soft-tissue stabilization alone may not be sufficient in patients who present with substantial bone loss to the posterior glenoid and/or the anterior humeral head.» For posterior glenoid defects, posterior glenoid osteoarticular augmentation can be used, and posterior glenoid opening wedge osteotomy can be considered in cases of posterior instability with pathologic retroversion.» For humeral head lesions, several surgical treatment options are available including subscapularis transposition into the humeral head defect, autograft or allograft reconstruction, humeral rotation osteotomy, and shoulder arthroplasty.
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Affiliation(s)
- Edward J Testa
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
| | - Jelle P van der List
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Brian R Waterman
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Paul E Caldwell
- Orthopaedic Research of Virginia, Richmond, Virginia
- Tuckahoe Orthopaedic Associates, Richmond, Virginia
| | - Stephen A Parada
- Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Brett D Owens
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
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Makovicka JL, Moore ML, Pollock JR, Rodriguez MJ, Shaha JS, Haglin JM, Tokish JM. Magnetic Resonance Imaging Analysis Demonstrates Improved Reliability in Measuring Shoulder Glenoid Bone Loss Using a Two-Thirds Glenoid Height Technique Compared to the "Best-fit Circle". Arthroscopy 2024; 40:666-671. [PMID: 37419223 DOI: 10.1016/j.arthro.2023.06.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/09/2023]
Abstract
PURPOSE To evaluate the superior to inferior glenoid height as a reliable reference in best-fit circle creation for glenoid anatomy. METHODS The morphology of the native glenoid was evaluated using magnetic resonance imaging (MRI) in patients without shoulder instability. Using T1 sagittal MRI images, 2 reviewers independently estimated glenoid size using the two-thirds technique and the "best-fit circle" technique at 2 different times. A Student t-test was used to determine significant difference between the two methodologies. Inter- and intra-rater reliability were calculated using interclass and intraclass coefficients. RESULTS This study included 112 patients. Using the results of glenoid height and "best-fit circle" diameter, the diameter of the "best-fit circle" was found to intersect the glenoid line at 67.8% of the glenoid height on average. We found no significant difference between the 2 measures of glenoid diameter (27.6 vs 27.9, P = .456). The interclass and intraclass coefficients for the two-third method were 0.85 and 0.88, respectively. The interclass and intraclass coefficients for the perfect circle methods were 0.84 and 0.73, respectively. CONCLUSIONS We determined that the diameter of a circle placed on the inferior glenoid using the "best-fit circle" technique corresponds to 67.8% of the glenoid height. Additionally, we found that constructing a perfect circle using a diameter equal to two-thirds the height of the glenoid may improve intraclass reliability. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
| | - M Lane Moore
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona.
| | | | - Marina J Rodriguez
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
| | - James S Shaha
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix
| | - Jack M Haglin
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix
| | - John M Tokish
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix
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Jezycki T, Jungmann F, Werth J, Emrich T, Kreitner KF. [Imaging of posttraumatic shoulder instability : Current concepts]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:134-141. [PMID: 37947866 DOI: 10.1007/s00117-023-01234-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 11/12/2023]
Abstract
Posttraumatic instability accounts for more than 95% of all shoulder instabilities with the highest incidence in patients between 20 and 30 years of age. In this age group, lesions of the capsulolabral complex are the most common sequelae after the first shoulder dislocation. Typical acute findings are the Bankart and Perthes lesions and humeral avulsion of the glenohumeral ligament (HAGL). Chronic sequelae are anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions, and nonclassifiable lesions with deficient anterioinferior labrum and glenohumeral ligaments. Recently, quantification of Hill-Sachs and bony Bankart lesions with glenoid defects have become the focus of interest: bipolar bone loss has emerged to be one important factor of recurrent instability that has not been addressed during the first stabilizing operation. The glenoid track concept emphasizes the importance of bipolar bone loss, where the glenoid track refers to the contact area between the humeral head and the glenoid at the end-range of motion in abduction, extension and external rotation. Any lesion of the humeral head that extends beyond the glenoid track is considered high risk for engagement of the humeral head at the glenoid margin with subsequent dislocation. Both the Hill-Sachs interval and the glenoid track can be determined using computed tomography (CT) and magnetic resonance imaging and, thus, help to define the status of the shoulder (on-track vs. off-track), which is prerequisite for planning the appropriate operative procedure. Similar tendencies also exist for posttraumatic posterior instabilities which are much rarer.
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Affiliation(s)
- Thomas Jezycki
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie der Universitätsmedizin Mainz, Johannes Gutenberg-Universität, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Florian Jungmann
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie der Universitätsmedizin Mainz, Johannes Gutenberg-Universität, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Johanna Werth
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie der Universitätsmedizin Mainz, Johannes Gutenberg-Universität, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Tilman Emrich
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie der Universitätsmedizin Mainz, Johannes Gutenberg-Universität, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Karl-Friedrich Kreitner
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie der Universitätsmedizin Mainz, Johannes Gutenberg-Universität, Langenbeckstr. 1, 55131, Mainz, Deutschland.
