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Oliver-Welsh L, Beni R, O'Flaherty E, Pearse Y, Arnander M, Tennent D. The scapula spine may not be a suitable source of bone graft for glenoid reconstruction in critical bone loss. J Shoulder Elbow Surg 2025; 34:e126-e132. [PMID: 39151669 DOI: 10.1016/j.jse.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 07/01/2024] [Accepted: 07/04/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND The hypothesis is that the scapula spine can provide a graft of suitable dimensions for use in cases of shoulder instability with critical bone loss. We aimed to investigate its utility with grafts of differing sizes. METHODS The scapula spine was measured on computed tomography scans of 50 patients who had undergone anterior stabilization. The theoretical ability to harvest a graft of either 2 × 1 × 1 cm or 2 × 0.8 × 0.8 cm was analyzed. RESULTS Using the 2 × 1 × 1 cm threshold, 36% of the scapulae had at least 1 zone from which a suitable graft could be obtained. 61% had only 1 zone from which a suitable graft could be obtained. Using the 2 × 0.8 × 0.8 cm threshold, 72% had at least 1 zone from which a graft could be obtained. A total of 47% met the threshold in 1 zone only. CONCLUSION The scapula spine can be used as a source of autograft. Grafts up to 2 x 1 × 1 cm can be harvested in some individuals; however, the anatomy is very variable.
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Affiliation(s)
- Lucy Oliver-Welsh
- St George's Shoulder Unit, St George's University Hospital London, London, UK.
| | - Rebecca Beni
- St George's Shoulder Unit, St George's University Hospital London, London, UK
| | - Emmett O'Flaherty
- St George's Shoulder Unit, St George's University Hospital London, London, UK
| | - Yemi Pearse
- St George's Shoulder Unit, St George's University Hospital London, London, UK
| | - Magnus Arnander
- St George's Shoulder Unit, St George's University Hospital London, London, UK
| | - Duncan Tennent
- St George's Shoulder Unit, St George's University Hospital London, London, UK
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Huddleston H, Credille K, Wang Z, Cregar W, Lansdown DA, Chahla J, Garrigues GE, Verma NN, Yanke AB. Current Methods Used to Evaluate Glenoid Bone Loss: A Survey of Orthopaedic Surgeons. Orthop J Sports Med 2025; 13:23259671241288163. [PMID: 39968413 PMCID: PMC11833853 DOI: 10.1177/23259671241288163] [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: 03/28/2024] [Accepted: 04/12/2024] [Indexed: 02/20/2025] Open
Abstract
Background Evaluation of glenoid bone loss is critical in preoperative planning, as bone loss >13.5% has been associated with worse clinical outcomes. While 3-dimensional computed tomography (3D CT) and the Pico method have been the gold standard in bone loss evaluation, it is unclear how most orthopaedic surgeons evaluate for bone loss in practice. Purpose To investigate the techniques used by orthopaedic surgeons to measure glenoid bone loss. Study Design Cross-sectional study. Methods A 12-question survey was sent to members of the AOSSM and Arthroscopy Association of North America. This survey included questions regarding the participants' demographic information, typical surgical practice and volume, and glenoid bone loss identification method. Friedman testing with multiple comparisons using Bonferroni correction was used to evaluate the ordinal variable, use frequency, while Kruskal-Wallis testing and Spearman correlations were used to evaluate the role of surgeon demographic factors on method usage. Results Overall, 171 orthopaedic surgeons responded to the survey. Participating surgeons were from a variety of locations, practice settings, and years in practice; 91.1% of respondents said that they routinely measure glenoid bone loss. The imaging modality most commonly used for bone loss evaluation was 3D CT, followed by 2-dimensional (2D) magnetic resonance imaging, then 2D CT and radiographs. Percentage diameter loss was the most commonly used method of bone loss evaluation. The intraoperative probe length method was used occasionally, the Pico method was used rarely, and the chord length method was never used. There was no significant effect of time in practice or practice location on bone loss methods used. Surgeons in private practice (P = .022) or other settings (P = .015) had a higher frequency of using the intraoperative probe length method compared with those in the military. Conclusion Overall, this study highlights the inconsistency in surgeon evaluation of glenoid bone loss in shoulder instability, despite good evidence of its clinical importance, especially in preventing recurrent instability. This lack of consistency may be mitigated with the establishment of best practice guidelines or accepted algorithms for evaluation and assessment of glenoid bone loss in shoulder instability.
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Affiliation(s)
| | | | - Zachary Wang
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | | | | | - Jorge Chahla
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Grant E. Garrigues
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Nikhil N. Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Adam B. Yanke
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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Zinner MA, Neufeld EV, Goodwillie AD. The Radiologic Evaluation and Clinical Significance of Glenohumeral Bone Loss in Anterior Shoulder Instability. J Clin Med 2024; 13:7708. [PMID: 39768631 PMCID: PMC11679992 DOI: 10.3390/jcm13247708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Revised: 11/13/2024] [Accepted: 11/21/2024] [Indexed: 01/11/2025] Open
Abstract
Glenoid and humeral bone loss is associated with a high incidence of recurrent shoulder instability and failure of arthroscopic stabilization procedures. However, the radiographic evaluation of bony Bankart and Hill-Sachs injuries continues to pose a diagnostic challenge, and a universally accepted optimal method of measurement is lacking. The purpose of this review is to summarize the advantages and disadvantages of various techniques and imaging modalities available for measuring glenoid bone loss in shoulder instability, including conventional roentgenography, 2-dimensional and 3-dimensional computed tomography (CT), and magnetic resonance imaging (MRI). We also review the concepts of engaging "on-track" and "off-track" Hill-Sachs lesions. Finally, we highlight the clinical importance of obtaining accurate determinations of bone loss by the various methods available, as it can affect surgical decision making and the appropriate procedure required to ensure shoulder stability is adequately restored.
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Affiliation(s)
- Matthew A. Zinner
- Northwell Health, New Hyde Park, NY 11040, USA (E.V.N.)
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center/North Shore University Hospital, New Hyde Park, NY 11030, USA
| | - Eric V. Neufeld
- Northwell Health, New Hyde Park, NY 11040, USA (E.V.N.)
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center/North Shore University Hospital, New Hyde Park, NY 11030, USA
| | - Andrew D. Goodwillie
- Northwell Health, New Hyde Park, NY 11040, USA (E.V.N.)
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center/North Shore University Hospital, New Hyde Park, NY 11030, USA
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Johnson CM, DeFoor MT, Griswold BG, Bozzone AE, Galvin JW, Parada SA. Functional Anatomy and Biomechanics of Shoulder Instability. Clin Sports Med 2024; 43:547-565. [PMID: 39232565 DOI: 10.1016/j.csm.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
The glenohumeral joint is the least congruent and least constrained joint with a complex relationship of static and dynamic stabilizers to balance its native mobility with functional stability. In the young athlete, anterior shoulder instability is multifactorial and can be a challenge to treat, requiring a patient-specific treatment approach. Surgical decision-making must consider patient-specific factors such as age, sport activity and level, underlying ligamentous laxity, and goals for return to activity, in addition to careful scrutiny of the underlying pathology to include humeral and glenoid bone loss and surrounding scapular bone morphology.
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Affiliation(s)
- Craig M Johnson
- Madigan Army Medical Center, 9040 Jackson Avenue, Tacoma, WA 98431, USA
| | - Mikalyn T DeFoor
- San Antonio Military Medical Center, 3551 Roger Brooke Drive, San Antonio, TX 78234, USA
| | - Branum Gage Griswold
- Denver Shoulder/Western Orthopaedics, 1830 Franklin Street, Denver, CO 80218, USA
| | - Anna E Bozzone
- Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA 30912, USA
| | - Joseph W Galvin
- Orthopaedic Surgery, Madigan Army Medical Center, 9040 Jackson Avenue, Tacoma, WA 98431, USA
| | - Stephen A Parada
- Orthopaedic Research, Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA 30912, USA.
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Vagstad T, Klungsøyr JA, Bjerknes C, Klungsøyr P, Skrede A, Dalen A, Drogset JO, Myklebust TÅ, Hermansen E. Biomechanical comparison shows increased stability of an arthroscopic subscapular sling procedure compared to an open Latarjet reconstruction for anterior shoulder instability in specimens with major glenoid bone defect. J Exp Orthop 2024; 11:e70015. [PMID: 39314811 PMCID: PMC11417344 DOI: 10.1002/jeo2.70015] [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: 03/31/2024] [Revised: 08/26/2024] [Accepted: 08/28/2024] [Indexed: 09/25/2024] Open
Abstract
Purpose Recurrent anterior glenohumeral instability (RASI) is commonly treated with arthroscopic techniques, though their effectiveness in providing stability may diminish in cases of critical glenoid bone loss. This study aimed to compare the stability outcomes and range of motion (ROM) associated with an arthroscopic subscapular sling procedure (SSP), first introduced in 2015. Methods Sixteen fresh-frozen human cadaveric shoulder specimens were biomechanically evaluated in four conditions: native, injured, post-SSP and post-LP. Glenohumeral translations were measured under anterior, anteroinferior and inferior loading, while external rotation ROM was assessed in neutral and abducted positions. Testing was conducted using a robotic system for precise force and torque application. Specimens were prepared with a 20% glenoid bone defect and subjected to stability testing sequentially. Results The SSP significantly reduced glenohumeral translations compared to LP, particularly under anterior loading in neutral (p < 0.001), external rotation (p = 0.007) and abduction (p < 0.001) positions. Although the SSP demonstrated superior stability in these key positions, it did not consistently outperform the LP across all scenarios, as stability was similar between the two in the abducted and rotated position under anterior loading (p = 0.379). Under anteroinferior loading, the SSP showed comparatively better stability at neutral (p = 0.003) and abduction (p < 0.001), whereas the LP led to greater anteroinferior translations in these same positions (p = 0.002 and p = 0.014, respectively). The SSP outperformed the LP under inferior loading in neutral (p = 0.005) and abduction (p = 0.02) positions, though it did not fully restore stability to native shoulder levels. The SSP maintained ROM similar to native shoulders. LP allowed greater ROM, potentially compromising stability. Conclusion The SSP provided greater stability than the open Latarjet in most positions and did not limit ROM, suggesting it could be a viable, less invasive option for managing shoulder instability. Level of Evidence Not applicable.
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Affiliation(s)
- Terje Vagstad
- Department of ICT and Natural SciencesNorwegian University of Science and Technology (NTNU)ÅlesundNorway
| | - Jan Arild Klungsøyr
- Orthopedic DepartmentMøre and Romsdal Hospital TrustÅlesundNorway
- Department of Neuromedicine and Movement ScienceNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | | | - Petter Klungsøyr
- Orthopedic DepartmentMøre and Romsdal Hospital TrustÅlesundNorway
| | - Aleksander Skrede
- Department of ICT and Natural SciencesNorwegian University of Science and Technology (NTNU)ÅlesundNorway
| | - Andreas Dalen
- Orthopedic DepartmentMøre and Romsdal Hospital TrustÅlesundNorway
| | - Jon Olav Drogset
- Department of Neuromedicine and Movement ScienceNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Orthopedic DepartmentTrondheim University HospitalTrondheimNorway
| | - Tor Åge Myklebust
- Department of Research and InnovationMøre and Romsdal Hospital TrustÅlesundNorway
| | - Erland Hermansen
- Department of Research and InnovationMøre and Romsdal Hospital TrustÅlesundNorway
- Department of Health SciencesNorwegian University of Science and Technology (NTNU)ÅlesundNorway
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Meisterhans M, Selman F, Ongini E, Borbas P, Wieser K. Stability of novel cow-hitch suture button coracoid bone graft fixation in Latarjet procedures: a biomechanical study. J Shoulder Elbow Surg 2024; 33:610-617. [PMID: 37788755 DOI: 10.1016/j.jse.2023.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/26/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND The Latarjet procedure is widely used to address anterior shoulder instability, especially in case of glenoid bone loss. Recently, cortical suture button fixation for coracoid transfer has been used to mitigate complications seen with screw placement. The aim of this biomechanical study was to evaluate the stability of a novel and cost-effective cow-hitch suture button technique, designed to be performed through a standard open deltopectoral approach, and compare this to a well-established double suture button technique. MATERIALS AND METHODS We randomly assigned 12 fresh frozen cadaveric shoulders to undergo the Latarjet procedure with either 4 suture button (S&N EndoButton) fixations (SB group; n = 6, age 72 ± 9.8 years) or cow-hitch suture button technique using a 1.7-mm FiberTape looped sequentially in 2 suture buttons (Arthrex Pectoralis Button) placed from anterior on the posterior glenoid (CH-SB group; n = 6, age 73 ± 9.3 years). After fixation, all shoulders underwent biomechanical testing with direct loading on the graft via a material testing system. Cyclic loading was performed for 100 cycles (10-100 N) to determine axial displacement with time; each graft was then monotonically loaded to failure. RESULTS The maximum cyclic displacement was 4.3 ± 1.6 mm for the cow-hitch suture button technique and 5.0 ± 1.7 mm for the standard double suture button technique (P = .46). Ultimate load to failure and stiffness were, respectively, 190 ± 82 N and 221 ± 124 N/mm for the CH-SB technique and 172 ± 48 N and 173 ± 34 N/mm for the standard double SB technique (P = .66 and .43). The most common failure mode was suture cut-through at the anteroinferior aspect of the glenoid for both fixation groups. CONCLUSIONS The cow-hitch suture button technique resulted in a similar elongation, stiffness, and failure load compared to an established double suture button technique. Therefore, this cost-effective fixation may be an alternative, eligible for open approaches, to the established double suture button techniques.
