The Anatomy of Glenoid Concavity—Bony and Osteochondral Assessment of a Stability-Related Parameter

Wermers, Jens; Raschke, Michael J.; Wilken, Marcel; Riegel, Arne; Katthagen, J. Christoph

doi:10.3390/jcm10194316

Cited by 8 publications

(12 citation statements)

References 25 publications

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“…One possible explanation for the decreasing stability during cartilage loss is that the concavity of the glenoid is essentially built up by the cartilage [ 33 ]. This was confirmed by the fact that the concavity gradient decreased with each further state of induced cartilage loss.…”

Section: Discussionmentioning

confidence: 99%

“…A layer of cartilage is deposited on the glenoid bone, increasing in thickness from the centre to the outer rim [ 15 ]. This cartilage layer increases the concavity gradient and concavity compression in addition to the concave shape of the bone [ 33 ]. In case of recurrent dislocations, higher grade loss of cartilage is reported [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Cartilage decisively shapes the glenoid concavity and contributes significantly to shoulder stability

Souleiman

Pastor

Варга

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose Glenohumeral joint injuries frequently result in shoulder instability. However, the biomechanical effect of cartilage loss on shoulder stability remains unknown. The aim of the current study was to investigate biomechanically the effect of two severity stages of cartilage loss in different dislocation directions on shoulder stability. Methods Joint dislocation was provoked in 11 human cadaveric glenoids for 7 different directions between 3 o'clock (anterior) and 9 o'clock (posterior). Shoulder stability ratio (SSR) and concavity gradient were assessed in three states: intact, 3 mm and 6 mm simulated cartilage loss. The influence of cartilage loss on SSR and concavity gradient was statistically evaluated. Results Both SSR and concavity gradient decreased significantly between intact state and 6 mm cartilage loss in every dislocation direction (p ≤ 0.038), except concavity gradient in 4 o'clock direction. Thereby, anterior–inferior dislocation directions were associated with the highest decrease in both SSR and concavity gradient of up to 59.0% and 49.4%, respectively, being significantly bigger for SSR compared with all other dislocation directions (p ≤ 0.040). Correlations between concavity gradient and SSR for pooled dislocation directions were significant in each separate specimen's state (p < 0.001). Conclusion From a biomechanical perspective, articular cartilage of the glenoid contributes significantly to the concavity gradient, correlating strongly with the associated loss in glenohumeral joint stability. The biggest effect of cartilage loss is observed in the most frequently occurring anterior–inferior dislocation directions, suggesting that surgical interventions to restore cartilage's surface and concavity should be considered for recurrent shoulder dislocations in presence of cartilage loss.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cartilage decisively shapes the glenoid concavity and contributes significantly to shoulder stability

Souleiman

Pastor

Варга

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…30,50 However, we found that once the traumatic instability occurred, the deeper native glenoid instead was associated with a more severe structural lesion because it is associated with deeper, wider, and more medialized HSL. Together with the previous finding that the loss of stability for a given level of bone loss is positively associated with native glenoid depth, 30,49,50 a deep native glenoid frequently results in a conspicuous decrease in both midrange stability 30,50,51 produced by glenoid defects and end-range stability 21 induced by humeral defects in the context of bipolar bone loss. Additionally, this study can aid in a quick comprehension of the 3D properties of HSL.…”

Section: Discussionmentioning

confidence: 59%

Native Glenoid Depth and Hill-Sachs Lesion Morphology in Traumatic Anterior Shoulder Instability

Wu,

Liu,

et al. 2023

Am J Sports Med

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Background: Although Hill-Sachs lesions (HSLs) are assumed to be influenced by glenoid characteristics in the context of bipolar bone loss, little is known about how glenoid concavity influences HSL morphology. Purpose: To investigate the relationship between the native glenoid depth and HSL morphological characteristics. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Computed tomography images of bilateral shoulders from 151 consecutive patients with traumatic unilateral anterior shoulder instability were retrospectively reviewed. Patients were categorized into flat (<1 mm), moderate (1-2 mm), and deep (>2 mm) groups based on the native glenoid depth measured from the contralateral unaffected shoulder. The HSL morphological characteristics included size (depth, width, length, and volume), location (medial, superior, and inferior extent), and orientation (rim and center angle). The glenoid characteristics included diameter, depth, version, and bone loss. The patient, glenoid, and HSL morphological characteristics were compared among the 3 depth groups. Subsequently, the independent predictors of some critical HSL morphological characteristics were determined using multivariate stepwise regression. Results: After exclusion of 55 patients, a total of 96 patients were enrolled and classified into the flat group (n = 31), moderate group (n = 35), and deep group (n = 30). Compared with those in the flat group, patients in the deep group were more likely to have dislocation (38.7% vs 93.3%; P = .009) at the primary instability and had a significantly larger number of dislocations (1.1 ± 1.0 vs 2.2 ± 1.8; P = .010); moreover, patients in the deep group had significantly deeper, wider, larger volume, more medialized HSLs and higher incidences of off-track HSLs (all P≤ .025). No significant differences were detected among the 3 groups in HSL length, vertical position, and orientation (all P≥ .064). After adjustment for various radiological and patient factors in the multivariate regression model, native glenoid depth remained the strongest independent predictor for HSL depth (β = 0.346; P < .001), width (β = 0.262; P = .009), volume (β = 0.331; P = .001), and medialization (β = −0.297; P = .003). Conclusion: The current study sheds light on the association between native glenoid depth and the morphology of HSLs in traumatic anterior shoulder instability. Native glenoid depth was independently and positively associated with HSL depth, width, volume, and medialization. Patients with deeper native glenoids were more likely to have off-track HSLs and thus require more attention in the process of diagnosis and treatment.