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Delgado C, Luengo-Alonso G, Valencia M, Martínez-Catalán N, Calvo E. Association of Instability History and Off-Track Hill-Sachs Lesions in Anterior Shoulder Instability. Orthop J Sports Med 2023; 11:23259671231213858. [PMID: 38035218 PMCID: PMC10686021 DOI: 10.1177/23259671231213858] [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: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 12/02/2023] Open
Abstract
Background The glenoid track concept is now widely accepted, and its evaluation is considered essential for making decisions about surgery. Purpose To define preoperative descriptive data and clinical and functional features in patients with anterior glenohumeral instability according to glenoid track status and to analyze the influence of off-track Hill-Sachs (HS) lesions on preoperative shoulder function. Study Design Case-control study; Level of evidence, 3. Methods Preoperative magnetic resonance imaging or computed tomography scans were used to measure the glenoid track. Descriptive data and preoperative objective and subjective clinical and functional features were compared between patients with on-track HS lesions versus off-track HS lesions. Multivariate regression analysis was conducted to identify potential risk factors for off-track HS lesion development. Results A total of 235 patients (201 men, 34 women; mean age, 29.6 ± 8.6 years) were included- 134 shoulders (57%) with on-track HS lesions and 101 shoulders (43%) with off-track HS lesions. Age <20 years at first dislocation, number of dislocations, and ≥2 years between first dislocation and surgery were significantly different between the study groups (P = .005, P = .0001, and P = .01, respectively). Regarding these characteristics, the odds ratios for the risk of developing an off-track lesion were 2.67 (95% CI, 1.2-5.99)-1.2 times higher for each additional instability episode (95% CI, 1.025-1.14) and 2.42 times higher (95% CI, 1.176-4.608) for patients whose first dislocation was ≥2 years before surgery, respectively. Patients with off-track HS lesions had a significantly greater degree of instability (P = .04), worse Rowe scores (48.8 ± 15.3 vs 54.8 ± 28.3 for on-track HS lesions; P = .04), and lower Western Ontario Shoulder Instability scores (975 ± 454 vs 1179 ± 428 for on-track HS lesions; P = .01). Conclusion Characteristics related to a history of instability (age <20 years at first instability episode, larger number of dislocations, ≥2 years between first dislocation and surgery) were found to be risk factors for the development of an off-track HS lesion in this study. Off-track lesions led to a higher degree of instability and worse objective and subjective preoperative shoulder function versus on-track HS lesions.
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Affiliation(s)
- Cristina Delgado
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Gonzalo Luengo-Alonso
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Maria Valencia
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Natalia Martínez-Catalán
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Emilio Calvo
- Shoulder and Elbow Reconstructive Surgery Unit, Department of Orthopedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, 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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Atwan Y, Wang A, Labrum JT, Sanchez-Sotelo J, Barlow JD, Dines JS, Camp CL. Management of Shoulder Instability in Patients with Seizure Disorders. Curr Rev Musculoskelet Med 2023; 16:201-210. [PMID: 37067689 DOI: 10.1007/s12178-023-09833-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE OF REVIEW Patients with seizure disorders commonly suffer shoulder dislocations and subsequent instability. Due to high rates of recurrence and bone loss, management of this instability and associated pathology has proven to be more complex than that of patients without seizure disorders. The ultimate goal of this review is to outline the various treatment modalities and their respective outcomes in this complex patient population. RECENT FINDINGS Optimization of medical management of seizure disorders is imperative. However, despite these efforts, the incidence of post-operative seizure activity continues to be a concern. These subsequent episodes increase the risk of further instability and failure of surgical procedures. Overall, the use of soft tissue procedures has proven to result in increased recurrence of instability compared to bone-block augmenting and grafting procedures. There are a variety of bone-block procedures that have been described for anterior and posterior instability. Despite their success in decreasing further instability, they are associated with several complications that patients should be informed of. There is no consensus regarding the optimal surgical management of shoulder instability in patients with seizure activity. A multidisciplinary approach to the management of the seizure activity is paramount to the success of their treatment. Further studies are required to evaluate the optimal timing and type of surgical intervention for individualized cases.
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Affiliation(s)
- Yousif Atwan
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Allen Wang
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Joseph T Labrum
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Joshua S Dines
- Sports Medicine and Shoulder Service, Hospital for Special Surgery Westside Sports Institute, 610 W. 58Th St, New York, NY, 10019, USA
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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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de Campos Azevedo C, Ângelo AC. Onlay Dynamic Anterior Stabilization With Biceps Transfer for the Treatment of Anterior Glenohumeral Instability Produces Good Clinical Outcomes and Successful Healing at a Minimum 1 Year of Follow-Up. Arthrosc Sports Med Rehabil 2023; 5:e445-e457. [PMID: 37101880 PMCID: PMC10123435 DOI: 10.1016/j.asmr.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 01/08/2023] [Indexed: 02/25/2023] Open
Abstract
Purpose To report the results of the onlay dynamic anterior stabilization (DAS) using the long head of biceps (LHB) and the double double-pulley technique for the treatment of anterior glenohumeral instability (AGI) with ≤20% glenoid bone loss (GBL). Methods From September 2018 to December 2021, patients with AGI and ≤20% GBL were enrolled in a prospective study on DAS and followed for a minimum of 1 year. The primary outcomes were Western Ontario Shoulder Instability Index, Rowe score, range of motion, and strength. The secondary outcomes were ability to return to play (RTP), RTP at same level, lack of recurrence of instability, successful LHB healing, and lack of complications. Magnetic resonance imaging was used to measure GBL, Hill-Sachs interval, glenoid track, and assess LHB integrity. Results Eighteen consecutive patients underwent DAS. Fifteen patients had a minimum follow-up of 12 months (mean, 23.93 ± 13.67 months). In total, 12 were male and 3 female patients; 73.3% practiced recreational sports; mean age at surgery was 23.40 ± 6.53 years; mean number of dislocation episodes were 10.13 ± 8.42; mean GBL was 8.21 ± 7.39% (range, 0-20.24%); mean Hill-Sachs interval was 15.00 ± 2.96 mm; and mean glenoid track was 18.87 ± 2.57mm. The mean improvement in the Western Ontario Shoulder Instability Index and Rowe score (959.27 ± 386.70 and 74.00 ± 22.22 points) was significant (P < .001 and P < .001) and more than 6 times greater than the minimum clinically important difference. The mean improvement in active elevation, abduction, and external and internal rotation (23.00 ± 27.76°, 33.33 ± 43.78°, 8.33 ± 13.58°, and 0.73 ± 1.28 points) was significant (P = .006, P = .011, P = .032, and P = .044). RTP rate was 93.33%. RTP at same level was 60.00%. One patient with hyperlaxity had a redislocation (6.7% recurrence). No complications were reported. Each magnetic resonance imaging scan showed successful LHB healing to the anterior glenoid. Conclusions At a minimum of 1-year follow-up, DAS produces significant and clinically important improvements in shoulder function, successful LHB healing, and is safe for the treatment of AGI with ≤20% GBL without severe hyperlaxity. Level of Evidence IV, therapeutic case series.