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Affiliation(s)
- Michel Meisterhans
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Farah Selman
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Esteban Ongini
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Paul Borbas
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Karl Wieser
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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7
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LaVigne CA, Griffith TB, Hanson ZC, Davis DD, Kercher JS, Duralde XA. Beyond guesswork: how accurate are surgeons at determining the degree of glenoid bone loss in instability surgery? JSES Int 2024; 8:268-273. [PMID: 38464449 PMCID: PMC10920134 DOI: 10.1016/j.jseint.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Background Accurate measurement of glenoid bone loss (GBL) is critical to preoperative planning in cases of recurrent shoulder instability. The concept of critical bone loss has been established with a value of GBL >13.5% being associated with higher failure rate following arthroscopic Bankart Repair. Advanced imaging, such as magnetic resonance imaging (MRI) scans, can be used to quantify GBL prior to surgery using the best-fit circle technique. Surgeons have traditionally relied on visual inspection of the MRI scan preoperatively or on visual inspection of the glenoid at the time of arthroscopy to determine whether GBL is present. The purpose of this study is to determine if 3 fellowship-trained shoulder surgeons could adequately quantify GBL without using best-fit circle measurements on MRI. Methods A retrospective review was performed which included 122 patients over an 8-year period that had an arthroscopic Bankart repair performed by 3 fellowship-trained surgeons. In all patients, preoperative MRI scans were retrospectively measured using best-fit circle technique to determine true GBL and compare that to the surgeons' preoperative and intraoperative estimation of GBL. Results GBL was correctly identified in only 36% (18/50) of patients when the preoperative best-fit circle measurements were not made. Critical bone loss was missed in 9.8% (12/122) of patients in the study group. The estimated mean bone loss in that group by visual inspection was 11.3% compared to 16% true bone loss measured on MRI. Even in the 18 patients with some identified bone loss prior to surgery, critical bone loss was missed in 6 patients when using visual inspection of the MRI or intraoperative inspection alone. Conclusion Simple visual inspection of glenoid images on MRI scan and visual inspection of the glenoid at the time of surgery are inaccurate in determining the true extent of GBL especially in cases of subtle bone deficiency. Preoperative planning is dependent on the exact degree of bone deficiency and measurement on the MRI scan using the best-fit circle technique is recommended in all cases of instability surgery.
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Affiliation(s)
- Caleb A. LaVigne
- Department of Orthopedic Surgery, Wellstar Health Systems, Marietta, GA, USA
| | | | - Zachary C. Hanson
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
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8
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Benes M, Fulin P, Kachlik D, Al-Redouan A, Tomaides J, Kysilko M, Salavova S, Kunc V. Osseous variations associated with physiological thinning of the glenoid articular cartilage: an osteological study with CT, MRI and arthroscopic correlations. Skeletal Radiol 2023; 52:2435-2449. [PMID: 37227484 PMCID: PMC10581943 DOI: 10.1007/s00256-023-04358-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/20/2023] [Accepted: 04/28/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To investigate the relationship between osseous variations of the glenoid fossa and thinning of the overlaying articular cartilage. MATERIALS AND METHODS In total, 360 dry scapulae, comprising adult, children and fetal specimens, were observed for potential presence of osseous variants inside the glenoid fossa. Subsequently, the appearance of the observed variants was evaluated using CT and MRI (each 300 scans), and in-time arthroscopic findings (20 procedures). New terminology of the observed variants was proposed by an expert panel formed by orthopaedic surgeons, anatomists and radiologists. RESULTS Tubercle of Assaky was observed in 140 (46.7%) adult scapulae, and an innominate osseous depression was identified in 27 (9.0%) adult scapulae. Upon radiological imaging, the tubercle of Assaky was found in 128 (42.7%) CTs and 118 (39.3%) MRIs, while the depression was identified in 12 (4.0%) CTs and 14 (4.7%) MRIs. Articular cartilage above the osseous variations appeared relatively thinner and in several young individuals was found completely absent. Moreover, the tubercle of Assaky featured an increasing prevalence with aging, while the osseous depression develops in the second decade. Macroscopic articular cartilage thinning was identified in 11 (55.0%) arthroscopies. Consequently, four new terms were invented to describe the presented findings. CONCLUSION Physiological articular cartilage thinning occurs due to the presence of the intraglenoid tubercle or the glenoid fovea. In teenagers, the cartilage above the glenoid fovea may be naturally absent. Screening for these variations increases the diagnostic accuracy of glenoid defects. In addition, implementing the proposed terminological updates would optimize communication accuracy.
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Affiliation(s)
- Michal Benes
- Department of Anatomy, Second Faculty of Medicine, Charles University, Plzenska 130/221, 150 06, Prague 5, Czech Republic
- Center for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Fulin
- 1st Department of Orthopaedics, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - David Kachlik
- Department of Anatomy, Second Faculty of Medicine, Charles University, Plzenska 130/221, 150 06, Prague 5, Czech Republic
- Center for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Health Care Studies, College of Polytechnics, Jihlava, Czech Republic
| | - Azzat Al-Redouan
- Department of Anatomy, Second Faculty of Medicine, Charles University, Plzenska 130/221, 150 06, Prague 5, Czech Republic
- Center for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Tomaides
- 1st Department of Orthopaedics, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Martin Kysilko
- Department of Radiology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Sarka Salavova
- Department of Anatomy, Second Faculty of Medicine, Charles University, Plzenska 130/221, 150 06, Prague 5, Czech Republic
- Center for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vojtech Kunc
- Department of Anatomy, Second Faculty of Medicine, Charles University, Plzenska 130/221, 150 06, Prague 5, Czech Republic.
- Center for Endoscopic, Surgical and Clinical Anatomy (CESKA), Second Faculty of Medicine, Charles University, Prague, Czech Republic.
- Clinic of Trauma Surgery, Masaryk Hospital, Usti Nad Labem, Czech Republic.
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Alkhelaifi K, Alzobi OZ, Mahmoud SA, Zikria BA. Recurrent Instability after the Latarjet Procedure. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202312000-00001. [PMID: 38011051 PMCID: PMC10664849 DOI: 10.5435/jaaosglobal-d-23-00205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 11/29/2023]
Abstract
The Latarjet procedure is a favored approach for managing chronic and recurrent dislocation, especially in the presence of bone loss. Although generally yielding excellent results, the procedure carries a 15 to 30% complication rate. Although recurrent instability is a major concern, various complications such as infection, nerve injuries, and hardware impingement can also necessitate revision after a Latarjet procedure. Strategies for addressing this issue include glenoid bone grafting, using autogenous bone grafts from the iliac crest or distal clavicle, and allografts, with fresh lateral distal tibial allografts offering advantages because of their osteochondral nature. In addition, soft-tissue procedures offer another solution for recurrent instability, suitable for patients lacking substantial bone loss or those experiencing multidirectional instability. This review aims to provide a comprehensive overview of the causes and management strategies for recurrent instability following a failed Latarjet procedure.
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Affiliation(s)
- Khalid Alkhelaifi
- From the Orthopaedic Surgeon, Aspetar-Qatar Orthopaedic and Sports Medicine Hospital, Qatar (Dr. Alkhelaifi and Dr. Zikria), and the Department of Orthopeadic (Dr. Alzobi and Dr. Mahmoud), Hamad General Hospital, Qatar
| | - Osama Z. Alzobi
- From the Orthopaedic Surgeon, Aspetar-Qatar Orthopaedic and Sports Medicine Hospital, Qatar (Dr. Alkhelaifi and Dr. Zikria), and the Department of Orthopeadic (Dr. Alzobi and Dr. Mahmoud), Hamad General Hospital, Qatar
| | - Shady A. Mahmoud
- From the Orthopaedic Surgeon, Aspetar-Qatar Orthopaedic and Sports Medicine Hospital, Qatar (Dr. Alkhelaifi and Dr. Zikria), and the Department of Orthopeadic (Dr. Alzobi and Dr. Mahmoud), Hamad General Hospital, Qatar
| | - Bashir A. Zikria
- From the Orthopaedic Surgeon, Aspetar-Qatar Orthopaedic and Sports Medicine Hospital, Qatar (Dr. Alkhelaifi and Dr. Zikria), and the Department of Orthopeadic (Dr. Alzobi and Dr. Mahmoud), Hamad General Hospital, Qatar
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10
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Bond EC, Florance J, Dickens JF, Taylor DC. Review of Burkhart and DeBeer's (2000) article on traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repair: Where have we taken the concept of glenoid bone loss in 2023? J ISAKOS 2023; 8:467-473. [PMID: 37673126 DOI: 10.1016/j.jisako.2023.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/03/2023] [Accepted: 08/25/2023] [Indexed: 09/08/2023]
Abstract
This classic discusses the original publication by Burkhart and DeBeer "Traumatic Glenohumeral Bone Defects and Their Relationship to Failure of Arthroscopic Bankart Repair" published in 2000 in Arthroscopy. At that time, the authors sought to understand the reasons behind the failure of arthroscopic soft tissue repair. Based on their findings, the authors introduced the concept of the inverted pear glenoid and engaging Hill-Sachs lesion which is now part of the orthopedic lexicon. The importance of bony pathologic changes in anterior glenohumeral instability has become so apparent, that it now forms the basis of clinical understanding and underpins treatment algorithms. Since this publication over 20 years ago, the idea of glenohumeral bone loss has been extensively explored and refined. There is no doubt of the importance of structural bone loss yet there is still uncertainty as to the best management of those with subcritical bone loss. The purpose of revisiting this classic article is to look at where we are in understanding recurrent instability and bony deficiency while appreciating how far we have come. This review begins with a detailed summary of the classic article along with a historic perspective. Next, we look at the current evidence as it pertains to the classic article and how modern technology and innovation has advanced our ability to assess and quantify glenohumeral bone loss. We finish with expert commentary on the topic from two current surgeons with a research interest in shoulder instability to offer an insight into how modern surgeons view and address this issue. One of the original authors also reflects on the topic. The findings of this classic study changed the way we think about shoulder instability and opened the doors to an exciting body of research that is still growing today. Future research offers an opportunity for high quality evidence to guide management in the group of patients with subcritical bone loss and we eagerly await the results.
