Assessing Bone Loss in the Unstable Shoulder: a Scoping Review

Gouveia, Kyle; Rizvi, Syed Fayyaz H; Dagher, Danielle; Leroux, Timothy; Bedi, Asheesh; Khan, Moin

doi:10.1007/s12178-022-09773-4

Cited by 7 publications

(10 citation statements)

References 52 publications

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“…Our findings indicate that such delays in care may place patients at risk not only for poor functional outcomes and higher rates of recurrent instability but also for greater GBL and subsequent need for open bony augmentation procedures. 1,2,12,23,27 Interestingly, we noted that patients with a traumatic mechanism of injury had significantly greater posterior GBL than patients who did not recall an acute traumatic event. This finding was unexpected as posterior labral tears are widely accepted to most often result from a "wear and tear"-type mechanism rather than discrete trauma.…”

Section: Discussionmentioning

confidence: 69%

“…4,22,26,32 Glenoid bone loss (GBL) in the setting of isolated anterior or posterior instability has been well described. 2,3,12,14,27,29,33 A reported 22% of patients have some degree of anterior GBL after an acute anterior instability event, and up to 86% of patients with recurrent anterior instability have appreciable GBL. 9,12 GBL is a well-known risk factor for the failure of arthroscopic shoulder stabilization procedures, 27,29,33 with bone loss >13.5% having been shown to negatively affect functional outcomes after arthroscopic stabilization for anterior instability.…”

mentioning

confidence: 99%

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Prevalence and Risk Factors of Glenoid Bone Loss in Combined Shoulder Instability in Young, Active-Duty Military Patients

Green

Sandler

Dunn

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: US military servicemembers experience higher rates of posterior and combined-type instability as compared with their nonmilitary peers. Purpose: (1) To determine the prevalence of glenoid bone loss (GBL) in young, active-duty military patients with combined-type shoulder instability who underwent operative shoulder stabilization; (2) to evaluate whether GBL is associated with differences in postoperative outcomes; and (3) to identify factors associated with larger defects. Study Design: Case series; Level of evidence, 4. Methods: This study included active-duty military patients who underwent primary surgical shoulder stabilization for combined anterior and posterior capsulolabral tears between January 2012 and December 2018. Preoperative magnetic resonance arthrograms were used to calculate anterior, posterior, and total GBL using the “perfect circle” technique. We recorded patient characteristics, revisions, complications, return to duty, range of motion, and scores on multiple outcome measures (visual analog scale for pain, Single Assessment Numeric Evaluation, American Shoulder and Elbow Surgeons, and Rowe). GBL prevalence was compared by time to surgery, glenoid version, history of trauma, and number of anchors used for labral repair. Outcome scores, return to active duty, and revision procedures were compared by degree of anterior or posterior GBL: <13.5% (mild) versus ≥13.5% (subcritical). Results: GBL was noted in 28 (77.8%) of the 36 patients. Nineteen (52.8%) patients had anterior GBL, 18 (50.0%) had posterior, and 9 (25.0%) had combined. Four (11.1%) patients had subcritical anterior or posterior GBL. Increased posterior GBL was associated with history of trauma ( P = .041), time to surgery >12 months ( P = .024), and glenoid retroversion ≥9° ( P = .010); increased total GBL was associated with longer time to surgery ( P = .023) and labral repair requiring >4 anchors ( P = .012); and increased anterior GBL was associated with labral repair requiring >4 anchors ( P = .011). There were statistically significant improvements on all outcome measures, with no changes in range of motion postoperatively. No significant difference on any outcome score was observed between patients with mild and subcritical GBL. Conclusion: In our analysis, 78% of patients had appreciable GBL, suggesting that GBL is highly prevalent in this patient population. Longer time to surgery, traumatic cause, significant glenoid retroversion, and large labral tears were identified as risk factors for increased GBL.

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Section: Discussionmentioning

confidence: 69%

mentioning

confidence: 99%

Prevalence and Risk Factors of Glenoid Bone Loss in Combined Shoulder Instability in Young, Active-Duty Military Patients

Green

Sandler

Dunn

et al. 2023

Orthopaedic Journal of Sports Medicine

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“…In a 2022 scoping review of the assessment and management of glenohumeral bone loss, Gouveia et al found that 34% of included studies used a threshold of 15% or less when deciding the appropriate amount of bone loss to perform an isolated soft tissue procedure. Notably, the authors also reported a trend based on the year of publication, with more recent studies reporting lower thresholds for the consideration of bony augmentation procedures ( 43 ).…”