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Affiliation(s)
- Clara de Campos Azevedo
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Hospital dos SAMS de Lisboa, Lisbon, Portugal
- Shoulder and Elbow Unit, Orthopaedic and Musculoskeletal Centre, Cuf Tejo Hospital, Lisbon, Portugal
- Address correspondence to Clara de Campos Azevedo, M.D., Ph.D., Serviço de Ortopedia e Traumatologia, Hospital dos SAMS de Lisboa, Rua Cidade de Gabela, 1. 1849-017 Lisboa, Portugal.
| | - Ana Catarina Ângelo
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Hospital dos SAMS de Lisboa, Lisbon, Portugal
- Shoulder and Elbow Unit, Orthopaedic and Musculoskeletal Centre, Cuf Tejo Hospital, Lisbon, Portugal
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16
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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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Glenoid Bone Loss Determination: Validity and Reliability of the Constellation Technique Versus the Sagittal Best Fit Circle Technique. Indian J Orthop 2022; 56:1824-1833. [PMID: 36034679 PMCID: PMC9396601 DOI: 10.1007/s43465-022-00720-6] [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: 05/20/2022] [Accepted: 08/01/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To propose a new method for glenoid bone loss measurement, the constellation technique (CST); determine its reliability and accuracy; and compare the validity of CST with that of the conventional technique (CVT) and standard measurements for ratio calculation. MATERIALS AND METHODS Sixty shoulders with intact glenoids and no glenohumeral instability and arthritis underwent CT scans. Simulated osteotomies were conducted on the 3D models of glenoids at two cutting locations, expressed as clock face times (2:30-4:20; 1:30-5:00). Two experienced surgeons compared three methods for glenoid bone loss measurement; CVT (best-fit circle), CST ('5S' steps), and standard measurement. Eight undergraduates remeasured five randomly chosen shoulders with moderate to severe bone loss. Intraclass correlation coefficients (ICCs) were calculated for raters. RESULTS With a defect range between 2:30 and 4:20, all 60 glenoids demonstrated minimal bone loss (< 15%); while between 1:30 and 5:00, 42 shoulders were with moderate bone loss (15-20%), and 18 shoulders with severe bone loss (≥ 20%). For experienced raters, no significant differences were noted between protocos for all categories of bone loss (p ≥ 0.051), with good inter- and intraobserver reliability indicated by ICC. For novice raters, post hoc Tukey analysis found that CST was more accurate in one patient with a standard mean bone loss of 23.2% ± 1.9% compared with CVT. CONCLUSION The CST turned the key step of glenoid defect evaluation from deciding an en face view to determining the glenoid inferior rim. The protocol is simple, accurate, and reproducible, especially for novice raters.
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18
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Armstrong T, Henderson DJ, Entwistle I, Iball G, Rowbotham E. Combination CT and MRI shoulder arthrography: a novel technique and improved patient journey. Clin Radiol 2022; 77:738-742. [PMID: 35981923 DOI: 10.1016/j.crad.2022.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/23/2022] [Accepted: 06/26/2022] [Indexed: 11/29/2022]
Affiliation(s)
- T Armstrong
- Leeds Musculoskeletal Radiology Department & The Leeds Upper Limb Unit, Chapel Allerton Hospital, Leeds, UK.
| | - D J Henderson
- Leeds Musculoskeletal Radiology Department & The Leeds Upper Limb Unit, Chapel Allerton Hospital, Leeds, UK
| | - I Entwistle
- Leeds Musculoskeletal Radiology Department & The Leeds Upper Limb Unit, Chapel Allerton Hospital, Leeds, UK
| | - G Iball
- Leeds Musculoskeletal Radiology Department & The Leeds Upper Limb Unit, Chapel Allerton Hospital, Leeds, UK
| | - E Rowbotham
- Leeds Musculoskeletal Radiology Department & The Leeds Upper Limb Unit, Chapel Allerton Hospital, Leeds, UK
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19
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Olmscheid N, Crawford SD, Dickinson C, Fajardo RS, Knake JJ, Wilcox CL, Joyner P. Novel anterior coracoglenoid line utilizing magnetic resonance imaging (MRI) corresponds with critical glenoid bone loss. Skeletal Radiol 2022; 51:1433-1438. [PMID: 34988628 DOI: 10.1007/s00256-021-03981-8] [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: 06/14/2021] [Revised: 10/25/2021] [Accepted: 12/19/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Glenoid bone loss is estimated using a best-fit circle method and requires software tools that may not be available. Our hypothesis is that a vertical reference line drawn parallel to the long axis of the glenoid and passing through the inflection point of the coracoid and glenoid will represent a demarcation line of approximately 20% of the glenoid. Our aim is to establish a more efficient method to estimate a surgical threshold for glenoid insufficiency. METHODS Fifty patients with normal glenoid anatomy were randomly chosen from an orthopedic surgeon's database. Two orthopedic surgeons utilized T1-weighted sagittal MRIs and the coracoglenoid line technique to determine the percentage of bony glenoid anterior to vertical line. Two musculoskeletal radiologists measured the same 50 glenoids using the circle technique. Differences were determined using dependent t test. Reliability was compared using interclass correlation coefficient and Kappa. Validity was compared using Pearson correlation coefficient. RESULTS Mean surface area of the glenoid anterior to the vertical line was on average 21.69% ± 3.12%. Surface area of the glenoid using the circle method was on average 20.86% ± 2.29%. Inter-rater reliability of the circle method was 0.553 (fair). Inter-rater reliability of the vertical line technique was 0.83 (excellent). There was a linear relationship between circle and vertical line measurements, r = 0.704 (moderate to high). CONCLUSION The coracoglenoid line appears to represent a line of demarcation of approximately 21% of glenoid bone anterior to the coracoglenoid line. Our technique was found to be reliable, valid, and accurate.