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Affiliation(s)
- Elizabeth C Bond
- Duke Sports Sciences Institute, Duke Centre for Living Campus, 3475 Erwin Road, Durham, NC 27705, USA.
| | - Jonathon Florance
- Duke Sports Sciences Institute, Duke Centre for Living Campus, 3475 Erwin Road, Durham, NC 27705, USA.
| | - Jonathan F Dickens
- Duke Sports Sciences Institute, Duke Centre for Living Campus, 3475 Erwin Road, Durham, NC 27705, USA.
| | - Dean C Taylor
- Duke Sports Sciences Institute, Duke Centre for Living Campus, 3475 Erwin Road, Durham, NC 27705, USA.
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11
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Orhan Ö, Sezgin EA, Özer M, Ataoğlu MB, Kanatlı U. Does glenoid bone loss accompany posterior shoulder instability with only labral tear? A magnetic resonance imaging-based study. J Shoulder Elbow Surg 2023; 32:2066-2073. [PMID: 37507000 DOI: 10.1016/j.jse.2023.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 06/07/2023] [Accepted: 06/24/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND The primary aim of this study was to investigate bone loss in the glenoid with magnetic resonance imaging in posterior shoulder instability with only a labral tear. METHODS A total of 76 patients operated on because of posterior and anteroposterior shoulder instability only with a labral tear between 2006 and 2019 (n = 40 and n = 36, respectively) were included in this study. The instability type, a presence of an additional superior labrum anteroposterior (SLAP) lesion, the number of dislocations, and the magnetic resonance imaging-based measurements (the glenoid diameter and the bone defect size in the glenoid, the Hill-Sachs lesion [HSL] and the reverse HSL [rHSL] length, the angle and the arc length of HSL and rHSL, and the humerus head diameter and its area) were analyzed. RESULTS The size of the anterior glenoid defect, the rHSL measurements (length, angle, and arc length), and the ratio of the anterior glenoid defect size to the glenoid diameter were significantly higher for anteroposterior instability (P < .01) cases. There was no significant difference (P = .49, .64, and .82, respectively) for the presence of an additional SLAP pathology, the glenoid diameter, the posterior glenoid defect, and the ratio of the posterior glenoid defect size to the glenoid diameter in posterior and anteroposterior instability groups. The increased number of dislocations was associated with increased rHSL length and total arc length (P = .04 and .03, respectively). An additional SLAP lesion in posterior shoulder instabilities was not associated with the bone defect size (P = .29). CONCLUSION Although the posterior shoulder instability with only a labral tear is likely to cause a bone defect, we have shown that the instability is not expected to be caused by the bone defect. Therefore, this study points out that only soft tissue repair without considering the bone defect could be promising in this patient group.
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Affiliation(s)
- Özlem Orhan
- Department of Orthopedics and Traumatology, Medical Faculty of Harran University, Şanlıurfa, Turkey.
| | - Erdem Aras Sezgin
- Department of Orthopedics and Traumatology, Aksaray University Training and Education Hospital, Aksaray, Turkey
| | - Mustafa Özer
- Department of Orthopedics and Traumatology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | | | - Ulunay Kanatlı
- Department of Orthopedics and Traumatology, Medical Faculty of Gazi University, Ankara, Turkey
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12
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Wood R, McCrum C. Humeral Head Articular Cartilage Damage by a Retained Arthroscopic Suture Anchor Inserter in a College Athlete. Cureus 2023; 15:e44536. [PMID: 37790009 PMCID: PMC10544675 DOI: 10.7759/cureus.44536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/05/2023] Open
Abstract
Arthroscopic repair of the glenoid labrum has been shown to be a safe and effective method to address recurrent shoulder instability. However, suture anchor devices must be used appropriately and with caution to avoid postoperative complications such as prominence, migration, and loosening, which can result in intraarticular pathology postoperatively. We report a case of significant glenohumeral articular cartilage damage that occurred as a result of a retained broken suture anchor inserter after arthroscopic Bankart repair. This case demonstrates an uncommon but serious complication that can occur during the surgical insertion of suture anchors when performing arthroscopic labral repairs. Although rare, retained foreign bodies must also be considered in the differential of a symptomatic postoperative patient. Thus, postoperative radiographs are also of extreme importance in evaluating a patient with persistent pain and crepitus after surgical glenoid labral repair.
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Affiliation(s)
- Robert Wood
- Orthopedics, Samaritan Health Services, Corvallis, USA
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13
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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: 7] [Impact Index Per Article: 3.5] [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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14
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Yeo MHX, Lie D, Cheong T, Wonggokusuma E, Mak WK. Anatomic risk factors for arthroscopic Bankart repair failure: A case-control study comparing failure and non-failure groups in an Asian population. J Orthop 2023; 41:73-78. [PMID: 37362959 PMCID: PMC10285502 DOI: 10.1016/j.jor.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Post-arthroscopic Bankart repair failure/re-dislocation rates are influenced by several risk factors, including anatomic defects. There is limited evidence on the role of anatomic defects, especially for Hill-Sachs size in on-track lesions. This study aimed to assess glenoid bone loss, Hill-Sachs lesion and labral tear size and evaluate their contribution to post-operative instability after a primary repair. Material and methods Across 169 patients with on-track Bankart lesions who underwent primary arthroscopic Bankart repair from 2010 to 2015, this study matched 14 failure with 14 non-failure cases based on age/gender. Patient demographics, pre-operative radiological parameters (including size of glenoid bone loss and Hill-Sachs lesion) and labral tear size were compared between the failure and non-failure groups. Result All patients were male with a mean age of 21.01 ± 4.97. Significantly greater glenoid bone loss (p = 0.024) and labral tear size (p = 0.039) were found in the failure group. However, there was no significant difference in mean volume of Hill-Sachs lesion between the two groups (p = 0.739). Conclusion Extensive glenoid bone loss and labral tears are risk factors for post-arthroscopic Bankart failure. However, the size of Hill-Sachs lesion is not a risk factor for failure, in a specific group of on-track Hill-Sachs lesions. Level of evidence Retrospective Study, Level IV.
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Affiliation(s)
- Mark HX Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Denny Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Teddy Cheong
- Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang E Way, 544886, Singapore
| | - Erick Wonggokusuma
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Wai Keong Mak
- Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang E Way, 544886, Singapore
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Tennent D, Antonios T, Arnander M, Ejindu V, Papadakos N, Rastogi A, Pearse Y. CT methods for measuring glenoid bone loss are inaccurate, and not reproducible or interchangeable. Bone Jt Open 2023; 4:478-489. [PMID: 37399100 PMCID: PMC10313462 DOI: 10.1302/2633-1462.47.bjo-2023-0066.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
Aims Glenoid bone loss is a significant problem in the management of shoulder instability. The threshold at which the bone loss is considered "critical" requiring bony reconstruction has steadily dropped and is now approximately 15%. This necessitates accurate measurement in order that the correct operation is performed. CT scanning is the most commonly used modality and there are a number of techniques described to measure the bone loss however few have been validated. The aim of this study was to assess the accuracy of the most commonly used techniques for measuring glenoid bone loss on CT. Methods Anatomically accurate models with known glenoid diameter and degree of bone loss were used to determine the mathematical and statistical accuracy of six of the most commonly described techniques (relative diameter, linear ipsilateral circle of best fit (COBF), linear contralateral COBF, Pico, Sugaya, and circle line methods). The models were prepared at 13.8%, 17.6%, and 22.9% bone loss. Sequential CT scans were taken and randomized. Blinded reviewers made repeated measurements using the different techniques with a threshold for theoretical bone grafting set at 15%. Results At 13.8%, only the Pico technique measured under the threshold. At 17.6% and 22.9% bone loss all techniques measured above the threshold. The Pico technique was 97.1% accurate, but had a high false-negative rate and poor sensitivity underestimating the need for grafting. The Sugaya technique had 100% specificity but 25% of the measurements were incorrectly above the threshold. A contralateral COBF underestimates the area by 16% and the diameter by 5 to 7%. Conclusion No one method stands out as being truly accurate and clinicians need to be aware of the limitations of their chosen technique. They are not interchangeable, and caution must be used when reading the literature as comparisons are not reliable.
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Affiliation(s)
| | - Tony Antonios
- Trauma & Orthopaedics, St Peter's Hospital, Surrey, UK
| | | | - Vivian Ejindu
- St. George's Hospital and Medical School, London, UK
| | - Nik Papadakos
- St. George's Hospital and Medical School, London, UK
| | | | - Yemi Pearse
- St. George's Hospital and Medical School, London, UK
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16
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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: 2.0] [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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Arenas-Miquelez A, Karargyris O, Graham PL, Hertel R. High correlation between inner and outer glenoid circle diameters and its clinical relevance. Knee Surg Sports Traumatol Arthrosc 2023; 31:199-205. [PMID: 35809103 DOI: 10.1007/s00167-022-07050-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 06/09/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE The majority of methods for measuring glenoid bone loss in shoulder instability use the best-fit circle following the inferior glenoid rim. However, there is no precise method on how to draw this circle, particularly in case of a missing rim segment. Defining the radius is a source of substantial error. It was hypothesized that there is a relationship between the best-fit inferior circle (inner circle), defined by Sugaya, and the circle tangent to the supra- and infra-glenoid tubercles (outer circle), defined by Itoi, thus allowing a more consistent appreciation of the paleo-glenoid. METHODS Ninety-five normal dry scapulae were examined. The specimens were digitally photographed obtaining perpendicular images of the glenoid cavity. Using HOROS® imaging software, a best-fit inferior circle (inner circle) and a second circle fitting the most inferior and superior points of the glenoid (outer circle) were drawn by two investigators. The diameters and areas of the circles were recorded. Two-way random-effects intra-class correlation coefficients (ICC) were used to measure intra- and inter-observer agreement. A Bayesian measurement-error regression model was used to determine the relationship between outer and inner circle measurements. RESULTS The mean glenoid height was 35.1 mm and the glenoid width 25.6 mm. The mean diameter of the outer circle was 35.7 ± 4.2 mm and the mean diameter of the inner circle was 26.8 ± 3.2 mm. ICC showed excellent inter- and intra-observer agreement for both the outer circle diameter (ICC ≥ 0.95) and inner circle diameter (ICC ≥ 0.93). The two diameters demonstrated a very strong significant Pearson correlation (0.92, p < 0.001) and the regression showed excellent model fit R2 = 0.87. The areas of the two circles were also highly and significantly correlated (r = 0.94; p < 0.001). The ratio of inner circle to outer diameters was 0.74. CONCLUSION There is a strong correlation between the inner and outer glenoid circle diameters. This study sets the base for the use the combined outer and inner circle and its ratio to better appreciate the paleo-glenoid morphology and thus obtain a more reliable bone loss estimation. Application of this method aids in a more reliable estimation bone loss with potential benefit in surgical decision-making.
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Affiliation(s)
- Antonio Arenas-Miquelez
- Shoulder and Elbow, Orthopaedics, Lindenhofspital, Bremgartenstrasse 117, 3001, Bern, Switzerland.
| | | | - Petra L Graham
- School of Mathematical and Physical Sciences, Macquarie University, Sydney, NSW, Australia
| | - Ralph Hertel
- Shoulder and Elbow, Orthopaedics, Lindenhofspital, Bremgartenstrasse 117, 3001, Bern, Switzerland
- Campus Stiftung Lindenhof Bern, Swiss Institute for Translational and Entrepreneurial Medicine, Bern, Switzerland
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18
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Tennent TD, Pearse Y, Arnander M. What Is the Most Reliable Method of Measuring Glenoid Bone Loss in Anterior Glenohumeral Instability? Letter to the Editor. Am J Sports Med 2022; 50:NP57-NP58. [PMID: 36318100 DOI: 10.1177/03635465221121605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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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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20
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Evaluating Bone Loss in Anterior Shoulder Instability. J Am Acad Orthop Surg 2022; 30:563-572. [PMID: 35653280 DOI: 10.5435/jaaos-d-22-00016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/23/2022] [Indexed: 02/01/2023] Open
Abstract
Anterior shoulder instability is a common orthopaedic condition that often involves damage to the bony architecture of the glenohumeral joint in addition to the capsulolabral complex. Patients with recurrent shoulder dislocations are at increased risk for glenohumeral bone loss, as each instability event leads to the accumulation of additional glenoid and/or humeral head bone defects. Depending on the degree of bone loss, successful treatment may need to address bony lesions in addition to injured soft-tissue structures. As such, a thorough understanding of methods for evaluating bone loss preoperatively, in terms of location, size, and significance, is essential. Although numerous imaging modalities can be used, three-dimensional imaging has proven particularly useful and is now an integral component of preoperative planning.