Section: Bone Loss In Shoulder Instabilitymentioning

confidence: 97%

“…Since that time, glenoid bone loss >20–25% has consistently been defined as critical, as numerous studies have shown high rates of recurrent instability following isolated capsulolabral repair in such patients ( 41 , 42 ). A recent scoping review found that 60.5% of included studies used this threshold as the determining factor when deciding to perform a soft tissue or bony augmentation procedure such as a Latarjet or bone block allograft ( 43 ). However, the authors also highlighted the emerging significance of subcritical bone loss, with increased failure rates following soft-tissue stabilization in patients with anterior glenoid bone loss of 15% or less ( 18 ).…”

Section: Bone Loss In Shoulder Instabilitymentioning

confidence: 99%

“…Interestingly, the authors also found that the use of the GT concept grew in popularity over the search period. In the earlier half of the search period [2017–2019], the GT was reported in <15% of studies (7 of 47), while in the latter half [2020–2022], 30% of studies (20 of 66) utilized the concept to examine the bipolar nature of bone loss ( 43 ). While the GT concept has been monumental in assessing and quantifying bipolar bone loss, current research has further classified “on-track” lesions, as these lesions should not all be viewed equally.…”

Section: Bone Loss In Shoulder Instabilitymentioning

confidence: 99%

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Bipolar bone loss and distance to dislocation

Herman,

Nazzal,

Keeling

et al. 2024

Ann Joint

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Studies have shown that glenoid- and humeral-sided bone loss may be present in up to 73–93% of individuals with recurrent anterior shoulder instability. As such, bone loss must be addressed appropriately, as the amount of bone loss drives surgical decision making and influences outcomes. Methods to describe and measure bone loss have changed over time. Originally, glenoid and humeral bone loss were viewed separately. However, the concepts of bipolar bone loss, the glenoid track (GT), and “on/off-track” lesions arose, highlighting the interplay between the two entities in contributing to recurrent instability. Classically, “off-track” lesions have been described as those Hill-Sachs interval (HSI) greater than the GT, and have been shown to result in higher rates of re-instability when addressed nonoperatively or with Bankart repair alone. More recently, further attention has been given to “on-track” lesions (HSI < GT). The new concept of “distance to dislocation” (DTD) has gained popularity. DTD is calculated as the difference between the GT and HSI, and literature evaluating DTD suggests that not all “on-track” lesions should be treated in the same manner. The purpose of this concept review article is twofold: (I) describe glenoid, humeral, and bipolar bone loss in the setting of anterior shoulder instability; and (II) elaborate on the new concept of “DTD” and its use in guidance of management.

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Accuracy and reliability of imaging modalities for studying bipolar bone loss in anterior shoulder instability: A systematic review

Adriani,

Saccomanno,

Bergomi

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeRecurrent shoulder instability, a common musculoskeletal disorder, often involves glenoid bone loss and Hill–Sachs lesions. However, the optimal imaging modality for accurately and reliably quantifying bipolar bone loss remains uncertain. This systematic review aims to evaluate the accuracy and reliability of various imaging modalities in assessing bipolar bone loss in anterior shoulder instability.MethodsMajor electronic databases were searched for English‐language studies reporting the measurement of glenoid track width and/or determination of on/off track HSL through imaging. Studies reporting statistical measures such as area under the curve, sensitivity, specificity, positive predictive value, NPV, intraobserver reliability and interobserver reliability were included. Data extraction and risk of bias assessment were performed independently by two reviewers.ResultsThe systematic review included 19 studies comprising 1567 shoulders. Overall, studies could be divided into those looking at the accuracy or reliability of determining glenoid track width, on‐ or off‐track Hill–Sachs lesions and near‐track lesions. Three‐dimensional images of computed tomography (3D‐CT) was the most reliable and accurate imaging modality to measure the glenoid track width. On the opposite, two‐dimensional magnetic resonance imaging (2D‐MRI) did not provide enough evidence of accuracy and reliability in the determination of On/Off track lesions and near‐track lesions.Conclusion3D‐CT demonstrated excellent reliability for measuring glenoid track width. However, the reliability of 2D‐MRI for determining on/off track Hill–Sachs lesions is still controversial.Level of EvidenceLevel III.

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Assessing Bone Loss in the Unstable Shoulder: a Scoping Review

Cited by 7 publications

References 52 publications

Prevalence and Risk Factors of Glenoid Bone Loss in Combined Shoulder Instability in Young, Active-Duty Military Patients

Prevalence and Risk Factors of Glenoid Bone Loss in Combined Shoulder Instability in Young, Active-Duty Military Patients

Bipolar bone loss and distance to dislocation

Accuracy and reliability of imaging modalities for studying bipolar bone loss in anterior shoulder instability: A systematic review

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