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Affiliation(s)
- Neil Olmscheid
- Michigan State University Orthopedic Surgery Residency, McLaren Greater Lansing Hospital, 401 W. Greenlawn Ave, Lansing, MI, 48910, USA.
| | - Stanley D Crawford
- Michigan State University Orthopedic Surgery Residency, McLaren Greater Lansing Hospital, 401 W. Greenlawn Ave, Lansing, MI, 48910, USA
| | - Christopher Dickinson
- Michigan State University Orthopedic Surgery Residency, McLaren Greater Lansing Hospital, 401 W. Greenlawn Ave, Lansing, MI, 48910, USA
| | - Ryan S Fajardo
- Department of Radiology, Michigan State University, 846 Service Road, East Lansing, MI, 48824, USA
| | - Jeffrey J Knake
- Department of Radiology, Michigan State University, 846 Service Road, East Lansing, MI, 48824, USA
| | - Christopher L Wilcox
- Michigan State University, Michigan State University Sports Medicine Faculty, 4660 South Hagadorn Road, Suite 420, East Lansing, MI, 48823, USA
| | - Patrick Joyner
- Orthocollier, 1250 Pine Ridge Rd, #202, Naples, FL, 34108, USA
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Paul RW, DeBernardis DA, Hameed D, Clements A, Kamel SI, Freedman KB, Bishop ME. Effect of Preoperative MRI Coracoid Dimensions on Postoperative Outcomes of Latarjet Treatment for Anterior Shoulder Instability. Orthop J Sports Med 2022; 10:23259671221083967. [PMID: 35923867 PMCID: PMC9340370 DOI: 10.1177/23259671221083967] [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] [Received: 12/05/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Preoperative coracoid dimensions may affect the size of the bone graft transferred to the glenoid rim and thus the postoperative outcomes of Latarjet coracoid transfer. Purpose: To determine the effect of coracoid length and width as measured on preoperative magnetic resonance imaging (MRI) on outcomes after Latarjet treatment of anterior shoulder instability. Study Design: Cohort study; Level of evidence, 3. Methods: Included were patients who underwent primary Latarjet surgery between 2009 and 2019 and had preoperative MRI scans and minimum 2-year postoperative outcomes. Longitudinal coracoid length was measured on axial MRI sequences as the distance from the coracoclavicular ligament insertion to the distal tip. Comparisons were made between shorter and longer coracoids and between narrower and wider coracoids. The outcomes of interest were recurrent instability, reoperation, complications, return to sport (RTS), and American Shoulder and Elbow Surgeons (ASES) score. Independent-samples t test, Mann-Whitney test, chi-square test, and Fisher exact test were used to compare outcomes between groups, and univariate correlation coefficients were calculated to evaluate the relationships between demographics and coracoid dimensions. Results: Overall, 56 patients were included (mean age, 28.4 years). The mean ± SD coracoid length was 21.6 ± 2.4 mm and width 10.0 ± 1.0 mm. Relative to patients with a longer coracoid (≥22 mm; n = 26), patients with a shorter coracoid (<22 mm; n = 30) had similar rates of recurrent instability (shorter vs longer; 6.7% vs 3.8%), complications (10.0% vs 15.4%), reoperation (3.3% vs 7.7%), and RTS (76.5% vs 58.8%) and similar postoperative ASES scores (85.0 vs 81.6) ( P ≥ .05 for all). Likewise, relative to patients with a wider coracoid (≥10 mm; n = 27), patients with a narrower coracoid (<10 mm; n = 29) had similar prevalences of recurrent instability (narrower vs wider; 6.9% vs 3.7%), complications (17.2% vs 7.4%), reoperation (3.5% vs 7.4%), and RTS (66.7% vs 68.4%) and similar postoperative ASES scores (87.1 vs 80.0) ( P ≥ .05 for all). Conclusion: Patients undergoing Latarjet coracoid transfer had similar postoperative outcomes regardless of preoperative coracoid dimensions. These findings should be confirmed in a larger cohort before further clinical recommendations are made.
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Affiliation(s)
- Ryan W. Paul
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | | | - Daniel Hameed
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Ari Clements
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Sarah I. Kamel
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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The Use of Multiple Imaging Studies Before Shoulder Stabilization Surgery Is Increasing. Arthrosc Sports Med Rehabil 2022; 4:e919-e925. [PMID: 35747651 PMCID: PMC9210371 DOI: 10.1016/j.asmr.2022.01.003] [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: 09/18/2021] [Accepted: 01/07/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose To determine the incidence of preoperative shoulder imaging, explore the prevalence of obtaining multiple advanced imaging studies, and identify patient characteristics associated with specific imaging studies before anterior versus posterior shoulder stabilization surgery. Methods The PearlDiver database was queried for patients who underwent anterior or posterior shoulder stabilization surgery from 2010 to 2019. The incidence of imaging studies within a year of surgery was collected. Patient characteristics were compared between groups using one-way analysis of variance or χ2 test. Results In total, 10,252 patients underwent anterior shoulder stabilization surgery, and 1,108 patients underwent posterior shoulder stabilization surgery. Imaging use before anterior and posterior shoulder stabilization surgery included plain radiographs (69%, 70%, respectively), magnetic resonance imaging (MRI; 43%, 33%), and computed tomography (CT; 22%, 22%). In total, 1,098 patients (11%) received MRI and CT before anterior stabilization surgery and 85 patients (8%) received MRI and CT before posterior stabilization surgery. Over time, the incidence of obtaining MRI and CT increased before anterior (z = 2.54, P = .011) and posterior (z = 2.36, P = .018) stabilization surgery. Conclusions This study highlights the increasing use of multiple imaging studies before shoulder stabilization surgery over recent years, including plain radiographs, MRI, and CT imaging. In total, 45% of anterior shoulder stabilization patients and 41% of posterior shoulder stabilization patients obtained more than 1 imaging study within a year of surgery, with a recent increase in patients obtaining both MR and CT scans preoperatively. Statement of Clinical Relevance The increasing use of multiple preoperative imaging studies observed in this study highlights an opportunity for new imaging technology to streamline and improve the preoperative workup.
