Algorithm for Evaluation of Bipolar Defects in Anterior Instability of the Shoulder

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Abstract

Purpose of the study — to justify the algorithm for evaluation of bipolar defects in anterior shoulder instrability using the most accurate, statistically significant and reproducible methods which would make the algorithm applicable in practical surgery.

Materials and methods. The authors established 4 groups with 6 patients in each with shoulder instability, group distribution was based on glenoid defect size: small (<15%), moderate (15-19%), large (20-25%) and massive (>25%). All 24 patients underwent 3D-CT, 3D VIBE MRI and shoulder arthroscopy. Measurements were taken by 7 specialists 5 of whom measured defect during arthroscopy. Glenoid defect was measured by linear and sectional relation methods. Pico method on 3D-CT was taken as the “golden standard”. Accuracy was verified by analysis of variance with post-hoc comparison. Reproducibility was evaluated by intraclass correlation coefficient.

Results. All groups excluding the one with massive glenoid defects demonstrated significant differences from the model (p≤0,05) for measurements during arthroscopy and examinations by 3D-CT and 3D VIBE MRI. Restrospective analysis confirmed the least accuracy and the worst reproducibility of visual evaluation of glenoid defects less than 25%. Sectional relation method on 3D-CT had the maximum accuracy and reproducibility in all groups (PE = 1,29%±2,39%, ICC = 0,756-0,856), excluding the group with massive defects, where researched measurement methods had close accuracy when applied on 3D-CT, 3D VIBE MRI and during arthroscopy. Linear relation method on 3D-CT overestimated the defect volume at 2,1-7,9% and demonstrated less reliable reproducibility (PE = 3,22%±5,31%, ICC = 0,612-0,621). The highest error (up to 7,9%) was demonstrated by linear method in case of borderline defects in the III group of 20-25%. Insufficient conformity of results for linear (ICC = 0,42) method and moderate conformity for sectional (ICC = 0,62) method were observed during comparison of 3D VIBE MRI with 3D-CT. MRI underestimated the value of small defects and overestimated large defects. Reproducibility of measurements on 3D-CT by different operators was moderate for visual (ICC=0,594) and linear methods (ICC = 0,621) and good for sectional method (ICC = 0,756). Reproducibility of measurements by each operator also was moderate for visual and linear methods (ICC = 0,553 и ICC = 0,612) and good for sectional method (ICC = 0,856). The authors suggested an algorithm for selection of examination method and measurements for defects of articular surfaces which also considers the main factors of prognosis and risk of recurrent instability.

Conclusion. Sectional relation method on 3D-CT is the most precise and reproducible method of glenoid defect measurements used in the clinical practice. MRI use without CT is inadmissible for bipolar defects of borderline size. Suggested algorithm allows not to make CT examination at extreme ISIS values and increases the share of osteoplastic surgeries due to identification of off-track injuries with glenoid defects of borderline size (15-25%).

About the authors

V. V. Khominets

Kirov Military Medical Academy

Email: fake@neicon.ru

Vladimir V. Khominets — Dr. Sci. (Med.), head of the Department and clinic of Traumatology and orthopedics.

St. Petersburg

Россия

R. V. Gladkov

Kirov Military Medical Academy

Author for correspondence.
Email: dr.gladkov@gmail.com

Roman V. Gladkov — cand. Sci. (Med.), lecturer of the Department and clinic of Traumatology and orthopedics.

St. Petersburg

Россия

I. S. Zheleznyak

Kirov Military Medical Academy

Email: fake@neicon.ru

Igor S. Zheleznyak — Dr. Sci. (Med.), head of the Department and clinic of Radiology and Radiology with a course of ultrasound diagnostics.

St. Petersburg

Россия

A. S. Grankin

Kirov Military Medical Academy

Email: fake@neicon.ru

Alexey S. Grankin — cand. Sci. (Med.), resident of the Department and clinic of Traumatology and orthopedics.

St. Petersburg Россия

D. A. Volov

Kirov Military Medical Academy

Email: fake@neicon.ru

Daniil A. Volov — resident of the Department and clinic of Traumatology and orthopedics.

St. Petersburg Россия

А. A. Emelyantsev

Kirov Military Medical Academy

Email: fake@neicon.ru

Alexandr A. Emelyantsev — cand. Sci. (Med.), lecturer of the Department and clinic of Radiology and Radiology with a course of ultrasound Diagnostics.