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Abstract
Aims Recurrent dislocation is both a cause and consequence of glenoid bone loss, and the extent of the bony defect is an indicator guiding operative intervention. Literature suggests that loss greater than 25% requires glenoid reconstruction. Measuring bone loss is controversial; studies use different methods to determine this, with no clear evidence of reproducibility. A systematic review was performed to identify existing CT-based methods of quantifying glenoid bone loss and establish their reliability and reproducibility Methods A Preferred Reporting Items for Systematic reviews and Meta-Analyses-compliant systematic review of conventional and grey literature was performed. Results A total of 25 studies were initially eligible. Following screening, nine papers were included for review. Main themes identified compared 2D and 3D imaging, as well as linear- compared with area-based techniques. Heterogenous data were acquired, and therefore no meta-analysis was performed. Conclusion No ideal CT-based method is demonstrated in the current literature, however evidence suggests that surface area methods are more reproducible and lead to fewer over-estimations of bone loss, provided the views used are standardized. A prospective imaging trial is required to provide a more definitive answer to this research question. Cite this article: Bone Jt Open 2022;3(2):114–122.
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Affiliation(s)
- Gemma L. Green
- Trauma and Orthopaedics, St George's Hospital, London, UK
| | | | - Eyiyemi Pearse
- Shoulder and Elbow Unit, St George's Hospital, London, UK
| | - Duncan Tennent
- Shoulder and Elbow Unit, St George's Hospital, London, UK
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22
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Ernat JJ, Golijanin P, Peebles AM, Eble SK, Midtgaard KS, Provencher MT. Anterior and Posterior Glenoid Bone Loss In Patients Receiving Surgery for Glenohumeral Instability Is Not the Same: A Comparative 3-Dimensional Imaging Analysis. JSES Int 2022; 6:581-586. [PMID: 35813144 PMCID: PMC9264014 DOI: 10.1016/j.jseint.2022.02.007] [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] [Indexed: 11/28/2022] Open
Abstract
Background Methods Results Conclusion
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Affiliation(s)
| | - Petar Golijanin
- The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | | | | | | | - Matthew T. Provencher
- The Steadman Clinic, Vail, CO, USA
- The Steadman Philippon Research Institute, Vail, CO, USA
- Corresponding author: CAPT Matthew T. Provencher, MD, MBA, MC, USNR (ret.), The Steadman Philippon Research Institute, The Steadman Clinic, 181 W Meadow Dr, Ste 400, Vail, CO 81657, 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: 0.7] [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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Bottoni CR, Johnson JD, Zhou L, Raybin SG, Shaha JS, Cruz CA, Lindell KK, Thoma DC. Arthroscopic Versus Open Anterior Shoulder Stabilization: A Prospective Randomized Clinical Trial With 15-Year Follow-up With an Assessment of the Glenoid Being "On-Track" and "Off-Track" as a Predictor of Failure. Am J Sports Med 2021; 49:1999-2005. [PMID: 34102075 DOI: 10.1177/03635465211018212] [Citation(s) in RCA: 16] [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 Recent studies have demonstrated equivalent short-term results when comparing arthroscopic versus open anterior shoulder stabilization. However, none have evaluated the long-term clinical outcomes of patients after arthroscopic or open anterior shoulder stabilization, with inclusion of an assessment of preoperative glenoid tracking. PURPOSE To compare long-term clinical outcomes of patients with recurrent anterior shoulder instability randomized to open and arthroscopic stabilization groups. Additionally, preoperative magnetic resonance imaging (MRI) studies were used to assess whether the shoulders were "on-track" or "off-track" to ascertain a prediction of increased failure risk. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A consecutive series of 64 patients with recurrent anterior shoulder instability were randomized to receive either arthroscopic or open stabilization by a single surgeon. Follow-up assessments were performed at minimum 15-year follow-up using established postoperative evaluations. Clinical failure was defined as any recurrent dislocation postoperatively or subjective instability. Preoperative MRI scans were obtained to calculate the glenoid track and designate shoulders as on-track or off-track. These results were then correlated with the patients' clinical results at their latest follow-up. RESULTS Of 64 patients, 60 (28 arthroscopic and 32 open) were contacted or examined for follow-up (range, 15-17 years). The mean age at the time of surgery was 25 years (range, 19-42 years), while the mean age at the time of this assessment was 40 years (range, 34-57 years). The rates of arthroscopic and open long-term failure were 14.3% (4/28) and 12.5% (4/32), respectively. There were no differences in subjective shoulder outcome scores between the treatment groups. Of the 56 shoulders, with available MRI studies, 8 (14.3%) were determined to be off-track. Of these 8 shoulders, there were 2 surgical failures (25.0%; 1 treated arthroscopically, 1 treated open). In the on-track group, 6 of 48 had failed surgery (12.5%; 3 open, 3 arthroscopic [P = .280]). CONCLUSION Long-term clinical outcomes were comparable at 15 years postoperatively between the arthroscopic and open stabilization groups. The presence of an off-track lesion may be associated with a higher rate of recurrent instability in both cohorts at long-term follow-up; however, this study was underpowered to verify this situation.
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Affiliation(s)
- Craig R Bottoni
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - John D Johnson
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Liang Zhou
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Sarah G Raybin
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - James S Shaha
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Christian A Cruz
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Kenneth K Lindell
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - David C Thoma
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
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25
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Pougès C, Hardy A, Vervoort T, Amouyel T, Duriez P, Lalanne C, Szymanski C, Deken V, Chantelot C, Upex P, Maynou C. Arthroscopic Bankart Repair Versus Immobilization for First Episode of Anterior Shoulder Dislocation Before the Age of 25: A Randomized Controlled Trial. Am J Sports Med 2021; 49:1166-1174. [PMID: 33705240 DOI: 10.1177/0363546521996381] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The risk of recurrence after the first episode of anterior shoulder dislocation is high with nonoperative treatment in younger patients. PURPOSE/HYPOTHESIS The aim of this study was to compare the results of arthroscopic Bankart repair and nonoperative treatment for shoulder dislocation in patients younger than 25 years, with a minimum of 2 years of follow-up. The hypothesis was that surgery would decrease the risk of recurrence. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS We included patients aged between 18 and 25 years after a first episode of anterior shoulder dislocation and divided them into 2 groups. The first group was treated surgically with an arthroscopic Bankart repair within 2 weeks after the dislocation; the second group was treated nonoperatively. Both groups were immobilized for 3 weeks in internal rotation and followed the same physical therapy protocol. Standard radiography and computed tomography were performed immediately after reduction of the dislocation, and follow-up was performed at 3, 6, 12, and 24 months. The primary outcome measure was instability recurrence, defined as another anterior shoulder dislocation requiring closed reduction by another person (the patient was unable to reduce the dislocated joint themselves), a subluxation, or a positive apprehension test. Secondary outcome measures included range of motion, return to sport, and functional scores such as the short version of the Disabilities of the Arm, Shoulder and Hand score the Walch-Duplay score, and the Western Ontario Shoulder Instability Index (WOSI). RESULTS A total of 20 patients were included in each group. The mean ± SD age was 21 ± 1.8 years, and there were 33 men (82.5%) and 7 women (17.5%) in the total sample. Recurrence of instability was significantly decreased in the surgical treatment group compared with the nonoperative group (2 [10%] vs 14 [70%], respectively; P = .0001). Fewer patients in the surgical treatment group versus the nonoperative group had another episode of dislocation (0 vs 6 [30%], respectively), subluxation (2 [10%] vs 13 [65%], respectively; P = .003), or a positive apprehension test (1 [5%] vs 11 [58%], respectively; P = .0005). The Walch-Duplay score (88.4 vs 70.3 points; P = .046) and WOSI (11.5 vs 17.7 points; P = .035) were significantly better in the surgical group versus the nonoperative group after a 2-year follow-up. Level of sport was the same or better in 89% of the surgical treatment group vs 53% of the nonoperative treatment group (P = .012). No surgical complication was recorded. We did not find any significant difference in range of motion. CONCLUSION In patients with first-time shoulder dislocations, arthroscopic labral repair (Bankart procedure) reduced the risk of secondary shoulder dislocation and improved functional outcome versus nonoperative treatment after a 2-year follow-up. Surgical treatment after a first episode of shoulder dislocation could be offered as a primary treatment option in a younger population if these results are confirmed by larger studies with a longer follow-up. REGISTRATION NCT03315819 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Cécile Pougès
- Lille-Hauts de France University, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital Salengro, Lille, France
| | - Alexandre Hardy
- Lille-Hauts de France University, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital Salengro, Lille, France
| | - Thomas Vervoort
- Lille-Hauts de France University, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital Salengro, Lille, France.,Arcachon Clinic, La Teste-de-Buch, France
| | - Thomas Amouyel
- Lille-Hauts de France University, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital Salengro, Lille, France
| | - Pauline Duriez
- Lille-Hauts de France University, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital Salengro, Lille, France
| | - Clément Lalanne
- Lille-Hauts de France University, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital Salengro, Lille, France
| | - Christophe Szymanski
- Lille-Hauts de France University, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital Salengro, Lille, France
| | - Valérie Deken
- Lille-Hauts de France University, Lille, France.,Methodology Unit-Biostatistics and Data Management, Lille University, France
| | - Christophe Chantelot
- Lille-Hauts de France University, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital Salengro, Lille, France
| | - Peter Upex
- Orthopedic Department, Saint Joseph Hospital, Paris, France
| | - Carlos Maynou
- Lille-Hauts de France University, Lille, France.,Department of Orthopaedic Surgery, Lille University Hospital Salengro, Lille, France
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26
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Avramidis G, Kokkineli S, Trellopoulos A, Tsiogka A, Natsika M, Brilakis E, Antonogiannakis E. Excellent Clinical and Radiological Midterm Outcomes for the Management of Recurrent Anterior Shoulder Instability by All-Arthroscopic Modified Eden-Hybinette Procedure Using Iliac Crest Autograft and Double-Pair Button Fixation System: 3-Year Clinical Case Series With No Loss to Follow-Up. Arthroscopy 2021; 37:795-803. [PMID: 33127552 DOI: 10.1016/j.arthro.2020.10.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 10/13/2020] [Accepted: 10/17/2020] [Indexed: 02/09/2023]
Abstract
PURPOSE To evaluate the clinical, functional, and radiological midterm outcomes of the all-arthroscopic modified Eden-Hybinette procedure in patients with recurrent anterior shoulder instability. METHODS A retrospective, single-center case series with prospectively collected data was conducted. The inclusion criterion was traumatic recurrent anterior shoulder instability with significant glenoid bone loss; patients with atraumatic or multidirectional instability were excluded. An all-arthroscopic modified Eden-Hybinette procedure using iliac crest autograft and double-pair button fixation was carried out. All patients were postoperatively assessed for recurrence and apprehension. Shoulder range of motion values and functional scores, including American Shoulder and Elbow Surgeons Score, Oxford instability, Rowe instability, and Walch-Dupplay, were recorded. Graft positions, healing, and absorption were evaluated with computed tomography. Comparisons of values were performed with paired t tests for normally distributed differences and with nonparametric Wilcoxon's signed rank test otherwise. RESULTS The final study cohort included 28 patients, mean age 36 ± 10 years, and mean follow-up period 43 ± 6 months (range 36 to 53). Median glenoid bone loss was 12.4% (range 8% to 33%). No recurrence occurred, no subjective shoulder instability was reported, and no major complications were documented through the last follow-up. Postoperative shoulder range of motion had no significant differences compared with the healthy side. All final postoperative functional scores significantly increased to show excellent results compared with preoperative values. All grafts were positioned and healed optimally, and none was completely reabsorbed. CONCLUSIONS The all-arthroscopic modified Eden-Hybinette procedure is safe, leading to excellent clinical and radiological midterm outcomes in patients with recurrent anterior shoulder instability. This technique restores glenoid bone defects and preserves the normal shoulder anatomy. LEVEL OF EVIDENCE IV, therapeutic, retrospective case series.