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Scanaliato JP, Dunn JC, Fares AB, Czajkowski H, Parnes N. Outcomes of 270° Labral Repair for Combined Shoulder Instability in Active-Duty Military Patients: A Retrospective Study. Am J Sports Med 2022; 50:334-340. [PMID: 34898288 DOI: 10.1177/03635465211061602] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is a high prevalence of combined shoulder instability in military patients. Short-term outcomes after 270° labral repair are promising; however, there is a paucity of longer term outcome data in this high-demand group of patients. PURPOSE To report the midterm outcomes of active-duty military patients treated with 270° labral repair for combined shoulder instability. STUDY DESIGN Case series; Level of evidence, 4. METHODS All consecutive patients between January 2011 and January 2019 who underwent 270° labral repair by the senior surgeon with complete outcome scores were identified. All patients had experienced a shoulder dislocation after a traumatic event and had magnetic resonance imaging and intraoperative findings consistent with combined-type instability. A total of 52 patients met the inclusion criteria for the study, and all were active-duty servicemembers at the time of surgery. RESULTS The mean follow-up was 78.21 months (range, 24-117 months). There was a statistically significant increase in the mean American Shoulder and Elbow Surgeons score (from 44.92 to 89.31; P < .0001), Single Assessment Numeric Evaluation score (from 52.32 to 93.17; P < .0001), and Rowe instability score (from 46.63 to 91.35; P < .0001) from preoperatively to postoperatively. Mean pain decreased significantly as measured by the visual analog scale for pain (from 8.04 to 1.44; P < .0001). Range of motion in forward flexion (from 155.29° to 155.96°; P = .6793), external rotation (from 67.50° to 65.29°; P = .0623), and internal rotation (from T9.58 to T9.56; P = .9650) did not change significantly postoperatively. Outcomes did not differ significantly for patients who underwent surgery on their dominant shoulder versus those who underwent surgery on their nondominant shoulder, nor did outcomes vary with the type of anchor utilized (biocomposite vs all-suture). The overall rate of return to active duty was 92.31%. CONCLUSION Midterm outcomes in this population of active-duty patients undergoing 270° labral repair for combined shoulder instability demonstrated a statistically and clinically significant improvement in patient-reported outcome scores, a significant decrease in pain, and an overall rate of return to active duty of 92.31%.
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Affiliation(s)
| | - John C Dunn
- William Beaumont Army Medical Center, El Paso, Texas, USA
| | - Austin B Fares
- William Beaumont Army Medical Center, El Paso, Texas, USA
| | | | - Nata Parnes
- Carthage Area Hospital, Carthage, New York, USA.,Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
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Dual energy CT arthrography in shoulder instability: successful iodine removal with virtual non-contrast images and accurate 3D reformats of the glenoid for assessment of bone loss. Skeletal Radiol 2022; 51:1027-1036. [PMID: 34601617 PMCID: PMC8930895 DOI: 10.1007/s00256-021-03916-3] [Citation(s) in RCA: 2] [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: 07/04/2021] [Revised: 09/16/2021] [Accepted: 09/19/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the image quality of dual energy CT (DECT) of the shoulder after arthrography and of virtual non-contrast (VNC) 3D reformats of the glenoid and to compare glenoid measurements on VNC 3D reformats and on 2D CTs. MATERIALS AND METHODS DECT arthrography (80 kV/140 kV) was performed in 42 shoulders of 41 patients with instability using diluted iodinated contrast media (80 mg/ml). VNC images and VNC 3D reformats of the glenoid were calculated using image postprocessing. Dose parameters, CT values of intraarticular iodine and muscle, image contrast (iodine/muscle), and image quality (5-point scale: 1 = worst, 5 = best) were evaluated. Two independent readers assessed glenoid morphology and performed glenoid measurements on 2D and 3D images. RESULTS Calculation of VNC images and VNC 3D reformats was successful in 42/42 shoulders (100%). The effective dose was mean 1.95 mSv (± 0.9 mSv). CT values of iodine and muscle were mean 1014.6 HU (± 235.8 HU) and 64.5 HU(± 8.6 HU), respectively, and image contrast was mean 950.2 HU (± 235.5 HU). Quality of cross-sectional images, VNC images, and VNC 3D reformats was rated good (median 4 (4-5), 4 (3-4), 4 (3-5), respectively). Detection of an osseous defect was equal on 2D and 3D images (13/42, P > 0.99) with no difference for measurement of the glenoid diameter with mean 28.3 mm (± 2.8 mm) vs. 28.4 mm (± 2.9 mm) (P = 0.5), width of the glenoid defect with 3.2 mm (± 2.1 mm) vs. 3.1 mm (± 2.3 mm) (P = 0.84), surface area with 638.5 mm2 (± 127 mm2) vs. 640.8 mm2 (± 129.5 mm2) (P = 0.47), and surface area of the defect with 46.6 mm2 (± 44.3 mm2) vs. 47.2 mm2 (± 48.0 mm2) (P = 0.73), respectively. CONCLUSION DECT shoulder arthrography is feasible and allows successful iodine removal with generation of VNC images and accurate VNC 3D reformats of the glenoid for assessment of bone loss.