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“…Several studies have described the biomechanical relationship between the 3D shape of the glenoid and the Linear (1-dimensional) BFC diameter 0.8 (0.5-0.9) Substantial 0.9 (0.7-1.0) Almost perfect Defect diameter 0.8 (0.7-0.9) Substantial 0.9 (0.9-1.0) Almost perfect Ratio 0.8 (0.7-0.9) Almost perfect 0.9 (0.9-1.0) Almost perfect Area (2-dimensional) BFC area 0.8 (0.4-0.9) Substantial 0.9 (0.7-1.0) Almost perfect Defect area 0.8 (0.6-0.8) Substantial 0.9 (0.9-1.0) Almost perfect Ratio 0.8 (0.7-0.9) Substantial 0.9 (0.8-0.9) Almost perfect Concavity (3-dimensional) BSSR 0.5 (0.2-0.7) Moderate 0.9 (0.9-0.9) Almost perfect a stability ratio. 9,11,12,17,27 Furthermore, Moroder et al 16,17 emphasized the differences in glenoid morphology between patients and challenged the current concept of defining a general threshold for a critical glenoid defect. In their finite element analysis, they showed a nonlinear relationship between the glenoid defect size and its biomechanical effect and differences in biomechanically relevant glenoid concavity between patients.…”

Section: Discussionmentioning

confidence: 99%

Reliability of Manual Measurements Versus Semiautomated Software for Glenoid Bone Loss Quantification in Patients With Anterior Shoulder Instability

Karpinski,

Akguen,

Gebauer

et al. 2024

Orthopaedic Journal of Sports Medicine

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Background: The presence of glenoid bone defects is indicative in the choice of treatment for patients with anterior shoulder instability. In contrast to traditional linear- and area-based measurements, techniques such as the consideration of glenoid concavity have been proposed and validated. Purpose: To compare the reliability of linear (1-dimensional [1D]), area (2-dimensional [2D]), and concavity (3-dimensional [3D]) measurements to quantify glenoid bone loss performed manually and to analyze how automated measurements affect reliability. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Computed tomography images of 100 patients treated for anterior shoulder instability with differently sized glenoid defects were evaluated independently by 2 orthopaedic surgeons manually using conventional software (OsiriX; Pixmeo) as well as automatically with a dedicated prototype software program (ImFusion Suite; ImFusion). Parameters obtained included 1D (defect diameter, best-fit circle diameter), 2D (defect area, best-fit circle area), and 3D (bony shoulder stability ratio) measurements. Mean values and reliability as expressed by the intraclass correlation coefficient [ICC]) were compared between the manual and automated measurements. Results: When manually obtained, the measurements showed almost perfect agreement for 1D parameters (ICC = 0.83), substantial agreement for 2D parameters (ICC = 0.79), and moderate agreement for the 3D parameter (ICC = 0.48). When measurements were aided by automated software, the agreement between raters was almost perfect for all parameters (ICC = 0.90 for 1D, 2D, and 3D). There was a significant difference in mean values between manually versus automatically obtained measurements for 1D, 2D, and 3D parameters ( P < .001 for all). Conclusion: While more advanced measurement techniques that take glenoid concavity into account are more accurate in determining the biomechanical relevance of glenoid bone loss, our study showed that the reliability of manually performed, more complex measurements was moderate.

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The Anatomy of Glenoid Concavity—Bony and Osteochondral Assessment of a Stability-Related Parameter

Cited by 8 publications

References 25 publications

Cartilage decisively shapes the glenoid concavity and contributes significantly to shoulder stability

Cartilage decisively shapes the glenoid concavity and contributes significantly to shoulder stability

Native Glenoid Depth and Hill-Sachs Lesion Morphology in Traumatic Anterior Shoulder Instability

Reliability of Manual Measurements Versus Semiautomated Software for Glenoid Bone Loss Quantification in Patients With Anterior Shoulder Instability

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