Abstract:Quantifying bone loss is important to decide the best treatment for patients with recurrent anterior glenohumeral instability. Currently, there is no standard method available to make a precise evaluation of the Hill–Sachs lesion and predict its engagement before the surgical procedure. This literature review was performed in order to identify existing published imaging methods quantifying humeral head bone loss in Hill–Sachs lesions. Searches were undertaken in Scopus and PubMed databases from January 2008 un… Show more
“…Just as in this study, we have proven that the 3D method allows for more accurate measurement by researchers with different levels of experience. Similar to the measurements of the glenoid defect, different measuring methods of the Hill-Sachs bone loss were described in the literature [31]. Kodali et al positively assessed the reliability of the Hill-Sachs measurement by two-dimensional tomography, measuring the width and depth of the defect in three planes (sagittal, frontal, and transverse) [17].…”
Purpose
The aim of the study was to compare two measurement methods of humeral head defects in patients with shoulder instability. Intra- and inter-observer reliability of humeral head parameters were performed with the use of 2D and 3D computed tomography.
Methods
The study group was composed of one hundred humeral heads measured with the use of preoperative 2D and 3D computed tomography by three independent observers (two experienced and one inexperienced). All observers repeated measurements after 1 week. The intra-class correlation coefficient (ICC) and the minimal detectable change with 95% confidence (MDC95%) were used for statistical analysis of diagnostic agreement.
Results
For 3D inter-observer reliability, ICC values were “excellent” for all parameters and MDC95% values were “excellent” or “reasonable.” All intra-observer ICC and MDC95% values for 3D were “excellent” for experienced and inexperienced observers. For 2D-CT, ICC values were usually “good” or “moderate” with MDC95% values higher than 10 or 30%.
Conclusions
Three-dimensional CT measurements are more reliable than 2D for humeral head and Hill-Sachs lesion assessment. This study showed that 2D measurements, even performed by experienced observers (orthopaedic surgeons), are burdened with errors. The 3D reconstruction decreased the risk of error by eliminating inaccuracy in setting the plane of the measurements.
“…Just as in this study, we have proven that the 3D method allows for more accurate measurement by researchers with different levels of experience. Similar to the measurements of the glenoid defect, different measuring methods of the Hill-Sachs bone loss were described in the literature [31]. Kodali et al positively assessed the reliability of the Hill-Sachs measurement by two-dimensional tomography, measuring the width and depth of the defect in three planes (sagittal, frontal, and transverse) [17].…”
Purpose
The aim of the study was to compare two measurement methods of humeral head defects in patients with shoulder instability. Intra- and inter-observer reliability of humeral head parameters were performed with the use of 2D and 3D computed tomography.
Methods
The study group was composed of one hundred humeral heads measured with the use of preoperative 2D and 3D computed tomography by three independent observers (two experienced and one inexperienced). All observers repeated measurements after 1 week. The intra-class correlation coefficient (ICC) and the minimal detectable change with 95% confidence (MDC95%) were used for statistical analysis of diagnostic agreement.
Results
For 3D inter-observer reliability, ICC values were “excellent” for all parameters and MDC95% values were “excellent” or “reasonable.” All intra-observer ICC and MDC95% values for 3D were “excellent” for experienced and inexperienced observers. For 2D-CT, ICC values were usually “good” or “moderate” with MDC95% values higher than 10 or 30%.
Conclusions
Three-dimensional CT measurements are more reliable than 2D for humeral head and Hill-Sachs lesion assessment. This study showed that 2D measurements, even performed by experienced observers (orthopaedic surgeons), are burdened with errors. The 3D reconstruction decreased the risk of error by eliminating inaccuracy in setting the plane of the measurements.
“… 13 Such studies reinforce the importance of quantifying bone loss preoperatively to facilitate the surgical decision-making process. 8 , 46 , 79 Figure 1 Modified classification of glenoid rim lesion types associated with anterior shoulder instability: type I, displaced avulsion fracture with attached capsule; type II, medially displaced fragment malunited to glenoid rim; type III, erosion of glenoid rim with <25% deficiency (type IIIA) or >25% deficiency (type IIIB); and type IV, erosion of glenoid rim with >25% deficiency combined with a stretched inferior glenohumeral ligament (ie, capsular laxity). (From Bois AJ, Miniaci A. Surgical management of instability with bone loss.…”
Background
Management of bone loss in recurrent traumatic anterior shoulder instability remains a topic of debate and controversy in the orthopedic community. The purpose of this study was to survey members of 4 North American orthopedic surgeon associations to assess management trends for bone loss in recurrent anterior shoulder instability.
Methods
An online survey was distributed to all members of the American Shoulder and Elbow Surgeons, American Orthopaedic Society for Sports Medicine, and Canadian Orthopaedic Association and to fellow members of the Arthroscopy Association of North America. The survey comprised 3 sections assessing the demographic characteristics of survey respondents, the influence of prognostic factors on surgical decision making, and the operative management of 12 clinical case scenarios of varying bone loss that may be encountered in clinical practice.
Results
A total of 150 survey responses were returned. The age of the patient and quantity of bone loss were consistently considered important prognostic criteria. However, little consensus was reached for critical thresholds of bone loss and how this affected the timing (ie, primary or revision surgery) and type of bony augmentation procedure to be performed once a critical threshold was reached, especially in the context of critical humeral and bipolar bone loss.
Conclusions
Consistent trends were found for the management of recurrent anterior shoulder instability in cases in which no bone loss existed and when isolated critical glenoid bone loss was present. However, inconsistencies were observed when isolated critical humeral bone loss and bipolar bone loss were present.
“…Precise determination of GBL percentage can be achieved mainly in two ways: 3D-CT scan was used by Shin et al , whereas MRI was used by Shaha et al . Although 3D-CT scan can help establish precise measurement of GBL (usually using the either the Glenoid Index49 or Pico Method50), 3D-MRI shows equivalent accuracy51–54 and allows for HSL evaluation (ie, on-track vs off-track) and soft tissue damage without the burden of high radiation exposure 55. When using CT scans, the contralateral comparison method was more reliable than the best-fit circle method for quantifying the amount of GBL 56…”
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