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Prada C, Al-Mohrej OA, Patel A, Flood B, Leroux T, Khan M. Managing Bone Loss in Shoulder Instability-Techniques and Outcomes: a Scoping Review. Curr Rev Musculoskelet Med 2021; 14:447-461. [PMID: 34961906 DOI: 10.1007/s12178-021-09727-2] [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: 10/06/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW The aim of this scoping review is to provide an overview of the literature published over the past 5 years related to the management of bone loss in anterior shoulder instability. RECENT FINDINGS During recent years, there has been a focus on patients at high risk for failure following soft tissue anterior stabilization (Bankart repair). A growing body of evidence suggests that anterior capsulolabral repair is insufficient in the setting of subcritical glenoid bone loss with an off-track Hill Sachs lesion. In such cases, the addition of a remplissage procedure to a Bankart repair or a bone-block augmentation to the glenoid (Latarjet, for example) is often advocated to decrease the risk of recurrent instability. Recent studies have also evaluated the role of alternative bone-block procedures in comparison to the Latarjet, outcomes with arthroscopic and open techniques as well as various fixation methods and radiological outcomes (bone graft resorption, glenohumeral osteoarthritis). Advances in our understanding of subcritical glenoid bone loss and the glenoid track concept have significantly impacted clinical decision making and treatment selection. The development of arthroscopic techniques has allowed for minimally invasive and safe arthroscopic bone-block procedures as an alternative to open procedures. Further research related to free bone-block procedures will inform long-term outcomes between these procedures and the gold standard Latarjet. Additionally, high-quality evidence is lacking to identify the ideal treatment for patients with glenoid subcritical glenoid bone defect. Variability in outcome reporting suggests the need to standardize outcome measures for future instability trials.
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Affiliation(s)
- Carlos Prada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.,Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Omar A Al-Mohrej
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.,Section of Orthopedic Surgery, Department of Surgery, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia
| | - Ashaka Patel
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Breanne Flood
- Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Timothy Leroux
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada. .,Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
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25
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Abstract
Magnetic resonance imaging provides a comprehensive evaluation of the shoulder including the rotator cuff muscles and tendons, glenoid labrum, long head biceps tendon, and glenohumeral and acromioclavicular joint articulations. Most institutions use two-dimensional sequences acquired in all three imaging planes to accurately evaluate the many important structures of the shoulder. Recently, the addition of three-dimensional (3D) acquisitions with 3D reconstructions has become clinically feasible and helped improve our understanding of several important pathologic conditions, allowing us to provide added value for referring clinicians. This article briefly describes techniques used in 3D imaging of the shoulder and discusses applications of these techniques including measuring glenoid bone loss in anterior glenohumeral instability. We also review the literature on routine 3D imaging for the evaluation of common shoulder abnormalities as 3D imaging will likely become more common as imaging software continues to improve.
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Affiliation(s)
- Steven P Daniels
- Department of Radiology, New York University Grossman School of Medicine, New York University, New York, New York
| | - Soterios Gyftopoulos
- Department of Radiology, New York University Grossman School of Medicine, New York University, New York, New York
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26
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Ladd LM, Crews M, Maertz NA. Glenohumeral Joint Instability: A Review of Anatomy, Clinical Presentation, and Imaging. Clin Sports Med 2021; 40:585-599. [PMID: 34509200 DOI: 10.1016/j.csm.2021.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The glenohumeral joint is intrinsically predisposed to instability because of the bony anatomy but maintained in alignment by many important structures, including the glenoid labrum, glenohumeral ligaments (GHLs), and muscles and tendons. Trauma and overuse can damage these stabilizers, which may then lead to subluxation or dislocation and eventually recurrent instability. This is most common in the anterior direction, which has several recognizable patterns of injury on advanced imaging, including humeral Hill Sachs deformities, bony Bankart lesion of the anteroinferior glenoid, soft tissue Bankart lesions, Bankart variant lesions (Perthes and ALPSA lesions), and HAGL/GAGL lesions. Similar reverse lesions are seen, as well as unique posterior lesions, such as Bennett and Kim's lesions. When symptoms of apprehension and instability in more than one direction are seen, one should consider multidirectional instability, which often presents with a patulous joint capsule. Finally, owing to significant impacts of daily activities and quality of life, surgical correction of labral tears, bony Bankart defects, Hill Sachs defects, and capsular laxity, may be considered.
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Affiliation(s)
- Lauren M Ladd
- Department of Radiology & Imaging Sciences, Indiana University School of Medicine, 1701 N. Senate Boulevard, Indianapolis, IN 46202, USA.
| | - Marlee Crews
- Indiana University School of Medicine, 340 W 10th St, Indianapolis, IN 46202, USA
| | - Nathan A Maertz
- Department of Radiology & Imaging Sciences, Indiana University School of Medicine, 1701 N. Senate Boulevard, Indianapolis, IN 46202, USA
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27
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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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28
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DeFroda SF, Perry AK, Bodendorfer BM, Verma NN. Evolving Concepts in the Management of Shoulder Instability. Indian J Orthop 2021; 55:285-298. [PMID: 33927807 PMCID: PMC8046877 DOI: 10.1007/s43465-020-00348-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 12/31/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Shoulder instability exists on a spectrum ranging from subtle subluxation and pain to dislocation and can be the result of a traumatic event or repetitive microtrauma. Shoulder instability can result in significant disability and often requires surgical intervention, especially amongst younger, active patient populations. The optimal treatment of shoulder instability depends on the degree of instability and concomitant pathology involving the labrum, capsule, and bony anatomy of the glenoid and humeral head. Even with surgical intervention, recurrent instability remains a relatively common and difficult problem to address. PURPOSE With a focus on anterior instability, the purpose of this review article is to discuss the current assessment and treatment of shoulder instability, and highlight current and future treatment modalities, as well as to identify current trends and deficiencies in our current management. We also provide an algorithm for the surgical treatment of anterior shoulder instability. METHODS Literature databases were extensively searched for recent articles related to the mechanism, diagnosis, and treatment of shoulder instability to comprise a comprehensive review. CONCLUSION Although there are multiple treatment modalities available for shoulder instability, such as nonoperative management, open and arthroscopic Bankart repair, Latarjet procedures, and remplissage, orthopaedic surgeons continue to learn about the most appropriate method of management as increasing long-term outcomes become available.