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27
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Klungsøyr JA, Vagstad T, Ferle M, Drogset JO, Hoff SR, Dalen AF, Hurschler C, von Falck C, Klungsøyr P. The novel arthroscopic subscapular quadriceps tendon-bone sling procedure provides increased stability in shoulder cadavers with severe glenoid bone loss. Knee Surg Sports Traumatol Arthrosc 2021; 29:170-180. [PMID: 32060592 PMCID: PMC7862209 DOI: 10.1007/s00167-020-05900-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 02/03/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE Treatment of anterior glenoid bone loss in patients with recurrent anterior shoulder instability is a challenge. The subscapular sling method with quadriceps tendon bone (QTB) graft is a modification of the subscapular sling with a semitendinosus (ST) graft. The aim of the study was to test the biomechanical stability of the QTB sling procedure in human shoulder cadavers with severe anterior glenoid bone loss. METHODS Fourteen cadaveric shoulders were tested with a force-moment-guided robot in three conditions: physiologically intact, anterior glenoid bone resection, and the subscapular sling procedure with a QTB graft. Joint stability was measured in anterior, anterior inferior and inferior directions in four glenohumeral joint positions: 0° and 60° of glenohumeral abduction, with each at 0° and 60° of external rotation. Maximum external rotation was measured at 0° and 60° glenohumeral abduction. Computer tomography scans were obtained preoperatively to plan the glenoid bone resection, as well as postoperatively to calculate the proportion of the glenoid bone actually resected. RESULTS Significantly decreased translations were observed in the shoulders with the QTB sling compared to the intact joint and the glenoid bone loss model. No significant differences in maximum external rotation were observed between the three different conditions. CONCLUSION This biomechanical study revealed a significant stabilizing effect of the arthroscopic subscapular QTB graft sling procedure in human shoulder cadavers without compromising external rotation. Clinical trials may reveal the usefulness of this experimental method.
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Affiliation(s)
- Jan Arild Klungsøyr
- Orthopedic Department, Ålesund Hospital, Møre and Romsdal Health Trust, Ålesund, Norway. .,Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Terje Vagstad
- Orthopedic Department, Ålesund Hospital, Møre and Romsdal Health Trust, Ålesund, Norway
| | - Manuel Ferle
- Labor für Biomechanik und Biomaterialien, Orthopädische Klinik der Medizinischen Hochschule Hannover-Annastift, Hannover, Germany
| | - Jon Olav Drogset
- Norwegian University of Science and Technology, Trondheim, Norway ,Trondheim University Hospital, Trondheim, Norway
| | - Solveig Roth Hoff
- Department of Radiology, Møre and Romsdal Hospital Trust, Ålesund, Norway ,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Andreas F. Dalen
- Orthopedic Department, Ålesund Hospital, Møre and Romsdal Health Trust, Ålesund, Norway
| | - Christof Hurschler
- Labor für Biomechanik und Biomaterialien, Orthopädische Klinik der Medizinischen Hochschule Hannover-Annastift, Hannover, Germany
| | - Christian von Falck
- Institut für Diagnostische und Interventionelle Radiologie Medizinische Hochschule Hannover (MHH) Hannover, Hannover, Germany
| | - Peter Klungsøyr
- Orthopedic Department, Ålesund Hospital, Møre and Romsdal Health Trust, Ålesund, Norway
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Mulleneers LIC, Van Rompaey H, Haloui B, Pouliart N. Determining On-/Off-track Lesions in Glenohumeral Dislocation Using Multiplanar Reconstruction Computed Tomography Is Easier and More Reproducible Than Using 3-dimensional Computed Tomography. Am J Sports Med 2021; 49:137-145. [PMID: 33270465 DOI: 10.1177/0363546520971856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The glenoid track is a useful tool to predict engagement and therefore the risk of recurrence of dislocation in the presence of Hill-Sachs and/or bony Bankart lesions. To assess the glenoid track preoperatively, only methods using 3-dimensional reconstruction (3DR) have been described, but these lack a standardized, reliable, and easy description. PURPOSE/HYPOTHESIS The purpose was to evaluate a new method for determining the glenoid track using computed tomography (CT) scan with multiplanar reconstruction (MPR) in comparison with using 3DR images. Our hypothesis was that the MPR method would be easier to standardize and more reproducible. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS A total of 52 patients whose arthro-CT scan revealed a Hill-Sachs lesion, whether in combination with a bony Bankart lesion or not, were included. Digital Imaging and Communications in Medicine data from the 52 CT scans were all analyzed using open source image analysis software. Glenoid width, with or without associated bony defect, and the Hill-Sachs interval (HSI) were measured on MPR as well as on 3DR images. All measurements obtained using both methods were directly compared and evaluated for intra- and interobserver reliability. RESULTS In absolute values, only small differences were seen between the MPR and 3DR methods, amounting to a maximal difference of 0.07 cm for the HSI and 0.04 cm for the glenoid width. For glenoid measurements, both methods were similar. For humeral measurements, the MPR method demonstrated higher inter- and intraobserver reliability than did the 3DR method. CONCLUSION The newly described MPR method for the assessment of the glenoid track and HSI is at least as accurate as the published 3DR method, with better intra- and interobserver reliability. Because MPRs are also easier to obtain, this method could be recommended in daily practice.
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Affiliation(s)
| | | | | | - Nicole Pouliart
- Shoulder and Elbow Surgery, Sports Traumatology, and Arthroscopic Surgery, Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel, Free University of Brussels, Brussels, Belgium.,Faculty of Medicine and Pharmacy, Free University of Brussels, Brussels, Belgium
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29
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Exploring Alternative Sites for Glenoid Component Fixation Through Three-Dimensional Digitization of the Glenoid Vault: An Anatomic Analysis. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e20.00199-9. [PMID: 33278183 PMCID: PMC7714053 DOI: 10.5435/jaaosglobal-d-20-00199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Glenoid component loosening has remained one of the most common complications for total shoulder arthroplasty. Three-dimensional modeling of the glenoid may reveal novel information regarding glenoid vault morphology, providing a foundation for implant designs that possess the potential to extend the survivorship of the prosthesis.
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30
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Alashkham A, Soames R. The glenoid and humeral head in shoulder osteoarthritis: A comprehensive review. Clin Anat 2020; 34:710-720. [PMID: 33191525 DOI: 10.1002/ca.23703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/14/2020] [Accepted: 11/11/2020] [Indexed: 01/03/2023]
Abstract
The key management of glenohumeral osteoarthritis is shoulder arthroplasty which aims to reduce pain and restore full shoulder function: it has increased in recent years. A detailed understanding of the anatomy of the glenoid and humeral head, as well as morphological changes of the glenoid in osteoarthritis, are important factors to consider when deciding on replacement components. This review begins with a brief introduction of the glenohumeral joint itself, and then considers the detailed anatomy of the glenoid fossa and humeral head, both of which are reported to have variable morphology. Several studies have been undertaken to assess various parameters, especially of the glenoid fossa including its shape, height, width, and articular surface area, version and inclination, in an attempt to define a standard classification that can be applied to surgical intervention. Nevertheless, no definitive consensus concerning the classification of these morphologies has been forthcoming, hence the need for this review. Following a consideration of these morphologies, the current state of knowledge regarding glenoid deformity in osteoarthritis, as well as its surgical management, is considered.
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Affiliation(s)
- Abduelmenem Alashkham
- Anatomy, School of Biomedical Sciences, University of Edinburgh, Edinburgh, UK.,Centre for Anatomy and Human Identification, University of Dundee, Dundee, UK.,Human Anatomy Department, Faculty of Medicine, University of Zawia, Zawia, Libya
| | - Roger Soames
- Centre for Anatomy and Human Identification, University of Dundee, Dundee, UK
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31
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Stefaniak J, Lubiatowski P, Kubicka AM, Wawrzyniak A, Wałecka J, Romanowski L. Clinical and radiological examination of bony-mediated shoulder instability. EFORT Open Rev 2020; 5:815-827. [PMID: 33312708 PMCID: PMC7722946 DOI: 10.1302/2058-5241.5.200049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The coexistence of glenoid and humeral head bone defects may increase the risk of recurrence of instability after soft tissue repair. Revealed factors in medical history such as male gender, younger age of dislocation, an increasing number of dislocations, contact sports, and manual work or epilepsy may increase the recurrence rate of instability. In physical examination, positive bony apprehension test, catching and crepitations in shoulder movement may suggest osseous deficiency. Anteroposterior and axial views allow for the detection of particular bony lesions in patients with recurrent anterior shoulder instability. Computed Tomography (CT) with multiplanar reconstruction (MPR) and various types of 3D rendering in 2D (quasi-3D-CT) and 3D (true-3D-CT) space allows not only detection of glenoid and humeral bone defects but most of all their quantification and relations (engaging/not-engaging and on-track/off-track) in the context of bipolar lesion. Magnetic resonance imaging (MRI) is increasingly developing and can provide an equally accurate measurement tool for bone assessment, avoiding radiation exposure for the patient. Cite this article: EFORT Open Rev 2020;5:815-827. DOI: 10.1302/2058-5241.5.200049
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Affiliation(s)
- Jakub Stefaniak
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, Poznan, Poland.,Sport Traumatology and Biomechanics Unit, Rehasport Clinic, Poznan University of Medical Sciences, Poznan, Poland
| | - Przemyslaw Lubiatowski
- Sport Traumatology and Biomechanics Unit, Rehasport Clinic, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Maria Kubicka
- Institute of Zoology, Poznan University of Life Sciences, Poznan, Poland
| | - Anna Wawrzyniak
- Sport Traumatology and Biomechanics Unit, Rehasport Clinic, Poznan University of Medical Sciences, Poznan, Poland
| | - Joanna Wałecka
- Sport Traumatology and Biomechanics Unit, Rehasport Clinic, Poznan University of Medical Sciences, Poznan, Poland
| | - Leszek Romanowski
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznan University of Medical Sciences, Poznan, Poland
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Cohen M, Zaluski AD, Siqueira GSDL, Amaral MVG, Monteiro MT, Filho GRM. Risk Factors for Coracoid Graft Osteolysis after the Open Latarjet Procedure. Rev Bras Ortop 2020; 55:585-590. [PMID: 33093723 PMCID: PMC7575390 DOI: 10.1055/s-0039-1698799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/23/2019] [Indexed: 11/23/2022] Open
Abstract
Objective
Coracoid osteolysis has been described as a possible complication after the Latarjet procedure. The aim of the present study was to investigate the incidence and risk factors associated to coracoid graft osteolysis and to correlate them with clinical results.
Methods
A retrospective review of 38 Latarjet procedures was conducted. Computed tomography (CT) scans were obtained from all of the patients before and at least 1 year after the surgery. Coracoid osteolysis was evaluated and correlated to preoperative factors, namely: age, smoking status, and preoperative glenoid bone loss. The patients were divided into 2 groups: A (no or minor bone resorption) and B (major or total bone resorption). The functional outcome was determined by the Rowe score.
Results
Coracoid graft osteolysis occurred in 22 cases (57.8%). The mean preoperative glenoid defect was 22.8% in group A, and 13.4% in group B (
p
= 0.0075). The mean ages of the subjects in both groups were not significantly different. Smoking did not seem to affect the main outcome either, and no correlation was found between graft osteolysis and postoperative range of motion, pain, or Rowe score. There were no cases of recurrent dislocations in our sample, although four patients presented with a positive anterior apprehension sign.
Conclusion
Bone resorption of the coracoid graft is present in at least 50% of the patients submitted to the Latarjet procedure, and the absence of significant preoperative glenoid bone loss showed to be the only risk factor associated with severe graft osteolysis, even though this did not influence significantly the clinical outcome.