St. Petersburg

Россия

References

  1. Balg F., Boileau P. The instability severity index score. A simple pre-operative score to select patients for arthroscopicor open shoulder stabilisation. J Bone Joint Surg Br. 2007;89(11):1470-1477. doi: 10.1302/0301-620X.89B11.18962.
  2. Shin S.J., Koh Y.W., Bui C., Jeong W.K., Akeda M., Cho N.S. et al. What is the critical value of glenoid bone loss at which soft tissue Bankart repair does not restore glenohumeral translation, restricts range of motion, and leads to abnormal humeral head position? Am J Sports Med. 2016;44(11):2784-2791. doi: 10.1177/0363546516656367.
  3. Beran M.C., Donaldson C.T., Bishop J.Y. Treatment of chronic glenoid defects in the setting of recurrent anterior shoulder instability: A systematic review. J Shoulder Elbow Surg. 2010;19(5):769-780. doi: 10.1016/j.jse.2010.01.011.
  4. Chen A.L., Hunt S.A., Hawkins R.J., Zuckerman J.D. Management of bone loss associated with recurrent anterior glenohumeral instability. Am J Sports Med. 2005;33(6):912-925. doi: 10.1177/0363546505277074.
  5. Lynch J.R., Clinton J.M., Dewing C.B., Warme W.J., Matsen F.A. 3rd. Treatment of osseous defects associated with anterior shoulder instability. J Shoulder Elbow Surg 2009;18(2):317-328. doi: 10.1016/j.jse.2008.10.013.
  6. Ochoa E. Jr., Burkhart S.S. Glenohumeral bone defects in the treatment of anterior shoulder instability. Instr courselect. 2009;58:323-336.
  7. Yamamoto N., Itoi E., Abe H., Kikuchi K., Seki N., Minagawa H., Tuoheti Y. Effect of an anterior glenoid defect on anterior shoulder stability: A cadaveric study. Am J Sports Med. 2009;37:949-954. doi: 10.1177/0363546508330139.
  8. Shaha J.S., Cook J.B., Song D.J., Rowles D.J., Bottoni C.R., Shaha S.H., Tokish J.M. Redefining «critical» bone loss in shoulder instability: Functional outcomes worsen with “subcritical” bone loss. Am J Sports Med. 2015;43(7): 1719-1725. doi: 10.1177/0363546515578250.
  9. Yamamoto N., Itoi E., Abe H., Minagawa H., Seki N., Shimada Y., Okada K. Contact between the glenoid and the humeral head in abduction, external rotation, and horizontal extension: a new concept of glenoid track. J Shoulder Elbow Surg. 2007;16(5):649-656. doi: 10.1016/j.jse.2006.12.012.
  10. Bishop J.Y., Jones G.L., Rerko M.A., Donaldson C., MOON Shoulder Group. 3-D ct is the most reliable imaging modality when quantifying glenoid bone loss. Clin Orthop Relat Res. 2013;471(4):1251-1256. doi: 10.1007/s11999-012-2607-x.
  11. Dumont G.D., Russell R.D., Browne M.G., Robertson W.J. Area-based determination of bone loss using the glenoid arc angle. Arthroscopy. 2012;28(7):1030-1035. doi: 10.1016/j.arthro.2012.04.147.
  12. Hamamoto J.T., Leroux T., Chahla J., et al. Assessment and evaluation of glenoid bone loss. Arthrosc Tech. 2016;5(4):e947-e951. doi: 10.1016/j.eats.2016.04.027.
  13. Magarelli N., Milano G., Baudi P., Santagada D.A., Righi P., Spina V. et al. Comparison between 2D and 3D computed tomography evaluation of glenoid bone defect in unilateral anterior gleno-hu-meral instability. Radiol Med. 2012;117(1):102-111. (In English, Italian). doi: 10.1007/s11547-011-0712-7.
  14. Rerko M.A., Pan X., Donaldson C., Jones G.L., Bishop J.Y. Comparison of various imaging techniques to quantify glenoid bone loss in shoulder instability. J Shoulder Elbow Surg. 2013;22(4):528-534. doi: 10.1016/j.jse.2012.05.034.
  15. Bakshi N.K., Patel I., Jacobson J.A., Debski R.E., Sekiya J.K. Comparison of 3-dimensional computed tomogra-phybased measurement of glenoid bone loss with arthroscopic defect size estimation in patients with anterior shoulder instability. Arthroscopy. 2015;31(10):1880-1885. doi: 10.1016/j.arthro.2015.03.024.
  16. Shin S.J., Jun B.J., Koh Y.W., Mcgarry M.H., Lee T.Q. Estimation of anterior glenoid bone loss area using the ratio of bone defect length to the distance from posterior glenoid rim to the centre of the glenoid. Knee Surg Sports Traumatol Arthrosc. 2018;26(1):48-55. doi: 10.1007/s00167-016-4312-x.