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Affiliation(s)
- Steven F. DeFroda
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, 1611 W. Harrison Street, Suite 300, Chicago, IL 60612 USA
| | - Allison K. Perry
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, 1611 W. Harrison Street, Suite 300, Chicago, IL 60612 USA
| | - Blake M. Bodendorfer
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, 1611 W. Harrison Street, Suite 300, Chicago, IL 60612 USA
| | - Nikhil N. Verma
- Department of Orthopaedic Surgery, Division of Sports Medicine, Rush University Medical Center, 1611 W. Harrison Street, Suite 300, Chicago, IL 60612 USA
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29
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Weber AE, Bolia IK, Horn A, Villacis D, Omid R, Tibone JE, White E, Hatch GF. Glenoid Bone Loss in Shoulder Instability: Superiority of Three-Dimensional Computed Tomography over Two-Dimensional Magnetic Resonance Imaging Using Established Methodology. Clin Orthop Surg 2021; 13:223-228. [PMID: 34094013 PMCID: PMC8173237 DOI: 10.4055/cios20097] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/11/2020] [Accepted: 07/03/2020] [Indexed: 11/06/2022] Open
Abstract
Backgroud Recent literature suggests that three-dimensional magnetic resonance imaging (3D MRI) can replace 3D computed tomography (3D CT) when evaluating glenoid bone loss in patients with shoulder instability. We aimed to examine if 2D MRI in conjunction with a validated predictive formula for assessment of glenoid height is equivalent to the gold standard 3D CT scans for patients with recurrent glenohumeral instability. Methods Patients with recurrent shoulder instability and available imaging were retrospectively reviewed. Glenoid height on 3D CT and 2D MRI was measured by two blinded raters. Difference and equivalence testing were performed using a paired t-test and two one-sided tests, respectively. The interclass correlation coefficient (ICC) was used to test for interrater reliability, and percent agreement between the measurements of one reviewer was used to assess intrarater reliability. Results Using an equivalence margin of 1 mm, 3D CT and 2D MRI were found to be different (p = 0.123). The mean glenoid height was significantly different when measured on 2D MRI (39.09 ± 2.93 mm) compared to 3D CT (38.71 ± 2.89 mm) (p = 0.032). The mean glenoid width was significantly different between 3D CT (30.13 ± 2.43 mm) and 2D MRI (27.45 ± 1.72 mm) (p < 0.001). The 3D CT measurements had better interrater agreement (ICC, 0.91) than 2D MRI measurements (ICC, 0.8). intrarater agreement was also higher on CT. Conclusions Measurements of glenoid height using 3D CT and 2D MRI with subsequent calculation of the glenoid width using a validated methodology were not equivalent, and 3D CT was superior. Based on the validated methods for the measurement of glenoid bone loss on advanced imaging studies, 3D CT study must be preferred over 2D MRI in order to estimate the amount of glenoid bone loss in candidates for shoulder stabilization surgery and to assist in surgical decision-making.
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Affiliation(s)
- Alexander E Weber
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, CA, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, CA, USA
| | - Andrew Horn
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, CA, USA
| | - Diego Villacis
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, CA, USA
| | - Reza Omid
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, CA, USA
| | - James E Tibone
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, CA, USA
| | - Eric White
- Department of Radiology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - George F Hatch
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, CA, USA
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30
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Verweij LPE, Schuit AA, Kerkhoffs GMMJ, Blankevoort L, van den Bekerom MPJ, van Deurzen DFP. Accuracy of Currently Available Methods in Quantifying Anterior Glenoid Bone Loss: Controversy Regarding Gold Standard-A Systematic Review. Arthroscopy 2020; 36:2295-2313.e1. [PMID: 32330485 DOI: 10.1016/j.arthro.2020.04.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/21/2020] [Accepted: 04/09/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine the accuracy of glenoid bone loss-measuring methods and assess the influence of the imaging modality on the accuracy of the measurement methods. METHODS A literature search was performed in the PubMed (MEDLINE), Embase, and Cochrane databases from 1994 to June 11, 2019. The guidelines and algorithm of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) were used. Included for analysis were articles reporting the accuracy of glenoid bone loss-measuring methods in patients with anterior shoulder instability by comparing an index test and a reference test. Furthermore, articles were included if anterior glenoid bone loss was quantified using a ruler during arthroscopy or by measurements on plain radiograph(s), computed tomography (CT) images, or magnetic resonance images in living humans. The risk of bias was determined using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. RESULTS Twenty-one studies were included, showing 17 different methods. Three studies reported on the accuracy of methods performed on 3-dimensional CT. Two studies determined the accuracy of glenoid bone loss-measuring methods performed on radiography by comparing them with methods performed on 3-dimensional CT. Six studies determined the accuracy of methods performed using imaging modalities with an arthroscopic method as the reference. Eight studies reported on the influence of the imaging modality on the accuracy of the methods. There was no consensus regarding the gold standard. Because of the heterogeneity of the data, a quantitative analysis was not feasible. CONCLUSIONS Consensus regarding the gold standard in measuring glenoid bone loss is lacking. The use of heterogeneous data and varying methods contributes to differences in the gold standard, and accuracy therefore cannot be determined. LEVEL OF EVIDENCE Level IV, systematic review of Level II, III, and IV studies.