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Affiliation(s)
- Marcio Cohen
- Department of Shoulder and Elbow Surgery, Instituto Nacional de Traumatologia e Ortopedia, Ministé da Saúde, Rio de Janeiro, RJ, Brazil
| | - Alexandre Dreifus Zaluski
- Department of Shoulder and Elbow Surgery, Instituto Nacional de Traumatologia e Ortopedia, Ministé da Saúde, Rio de Janeiro, RJ, Brazil
| | - Glaucio Sales de Lima Siqueira
- Department of Shoulder and Elbow Surgery, Instituto Nacional de Traumatologia e Ortopedia, Ministé da Saúde, Rio de Janeiro, RJ, Brazil
| | - Marcus Vinicius Galvão Amaral
- Department of Shoulder and Elbow Surgery, Instituto Nacional de Traumatologia e Ortopedia, Ministé da Saúde, Rio de Janeiro, RJ, Brazil
| | - Martim Teixeira Monteiro
- Department of Shoulder and Elbow Surgery, Instituto Nacional de Traumatologia e Ortopedia, Ministé da Saúde, Rio de Janeiro, RJ, Brazil
| | - Geraldo Rocha Motta Filho
- Department of Shoulder and Elbow Surgery, Instituto Nacional de Traumatologia e Ortopedia, Ministé da Saúde, Rio de Janeiro, RJ, Brazil
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Parada SA, Jones MC, DeFoor MT, Griswold BG, Roberts AD, Provencher MT. Mathematical modeling of glenoid bone loss demonstrate differences in calculations that May affect surgical decision making. J Orthop 2020; 22:402-407. [PMID: 33029044 DOI: 10.1016/j.jor.2020.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/21/2020] [Indexed: 12/01/2022] Open
Abstract
Objective Two glenoid bone loss calculations are compared across a range of anatomic glenoid sizes. Methods 20 cadaveric paired glenoid diameters were measured to create glenoid models with bone loss calculated in 1 mm linear increments up to 50% bone loss comparing the linear measurement percentage (LMP) to the circle line method (CLM) gold standard. Results The LMP overestimates glenoid bone loss at every potential 1 mm increment across each glenoid model until bone loss reaches 50%. Conclusion The widely-used LMP method overestimates bone loss compared to a gold standard potentially misguiding surgeons towards bony reconstruction in shoulder instability during preoperative planning.
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Affiliation(s)
- Stephen A Parada
- Department of Orthopaedics, Medical College of Georgia at Augusta University Medical Center, Augusta, GA, USA
| | - Matthew C Jones
- Department of Orthopaedics, Medical College of Georgia at Augusta University Medical Center, Augusta, GA, USA
| | - Mikalyn T DeFoor
- School of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - B Gage Griswold
- Department of Orthopaedics, Medical College of Georgia at Augusta University Medical Center, Augusta, GA, USA
| | - Aaron D Roberts
- Department of Orthopaedics, Winn Army Community Hospital, Ft Stewart, GA, USA
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RAMOS MAXROGÉRIOFREITAS, HIDALGO PEDROFILGUEIRAS, FAGUNDES DIOGO, SAN JUNIOR YONDERARCHANJOCHING. BARE SPOT LOCATION IN GLENOID CAVITY: COMPARISON BETWEEN ARTHROSCOPY AND CT SCAN. ACTA ORTOPEDICA BRASILEIRA 2020; 28:243-246. [PMID: 33144840 PMCID: PMC7580293 DOI: 10.1590/1413-785220202805232045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To assess whether Bare Spot is previously displaced by proportion (MEASURE BP-A × 1.25/MEASURE BP-P = 1). METHODS 35 patients with surgical indication for rotator cuff injury repair were evaluated. The distances from the Bare Spot to the anterior edge of the glenoid cavity (BS-A) and to the posterior edge (BS-P) were measured by arthroscopy and computed tomography with three-dimensional reconstruction of the scapula. RESULTS The distance from the Bare Spot to the anterior border (BS-A tc) was 11.6 mm with a median 12 mm; The distance to the posterior border (BS-P tc) was on average 15.5 mm with a median 15 mm. The distances from BS to anterior cavity edge measured by arthroscopy were on average (BS-A video) 12.25 mm with a median of 12 mm, and from BS to posterior edge (BS-P video) 16.25 mm on average with median 16 mm (p < 0.005). CONCLUSION Bare Spot is displaced anteriorly at a proportion of 40% of the anterior margin and 60% of the posterior margin. Level of Evidence II - Development of diagnostic criteria on consecutive patients (with universally applied reference "gold standard").
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Affiliation(s)
| | | | - DIOGO FAGUNDES
- Universidade Federal do Estado do Rio de Janeiro, Brazil
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Levy BJ, Grimm NL, Arciero RA. When to Abandon the Arthroscopic Bankart Repair: A Systematic Review. Sports Health 2020; 12:425-430. [PMID: 32716726 DOI: 10.1177/1941738120940676] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
CONTEXT Bone loss is a major factor in determining surgical choice in patients with anterior glenohumeral instability. Although bone loss has been described, there is no consensus on glenoid, humeral head, and bipolar bone loss limits for which arthroscopic-only management with Bankart repair can be performed. OBJECTIVE To provide guidelines for selecting a more complex repair or reconstruction (in lieu of arthroscopic-only Bankart repair) in the setting of glenohumeral instability based on available literature. DATA SOURCES An electronic search of the literature for the period from 2000 to 2019 was performed using PubMed (MEDLINE). STUDY SELECTION Studies were included if they quantified bone loss (humeral head or glenoid) in the setting of anterior instability treated with arthroscopic Bankart repair. STUDY DESIGN Systematic review. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION Study design, level of evidence, patient demographics, follow-up, recurrence rates, and measures of bone loss (glenoid, humeral head, bipolar). RESULTS A total of 14 studies met the inclusion criteria. Of these, 10 measured glenoid bone loss, 5 measured humeral head bone loss, and 2 measured "tracking" without explicit measurement of humeral head bone loss. Measurement techniques for glenoid and humeral head bone loss varied widely. Recommendations for maximum glenoid bone loss for arthroscopic repair were largely <15% of glenoid width in recent studies. Recommendations regarding humeral head loss were more variable (many authors providing only qualitative descriptions) with increasing attention on glenohumeral tracking. CONCLUSION It is essential that a standardized method of glenoid and humeral head bone loss measurements be performed preoperatively to assess which patients will have successful stabilization after arthroscopic Bankart repair. Glenoid bone loss should be <15%, and humeral head lesions should be "on track" if an arthroscopic-only Bankart is planned. If there is greater bone loss, adjunct or open procedures should be performed.
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Affiliation(s)
- Benjamin J Levy
- UConn Health-Department of Orthopedics and University of Connecticut School of Medicine, Farmington, Connecticut
| | - Nathan L Grimm
- UConn Health-Department of Orthopedics and University of Connecticut School of Medicine, Farmington, Connecticut.,Idaho Sports Medicine Institute, Boise, Idaho
| | - Robert A Arciero
- UConn Health-Department of Orthopedics and University of Connecticut School of Medicine, Farmington, Connecticut
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Chen XZ, Liu TX, Chen Y, Du L, Liu WF, Lin P. Simple Linear Calculating Method of Glenoid Bone Defects Using 3-Dimensional Computed Tomography Based on an East Asian Population in China. Orthop J Sports Med 2020; 8:2325967120914273. [PMID: 32426403 PMCID: PMC7218985 DOI: 10.1177/2325967120914273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: The evaluation of glenoid bone defects in the preoperative stage for patients with anterior shoulder instability is critical for surgical decision making. A novel method that predicts the intact glenoid width based purely on the measurement of the glenoid height has been advocated. Despite the convenience, all studies to date have focused on the Western population, and there is no similar research based on an East Asian population. Purpose: To determine the relationship between glenoid height and width in an East Asian population. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Spiral computed tomography (CT) scans of both sides of the shoulder joints were obtained from 205 patients of Han nationality (China) who had no history of shoulder trauma or pain. The maximal height and width of each glenoid were measured on the en face view by 2 radiologists who were blinded to each other’s results. Pearson correlation coefficients and multivariable linear regression were calculated from all data measured to evaluate the relationship between maximal glenoid height and width between the sexes. Results: A total of 205 patients (410 shoulder CT scans) were analyzed. The mean glenoid height was 34.45 ± 2.82 mm, and the mean glenoid width was 23.35 ± 2.40 mm. There was a statistical difference between male and female patients with regard to glenoid height (36.61 vs 32.39 mm, respectively; t = 9.76; P < .001) and width (25.26 vs 21.54 mm, respectively; t = 20.73; P < .001). Analysis of the measured glenoid height and width demonstrated a strong linear correlation of 0.82 (R2 = 0.68; P < .001) for the entire cohort and similarly strong linear correlations when each sex was analyzed separately. For male patients, the glenoid width was measured as: glenoid height × 0.50 + 7 mm (R2 = 0.36; P < .001); for female patients, the glenoid width was measured as: glenoid height × 0.45 + 7 mm (R2 = 0.31; P < .001). Conclusion: In an East Asian population, the mean glenoid height and width were 34.45 and 23.35 mm, respectively. The formulas that represent the relationship between glenoid width and height for male and female patients are the following: glenoid width = glenoid height × 0.50 + 7 mm and glenoid width = glenoid height × 0.45 + 7 mm, respectively.
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Affiliation(s)
- Xing-Zuo Chen
- Department of Orthopaedics, China-Japan Friendship Hospital, Beijing, China
| | - Tong-Xi Liu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Ying Chen
- Department of Orthopaedics, China-Japan Friendship Hospital, Beijing, China
| | - Lei Du
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Wei-Fang Liu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Peng Lin
- Department of Orthopaedics, China-Japan Friendship Hospital, Beijing, China
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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: 2.4] [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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Abstract
Background: The size of the glenoid bone defect is an important index in selecting the appropriate treatment for anterior shoulder instability. However, the reliability of glenoid bone defect measurement is controversial. The purpose of the present study was to investigate the reliabilities of measurements of the glenoid bone defect on computed tomography and to explore the predisposing factors leading to inconsistency of these measurements. Methods: The study population comprised 69 consecutive patients who underwent surgery for recurrent anterior shoulder dislocation in Peking University Fourth School of Clinical Medicine from March 2016 to January 2017. The glenoid bone defect was measured by three surgeons on ‘self-confirmed’ and ‘designated’ 3-D en-face views, and repeated after an interval of 3 months. Measurements included the ratio of the defect area to the best-fit circle area, and the ratio of the defect width to the diameter of the best-fit circle. The inter- and intra-observer reliabilities of the measurements were evaluated using intraclass correlation coefficients (ICCs). The maximum absolute inter- and intra-observer differences and the cumulative percentages of cases with inter- and intra-observer differences greater than these respective levels were calculated. Results: Almost all linear defect values were bigger than the areal defect values. The inter-observer ICCs for the areal defect were 0.557 and 0.513 in the ‘self-confirmed’ group and 0.549 and 0.431 in the ‘designated’ group. The inter-observer reliabilities for the linear defect were moderate or fair in the ‘self-confirmed’ group (ICC = 0.446, 0.374) and ‘designated’ group (ICC = 0.402, 0.327). The ICCs for intra-observer measurements were higher than those for inter-observer measurements. The respective maximum inter- and intra-observer absolute differences were 13.9% and 13.2% in the ‘self-confirmed’ group, and 15.8% and 9.8% in the ‘designated’ group. Conclusions: The areal measurement of the glenoid bone defect is more reliable than the linear measurement. The reliability of the glenoid defect areal measurement is moderate or worse, suggesting that a more accurate and objective measurement method is needed in both en-face view and best-fit circle determination. Subjective factors affecting the glenoid bone loss measurement should be minimized.
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Dekker TJ, Peebles LA, Goldenberg BT, Millett PJ, Bradley JP, Provencher MT. Location of the Glenoid Defect in Shoulders With Recurrent Posterior Glenohumeral Instability. Am J Sports Med 2019; 47:3051-3056. [PMID: 31618065 DOI: 10.1177/0363546519876282] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Posterior glenoid bone deficiency is an increasingly recognized entity in the setting of recurrent posterior shoulder instability; however, little is known about the subject. Due to the paucity of literature on posterior bone loss, historical comparisons with anterior bone loss may not be fully accurate. PURPOSE To systematically describe the morphology of posterior bone defects in the setting of recurrent posterior shoulder instability based on several quantitative parameters, including the mean location, orientation, and extent of bone loss on a clockface model, as well as the angle of the defect relative to the long axis of the glenoid. STUDY DESIGN Cross-sectional study; Level of evidence, 4. METHODS Three-dimensional reconstructed computed tomography scans of serially collected patients with a history of recurrent posterior shoulder instability were evaluated by 3 separate reviewers. The posterior glenoid bone defect was characterized using the following measures: (1) the mean lesion location and orientation based on a clockface model with 6 o'clock denoted as inferior and 9 o'clock as directly posterior for all patients; (2) the total extent of the posterior bone defect based on the clockface; and (3) the average angle of the bone loss relative to the long axis of the glenoid. RESULTS A total of 70 male patients and 1 female patient with a mean age of 29.3 years (range, 24.4-35.1 years) were included in the analysis. The mean clockface location of the posterior glenoid defect originated at 6:44 (range, 4:16-8:12) and extended to a mean of 9:28 (range, 7:02-10:38). The mean extent of the posterior glenoid defect was 2:43 (range, 1:08-4:50), which corresponds to a mean total bone loss arc of 81.5° (range, 34.2°-144.9°), nearly 1 quadrant of the glenoid. Posterior bone loss occurred in a posteroinferior direction at a mean angle of 30.7° (range, 8.0°-80.0°) relative to the long axis of the glenoid. CONCLUSION Posterior bone defects in the setting of posterior shoulder instability most commonly occur in the posteroinferior quadrant of the glenoid and extend on average from 6:44 to 9:28 (81.5° total degrees of arc) on a clockface model. Posterior bone loss occurs at a mean of 30° off the long axis of the glenoid in a posteroinferior direction, which is historically different from anterior bone loss, which occurs parallel to the long axis of the glenoid. This study serves to highlight the location and orientation of bone loss that one can expect in a patient with recurrent posterior shoulder instability, although additional work is needed to assess why this develops.
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Affiliation(s)
| | - Liam A Peebles
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Peter J Millett
- The Steadman Clinic, Vail, Colorado, USA.,Steadman Philippon Research Institute, Vail, Colorado, USA
| | - James P Bradley
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Matthew T Provencher
- The Steadman Clinic, Vail, Colorado, USA.,Steadman Philippon Research Institute, Vail, Colorado, USA
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Kho J, Kholinne E, Lim S, Hong H, Kwak JM, Sun Y, Koh KH, Jeon IH. Arthroscopic bare spot method underestimates true bone defect in bony Bankart lesion. Arch Orthop Trauma Surg 2019; 139:1269-1275. [PMID: 31111200 DOI: 10.1007/s00402-019-03195-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The need for precise quantification of the glenoid defect should be emphasized in the choice of surgery for bony Bankart lesion especially in its critical values of 16% to 25. The study aims to verify the validity of bare spot method for arthroscopic quantification of glenoid bone defect using several varieties of posterior portal location. MATERIALS AND METHODS Two intact cadaveric glenoids were prepared for the study. The greatest anteroposterior diameter of the perfect circle concept of the glenoid is identified and center of the circle is marked as glenoid bare spot with metal marker. Sixteen percent and 25% defect were sequentially created using a saw at 0° axis parallel to the longitudinal axis of the glenoid. These were confirmed by 3D CT glenoid scan based on glenoid rim distances. Each glenoids were mounted on Sawbone dome holder model simulating neutral version. Quantification of Glenoid bone defects were sequentially measured by glenoid bare spot method arthroscopically by 5 shoulder arthroscopy trained surgeons in 5 varieties of posterior portals in 5 cycles. Paired sample t test was done for arthroscopic over CT scan method of glenoid bone loss quantification. One way ANOVA for portal location analysis was done. RESULTS Glenoid bare spot method significantly underestimates 16% and 25% glenoid bone defect to 9% ± 2 (P < 0.001) and 18% ± 2 (P < 0.001), respectively, compared to 3D CT scan method. There was good intra-class correlation coefficient of 0.97 for inter-rater reliability. There was no significant difference in quantification in between five portal sites by one-way ANOVA (P > 0.05). CONCLUSIONS Arthroscopic glenoid bare spot method using the anterior viewing portal significantly underestimates glenoid bone loss in critical margin degrees of decision making in shoulder instability surgery. Minimal variation of posterior portal location for the calibrated probe does not cause significant difference in Glenoid bone loss quantification.
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Affiliation(s)
- Julius Kho
- Department of Orthopaedics, Chong Hua Hospital, Don Mariano Cui St., Fuente Osmeña, Cebu City, Philippines
| | - Erica Kholinne
- Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia.,Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sungjoon Lim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hanpyo Hong
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae-Man Kwak
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yucheng Sun
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.,Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong University, Nantong, Jiangsu, China
| | - Kyoung-Hwan Koh
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Bazzocchi A, Aparisi Gómez MP, Spinnato P, Marinelli A, Napoli A, Rotini R, Catalano C, Guglielmi G. Imaging the Postsurgical Upper Limb: The Radiologist Perspective. Radiol Clin North Am 2019; 57:977-1000. [PMID: 31351545 DOI: 10.1016/j.rcl.2019.03.009] [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: 10/26/2022]
Abstract
Imaging has a paramount role in postsurgical assessment. Radiologists need to be familiar with the different surgical procedures to be able to identify expected postsurgical appearances and also detect potential complications. This article reviews the indications, normal expected postsurgical appearances, and complications of the most frequently used surgical procedures in the shoulder, elbow, and wrist. The emphasis is on points that should not be overlooked in the surgical planning.
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Affiliation(s)
- Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy.
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, National Women's Hospital, Auckland City Hospital, Greenlane Clinical Center, Auckland District Health Board, 2 Park Road, Grafton, Auckland 1023, New Zealand; Department of Ultrasound, National Women's Hospital, Auckland City Hospital, Greenlane Clinical Center, Auckland District Health Board, 2 Park Road, Grafton, Auckland 1023, New Zealand; Department of Radiology, Hospital Nisa Nueve de Octubre, Calle Valle de la Ballestera, 59, Valencia 46015, Spain
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy
| | - Alessandro Marinelli
- Shoulder and Elbow Surgery, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy
| | - Alessandro Napoli
- Department of Radiologic, Oncologic and Pathologic Sciences, La Sapienza University of Rome, V.le Regina Elena 324, Rome 00180, Italy
| | - Roberto Rotini
- Shoulder and Elbow Surgery, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna 40136, Italy
| | - Carlo Catalano
- Department of Radiologic, Oncologic and Pathologic Sciences, La Sapienza University of Rome, V.le Regina Elena 324, Rome 00180, Italy
| | - Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Viale Luigi Pinto 1, Foggia 71100, Italy
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Pan Z, Huang F, Li J, Tang X. [Current concepts of diagnostic techniques and measurement methods for bone defect in patient with anterior shoulder instability]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:762-767. [PMID: 31198007 DOI: 10.7507/1002-1892.201812078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To summarize the diagnosis and measurement methods of bone defect in anterior shoulder instability (glenoid bone defect and Hill-Sachs lesion). Methods The related literature on the diagnosis and measurement of the bone defect in anterior shoulder instability was reviewed and summarized. Results The commonly used techniques for the diagnosis of anterior glenoid bone defect and Hill-Sachs lesion of humeral head include X-ray, CT, MRI, arthroscopy, arthrography. The methods for measuring the degree of anterior glenoid bone defect include Griffith method, glenoid index method, Pico method, and best-fit circle method. The indexes for measuring the Hill-Sachs lesion include the length, width, depth, and volume. X-ray is mainly used for primary screening. Best-fit circle method on three-dimensional (3D) CT reconstruction is commonly used to measure the glenoid bone defect currently. Glenoid track theory on 3D CT reconstruction is popular in recent years. Reliability of measuring the glenoid bone defect and Hill-Sachs lesion with MRI and arthroscopy is still debatable. Arthrography is more and more used in the diagnosis of shoulder joint instability of bone defect and concomitant soft tissue injury. Conclusion How to improve the accuracy of evaluating glenoid bone defect and Hill-Sachs lesion before surgery still need further study.
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Affiliation(s)
- Zhengfeng Pan
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Fuguo Huang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Jian Li
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Xin Tang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
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Lansdown DA, Wang K, Yanke AB, Nicholson GP, Cole BJ, Verma NN. A Flat Anterior Glenoid Corresponds to Subcritical Glenoid Bone Loss. Arthroscopy 2019; 35:1788-1793. [PMID: 31060758 DOI: 10.1016/j.arthro.2018.12.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/19/2018] [Accepted: 12/04/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To define a quickly recognizable pattern for subcritical bone loss using the inflection point between the superior and inferior glenoid. METHODS Following institutional review board approval, 3-dimensional reconstructions of 31 shoulder computed tomography scans from cadaveric specimens were obtained. Exclusion criteria were age >65 years or evidence of fracture or arthritis of the glenoid. An en face image was obtained for each glenoid. A vertical line was defined at the most anterior point of the superior glenoid. The area of the inferior glenoid anterior to this vertical line, area of the total glenoid, chord length of the anterior portion, and a best-fit circle for the inferior glenoid were measured. These numbers were compared with determine predicted bone loss relative to this vertical line. This investigation was performed at Rush University Medical Center, Chicago, IL. RESULTS The mean surface area of the glenoid anterior to the vertical line was 10.2% (95% confidence interval [CI], 9.6-10.9) of the total glenoid, and 12.8% (95% CI, 12.0-13.6) of the best-fit circle of the inferior glenoid. The chord length measurement was 16.8% (95% CI, 15.7-18.3) of the total diameter of the best-fit circle. Compared with the best-fit circle, bone loss to this vertical line would represent >10% bone loss in 80.7% of patients and >13.5% bone loss in 35.5% of patients (range, 14.3%-18.1%). The negative predictive value of the vertical line was 19% for predicting 10% bone loss, 65% for predicting 13.5% bone loss, 74% for predicting 15% bone loss, and 100% for predicting 20% bone loss. CONCLUSIONS A flat anterior glenoid may offer a consistent pattern that corresponds to 12.8 ± 3% bone loss relative to a best-fit circle. This measurement is in line with published values of subcritical bone loss, making this a clinically useful pattern to recognize in patients with subcritical glenoid bone loss. CLINICAL RELEVANCE Our results suggest that an easily recognizable pattern of a flat anterior glenoid may correspond with more recently suggested levels of subclinical bone loss in patients with anterior shoulder instability. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Drew A Lansdown
- Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A..
| | - Kevin Wang
- Midwest Orthopedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Adam B Yanke
- Midwest Orthopedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Gregory P Nicholson
- Midwest Orthopedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Midwest Orthopedics, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Midwest Orthopedics, Rush University Medical Center, Chicago, Illinois, U.S.A
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Ramos MRF, San-Júnior YAC, Alves LHP. Surgical treatment of shoulder instability with trans-subscapularis transfer of the biceps long tendon. Rev Col Bras Cir 2019; 46:e2151. [PMID: 31141032 DOI: 10.1590/0100-6991e-20192151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/02/2019] [Indexed: 11/22/2022] Open
Abstract
Our objective is to describe the long biceps tendon transfer technique for the treatment of shoulder anterior instability. In this procedure, the long tendon of the biceps brachii is detached from the supraglenoid tubercle and transferred to the anterior edge of the glenoid cavity through a subscapularis tenotomy, reproducing the sling effect and increasing the anterior block. The technique is easy to perform and minimizes the risks of the coracoid process transfer. In conclusion, the transfer of the long tendon of the biceps brachii is an option for the treatment of glenohumeral instability.