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Affiliation(s)
- Lukas P E Verweij
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Alexander A Schuit
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Leendert Blankevoort
- Department of Orthopedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Academic Center for Evidence-based Sports medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Derek F P van Deurzen
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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31
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Bois AJ, Mayer MJ, Fening SD, Jones MH, Miniaci A. Management of bone loss in recurrent traumatic anterior shoulder instability: a survey of North American surgeons. JSES Int 2020; 4:574-583. [PMID: 32939489 PMCID: PMC7479034 DOI: 10.1016/j.jseint.2020.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Management of bone loss in recurrent traumatic anterior shoulder instability remains a topic of debate and controversy in the orthopedic community. The purpose of this study was to survey members of 4 North American orthopedic surgeon associations to assess management trends for bone loss in recurrent anterior shoulder instability. Methods An online survey was distributed to all members of the American Shoulder and Elbow Surgeons, American Orthopaedic Society for Sports Medicine, and Canadian Orthopaedic Association and to fellow members of the Arthroscopy Association of North America. The survey comprised 3 sections assessing the demographic characteristics of survey respondents, the influence of prognostic factors on surgical decision making, and the operative management of 12 clinical case scenarios of varying bone loss that may be encountered in clinical practice. Results A total of 150 survey responses were returned. The age of the patient and quantity of bone loss were consistently considered important prognostic criteria. However, little consensus was reached for critical thresholds of bone loss and how this affected the timing (ie, primary or revision surgery) and type of bony augmentation procedure to be performed once a critical threshold was reached, especially in the context of critical humeral and bipolar bone loss. Conclusions Consistent trends were found for the management of recurrent anterior shoulder instability in cases in which no bone loss existed and when isolated critical glenoid bone loss was present. However, inconsistencies were observed when isolated critical humeral bone loss and bipolar bone loss were present.
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Affiliation(s)
- Aaron J Bois
- Section of Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Michelle J Mayer
- Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Stephen D Fening
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Morgan H Jones
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anthony Miniaci
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
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32
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Kuberakani K, Aizawa K, Yamamoto N, Shinagawa K, Suzuki T, Hatta T, Kawakami J, Itoi E. Comparison of best-fit circle versus contralateral comparison methods to quantify glenoid bone defect. J Shoulder Elbow Surg 2020; 29:502-507. [PMID: 31564576 DOI: 10.1016/j.jse.2019.07.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 07/13/2019] [Accepted: 07/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Several measurement techniques have been reported to quantify glenoid bone defect in patients with anterior shoulder instability. Among them, the method that uses a best-fit circle and another that uses the contralateral glenoid as a control are most commonly used. However, to our knowledge, no study has been reported that compared the reliability of these methods. The purpose of this study, therefore, was to determine which of these methods has higher reproducibility. METHOD In this study, 3-dimensional computed tomography data from 94 patients (mean age 29 years) with unilateral anterior shoulder instability were used. Three examiners measured the glenoid bone defect of each patient 3 times using 2 techniques: the best-fit circle method and the contralateral comparison method. Intra- and interobserver reliabilities were measured using intraclass correlation coefficient (ICC). RESULTS The intraobserver reliability was found to be 0.91 for the best-fit circle method and 0.98 for the contralateral comparison method. The interobserver reliability was 0.77 for the best-fit circle method and 0.88 for the contralateral method. The percentage of glenoid defect was 11.5% when using the best-fit circle and 10.7% with the contralateral method. CONCLUSION The contralateral comparison method was more reliable than the best-fit circle method for quantifying the amount of glenoid bone loss.
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Affiliation(s)
- Karthikraj Kuberakani
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Kazuho Aizawa
- Department of Orthopaedic Surgery, Iwaki City Medical Center, Iwaki, Japan
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Kiyotsugu Shinagawa
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Takayuki Suzuki
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Taku Hatta
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Jun Kawakami
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan.
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33
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Foti G, Mantovani W, Catania M, Avanzi P, Caia S, Zorzi C, Carbognin G. Evaluation of glenoid labral tears: comparison between dual-energy CT arthrography and MR arthrography of the shoulder. Radiol Med 2019; 125:39-47. [PMID: 31541346 DOI: 10.1007/s11547-019-01083-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/12/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the diagnostic accuracy of dual-energy computed tomography arthrography (DE-CTA) and magnetic resonance arthrography (MRA) of the shoulder in depicting glenoid labral tears. METHODS This prospective institutional review board-approved study included 47 consecutive patients (28 males, 19 females; mean age of 34.2 years) studied between January 2017 and October 2018. All patients underwent DE-CTA and MRA the same day. Two radiologists (25 and 11 years of experience, respectively), blinded to clinical data, evaluated the presence labral tears on virtual-blended 120 kV standard CTA and on DE-CTA images. A third radiologist (18 years of experience) evaluated the MRA images. Diagnostic accuracy values were calculated by using surgery as standard of reference. Inter-observer and intra-observer agreements were calculated with k statistics. A value of p < 0.05 was considered statistically significant. RESULTS Surgery revealed the presence of labral tears in 38/47 patients (80.9%). Sensitivity and specificity values in diagnosing labral tears were 84.2% and 77.8% for MRA (Reader 3), 84.2% and 77.8% for CTA (Reader 1), 84.2% and 88.9% for CTA (Reader 2), 89.5% and 88.9% for DE-CTA (Reader 1), and 92.1% and 88.9% for DE-CTA (Reader 2). A nonsignificant increase in AUC values with respect to MRA was obtained by reading the CTA (p = 0.470) and DE-CTA dataset (p = 0.217), respectively. Inter-observer agreements were near perfect for CTA (k = 0.84) and substantial for DE-CTA reading (k = 0.76). Intra-observer agreements were near perfect both for CTA (k = 0.88) and for DE-CTA reading (k = 0.82). CONCLUSION DE-CTA and MRA were not different in terms of diagnostic performance.
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Affiliation(s)
- Giovanni Foti
- Department of Radiology, IRCCS Sacro Cuore Hospital, Negrar, Italy.
| | - William Mantovani
- Department of Preventive Medicine Public Health Trust, Trento, Italy
| | - Matteo Catania
- Department of Radiology, IRCCS Sacro Cuore Hospital, Negrar, Italy
| | - Paolo Avanzi
- Department of Orthopaedic Surgery, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Simone Caia
- Department of Radiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Claudio Zorzi
- Department of Orthopaedic Surgery, Sacro Cuore Hospital, Negrar, Italy
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