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Affiliation(s)
- Max Rogério Freitas Ramos
- Universidade Federal do Estado do Rio de Janeiro, Departamento de Ortopedia e Traumatologia, Rio de Janeiro, RJ, Brasil
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45
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Williams AA, Mancini NS, Kia C, Wolf MR, Gupta S, Cote MP, Arciero RA. Recurrent Shoulder Instability: Do Morbidity and Treatment Differ Based on Insurance? Orthop J Sports Med 2019; 7:2325967119841079. [PMID: 31065553 PMCID: PMC6487768 DOI: 10.1177/2325967119841079] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Patients with public insurance often face barriers to obtaining prompt orthopaedic care. For patients with recurrent traumatic anterior shoulder instability, delayed care may be associated with increasing bone loss and subsequently more extensive surgical procedures. Purpose/Hypothesis: The purpose of this study was to evaluate whether differences exist in patients undergoing treatment for shoulder instability between those with Medicaid versus non-Medicaid insurance. We hypothesized that at the time of surgery, Medicaid patients would have experienced greater delays in care, would have a more extensive history of instability, would have more bone loss, and would require more extensive surgical procedures than other patients. Study Design: Cohort study; Level of evidence, 3. Methods: Patients were identified who underwent surgical stabilization for traumatic anterior shoulder instability between January 1, 2011, and December 1, 2015, at a single sports medicine practice. Clinic, billing, and operative records were reviewed for each patient to determine age, sex, insurance type, total number of instability episodes, time from first instability episode to surgery, intraoperative findings, and procedure performed. Glenoid bone loss was quantified by use of preoperative imaging studies. Results: During this time period, 206 patients (55 Medicaid, 131 private insurance, 11 Tricare, 9 workers’ compensation) underwent surgical stabilization for traumatic anterior shoulder instability. Average wait time from initial injury to surgery was 1640 days (95% CI, 1155-2125 days) for Medicaid patients compared with 1237 days (95% CI, 834-1639 days) for others (P = .005). Medicaid patients were more likely to have sustained 5 or more instability events at the time of surgery (OR, 3.3; 95% CI, 1.64-6.69; P = .001), had a higher risk of having 15% or more glenoid bone loss on preoperative imaging (OR, 3.5; 95% CI, 1.3-10.0; P = .01), and had a higher risk of requiring Latarjet or other open stabilization procedures as opposed to an arthroscopic repair (OR, 3.0; 95% CI, 1.5-6.2; P = .002) when compared with other patients. Conclusion: Among patients undergoing surgery for traumatic anterior shoulder instability, patients with Medicaid had significantly more delayed care. Correspondingly, they reported a more extensive history of instability, were more likely to have severe bone loss, and required more invasive stabilization procedures.
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Affiliation(s)
- Ariel A Williams
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Nickolas S Mancini
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Cameron Kia
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Megan R Wolf
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Simran Gupta
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Robert A Arciero
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
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Ramos MRF, San Junior YAC, Alves LHP, Cruz FC, Mansur H. Is the Bare Spot reliable for the bone loss measurement? Shoulder Elbow 2019; 11:106-112. [PMID: 30936949 PMCID: PMC6434960 DOI: 10.1177/1758573218760265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 01/26/2018] [Accepted: 01/28/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND To evaluate the reliability of the Bare Spot (BS) as an anatomical landmark for the intra-operative definition of bone loss in anterior shoulder instability. METHODS The distances from the BS to the anterior (BS-A), posterior (BS-P) and inferior margins of the glenoid cavity were determined both under arthroscopic visualization and by an open approach in 20 shoulders. RESULTS The BS did not coincide with the centre of the glenoid cavity of the studied shoulders because the BS-P distance was greater than the BS-A distance (p < 0.05) and was located 40% closer to the anterior margin. The authors suggest a correction factor: BP-A × 1.25/BP-P = 1. CONCLUSIONS The BS is located at a mean distance of 40% of the joint diameter, relative to the anterior margin of the glenoid. This point may be used as a landmark, using a correction factor of its mostly anterior positioning. Arthroscopy was reliable for bone measurements of the shoulder joint.
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Affiliation(s)
- Max Rogerio Freitas Ramos
- Department of Orthopaedic Surgery, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Yonder Archanjo Ching San Junior
- Department of Orthopaedic Surgery, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil,Yonder Archanjo Ching San Junior, Universidade Federal do Rio de Janeiro (UNIRIO), R. Mariz e Barros 775, Maracanã, Rio de Janeiro, RJ 20270-001, Brazil.
| | - Luiz Henrique Pereira Alves
- Department of Anatomy, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Flavio Carvalho Cruz
- Department of Orthopaedic Surgery, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Henrique Mansur
- Department of Orthopaedic Surgery, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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Vopat BG, Cai W, Torriani M, Vopat ML, Hemma M, Harris GJ, Schantz K, Provencher MT. Measurement of Glenoid Bone Loss With 3-Dimensional Magnetic Resonance Imaging: A Matched Computed Tomography Analysis. Arthroscopy 2018; 34:3141-3147. [PMID: 30396796 DOI: 10.1016/j.arthro.2018.06.050] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 06/20/2018] [Accepted: 06/25/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the measurement of glenoid bone surface area (GBSA) and glenoid bone loss (GBL) between 3-dimensional computed tomography (3D CT) and an autosegmentation approach for 3D magnetic resonance imaging (MRI) of patients with recurrent shoulder instability. METHODS Eight subjects (2 women and 6 men; age range, 15-72 years [mean, 44 ± 19 years]) were consecutively enrolled who had both CT and MRI of the shoulder for clinical shoulder instability. Inclusion criteria were patients with shoulder instability or other shoulder injury who had both a CT scan and MRI performed of the same shoulder. All patients underwent a 3D CT scan and a 3-Tesla 3D MRI with additional volumetric and autosegmented sequences. En face views of the glenoid for both CT and MRI were auto- and manually measured for overall GBSA and GBL using best-fit circle technique; the amount of GBL was compared with loss of GBSA and was expressed as a percentage of bone loss. RESULTS There were no differences in GBL measured by 3D CT (41 mm2, 6.6%) vs 3D MRI (40 mm2, 6.5%, P = .852). The mean GBSA was not different among the manual- and autocalculated 3D CT (644 mm2 vs 640 mm2, P = .482). In addition, the manual MRI scan glenoid area was similar to the autocalculated 3D MRI (622 mm2 vs 618 mm2, respectively; P = .482). Overall regression analysis demonstrated excellent correlation between CT and MRI for both GBSA and GBL calculations (R2 = 0.84-0.90). CONCLUSIONS 3D MRI of the glenoid is nearly identical to 3D CT scans for measurement of GBSA and GBL, making 3D MRI a reliable alternative to a CT scan for a preoperative shoulder evaluation of the glenoid pathology. This study shows that a 3D MRI could be a radiation-free and reliable alternative to a preoperative CT shoulder scan. LEVEL OF EVIDENCE Level III, case-control study.
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Affiliation(s)
- Bryan G Vopat
- University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Wenli Cai
- Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Martin Torriani
- Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Matthew L Vopat
- University of Kansas School of Medicine-Wichita, Wichita, Kansas, U.S.A..
| | - Murali Hemma
- Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Gordon J Harris
- Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Kati Schantz
- Massachusetts General Hospital, Boston, Massachusetts, U.S.A
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Lansdown DA, Wang K, Bernardoni E, Frank RM, Yanke AB, Cole BJ, Verma NN, Romeo AA. Variability in the Contour of Cadaveric Anterior and Posterior Glenoids Based on Ipsilateral 3-Dimensional Computed Tomography Reconstructions: Implications for Clinical Estimation of Bone Loss. Arthroscopy 2018; 34:2560-2566. [PMID: 30037572 DOI: 10.1016/j.arthro.2018.04.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/03/2018] [Accepted: 04/03/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare differences in the contour of the anterior and posterior glenoid in 3-dimensional computed tomography reconstructions as a reason for variability in estimating glenoid bone loss. METHODS Three reviewers digitally placed 11 points (1 at 6 o'clock, 5 from 3 to 6 o'clock, and 5 from 6 to 9 o'clock) along the inferior half of glenoid 3-dimensional computed tomography reconstructions of 32 cadaveric specimens. A best-fit circle for the whole glenoid was determined from all 11 points. The anterior 6 points determined an anterior-based circle, as for estimation of posterior bone loss. The posterior 6 points determined a posterior-based circle, as for estimation of anterior bone loss. The area and radii were determined for all circles. Individual intraclass correlations were used to evaluate reliability. Paired t-tests and Wilcoxon signed rank tests were used to compare areas and radii of the anterior and posterior circles relative to the best-fit glenoid circle. Significance was defined as P < .05. RESULTS There was good-to-excellent inter-rater reliability for the overall best-fit circle (intraclass correlation coefficient [ICC] = 0.97 [95% confidence interval (CI), 0.95-0.99]), anterior circle (ICC = 0.82 [95% CI, 0.71-0.90]), and posterior circle (ICC = 0.78 [95% CI, 0.65-0.88]). The average area of the posterior-based circle was significantly greater than the area of the best-fit circle for the intact glenoid (111% [95% CI, 104.3%-117.7%]; P = .0016). The average radius of the posterior-based circle was significantly larger than the radius of the intact glenoid (105% [95% CI, 101.7%-108.3%]; P = .0042). There were no significant differences between the average area (96% [95% CI, 89.0%-103.0%]; P = .16) and average radius (97% [95% CI, 93.5%-100.5%]; P = .19) for the anterior-based circle relative to the actual whole glenoid. CONCLUSIONS Estimation of anterior glenoid bone loss based on the normal posterior glenoid rim may overestimate glenoid bone loss because of differences in the contour of the anterior and posterior glenoid, whereas estimations of posterior glenoid bone loss based on the anterior rim did not differ significantly from the intact glenoid. CLINICAL RELEVANCE A circle based on the remaining intact portion of the injured glenoid may lead to an inaccurate estimate of glenoid bone loss.
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Affiliation(s)
- Drew A Lansdown
- Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, California, U.S.A..
| | - Kevin Wang
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Eamon Bernardoni
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Rachel M Frank
- Department of Orthopedic Surgery, University of Colorado, Denver, Colorado, U.S.A
| | - Adam B Yanke
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Anthony A Romeo
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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New multidetector computed tomography quantitative technique in evaluation of shoulder instability. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Bakshi NK, Cibulas GA, Sekiya JK, Bedi A. A Clinical Comparison of Linear- and Surface Area-Based Methods of Measuring Glenoid Bone Loss. Am J Sports Med 2018; 46:2472-2477. [PMID: 30010384 DOI: 10.1177/0363546518783724] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The purpose of this study was to determine whether linear-based measurement significantly overestimates glenoid bone loss in comparison with surface area-based measurement in patients with recurrent anterior shoulder instability and glenoid bone loss. HYPOTHESIS Linear-based measurement will significantly overestimate glenoid bone loss in comparison with surface area-based measurement in patients with anterior shoulder instability and glenoid bone loss. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS Thirty patients with anterior shoulder instability underwent preoperative bilateral shoulder computed tomography (CT) scans. Three-dimensional CT (3D-CT) reconstruction with humeral head subtraction was performed to obtain an en face view of the 3D-CT glenoid. Glenoid bone loss was measured with the surface area and linear methods of measurement. Statistical analysis was performed with a paired 2-tailed t test. RESULTS Twenty-eight patients (5 female and 23 male; mean age, 25.1 years; age range, 15-58 years) were included in the study; 17 patients underwent a glenoid augmentation procedure, and 11 underwent arthroscopic Bankart repair. The mean percentage glenoid bone loss calculated with the surface area and linear methods was 12.8% ± 8.0% and 17.5% ± 9.7% ( P < .0001), respectively. For the 17 patients who underwent glenoid augmentation, mean percentage bone loss with the surface area and linear methods was 16.6% ± 7.9% and 23.0% ± 8.0% ( P < .0001), respectively. CONCLUSION Linear measurement of glenoid bone loss significantly overestimates bone loss compared with surface area measurement in patients with anterior glenoid bony defects. These results indicate that these different methods cannot be used interchangeably and cannot be used with the same critical thresholds for glenoid bone loss.
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Affiliation(s)
- Neil K Bakshi
- MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - George A Cibulas
- MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Jon K Sekiya
- MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Asheesh Bedi
- MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
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