  17. Magarelli N., Milano G., Sergio P., Santagada D.A., Fabbriciani C., Bonomo L. Intra-observer and interobserver reliability of the «pico» computed tomography method for quantification of glenoid bone defect in anterior shoulder instability. Skeletal Radiol. 2009;38(11):1071-1075. doi: 10.1007/s00256-009-0719-5.
  18. Gyftopoulos S., Hasan S., Bencardino J., Mayo J., Nayyar S., Babb J., Jazrawi L. Diagnostic accuracy of MRI in the measurement of glenoid bone loss. AJR Am J Roentgenol. 2012;199(4):873-878. doi: 10.2214/ajr.11.7639.
  19. Huijsmans P.E., Haen P.S., Kidd M., Dhert W.J., Van Der Hulst V.P., Willems W.J. Quantification of a glenoid Defect with three-dimensional computed tomography and magnetic resonance imaging: a cadaveric study. J Shoulder Elbow Surg. 2007;16(6):803-809. doi: 10.1016/j.jse.2007.02.115.
  20. Friedman L.G.M., Ulloa S.A., David T.B., Hussein A.S., Morgan H.J., Miniaci A.A. Glenoid Bone Loss Measurement in Recurrent Shoulder Dislocation. Assessment of Measurement Agreement Between ct and MRI. Orthop J Sports Med. 2014;2(9):2325967114549541. doi: 10.1177/2325967114549541.
  21. Sugaya H., Moriishi J., Dohi M., Kon Y., T Suchiya A. Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Joint Surg Am. 2003;85-A(5):878-884.
  22. Huysmans P.E., Haen P.S., Kidd M., Dhert W.J., Willems J.W. The shape of the inferior part of the glenoid: A ca-davericstudy. J Shoulder Elbow Surg. 2006;15(6):759-763. doi: 10.1016/j.jse.2005.09.001.
  23. Bois A.J., Fening S.D., Polster J., Jones M.H., Miniaci A. Quantifying glenoid bone loss in anterior shoulder instability: Reliability and accuracy of 2-dimensional and 3-dimensional computed tomography measurement techniques. Am J Sports Med. 2012;40(11):2569-2577. doi: 10.1177/0363546512458247.
  24. Burkhart S.S., De Beer J.F. Traumatic glenohumeral bone defects and their relationship to failure of arthroscop-icbankart repairs: Significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy. 2000;16(7):677-694.
  25. Gyftopoulos S., Beltran L.S., Bookman J., Rokito A. MRI Evaluation of Bipolar Bone Loss using the on-Track offtrack Method: A feasibility Study. AJR Am J Roentgenol. 2015;205(4):848-852. doi: 10.2214/ajr.14.14266.
  26. Detterline A.J., Provencher M.T., Ghodadra N., Bach B.R. Jr, Romeo A.A., Verma N.N. A New arthroscopic technique to determine anterior-inferior glenoid bone loss: Validation of the secant chord theory in a cadaveric model. Arthroscopy. 2009;25(11):1249-1256. doi: 10.1016/j.arthro.2009.05.019.
  27. Provencher M.T., Detterline A.J., Ghodadra N., Romeo A. A., Bach B.R. Jr, Cole B.J., Verma N. Measurement of glenoid bone loss: A comparison of measurement error between 45 degrees and 0 degrees bone loss models and with different posterior arthroscopy portal locations. Am J Sports Med. 2008;36(6):1132-1138. doi: 10.1177/0363546508316041.
  28. Bhatia S., Saigal A., Frank R.M., Bach B.R. Jr, Cole B. J., Romeo A.A., Verma N.N. Glenoid diameter is an inaccurate method for percent glenoid bone loss quantification: Analysis and techniques for improved accuracy. Arthroscopy. 2015;31(4):608-614.e1. doi: 10.1016/j.arthro.2015.02.020.
  29. Barchilon V.S., Kotz E., Barchilon Ben-Av M., Glazer E., Nyska M. A simple method for quantitative evaluation of the missing area of the anterior glenoid in anterior instability of the glenohumeral joint. Skeletal Radiol. 2008;37(8):731-736. doi: 10.1007/s00256-008-0506-8.
  30. Nofsinger C., Browning B., Burkhart S.S., Pedowitz R.A. Objective preoperative measurement of anterior glenoid bone loss: A pilot study of a computer-based method using unilateral 3-dimensional computed tomography. Arthroscopy. 2011;27(3):322-329. doi: 10.1016/j.arthro.2010.09.007.
  31. Baudi P., Righi P., Bolognesi D., Rivetta S., Rossi Urtoler E., Guicciardi N., Carrara M. How to identify and calculate glenoid bone deficit. Chir Organi Mov. 2005;90(2): 145-152. (In English, Italian).
  32. Parada S.A., Eichinger J.K., Dumont G.D., Parada C.A., Greenhouse A.R., Provencher M.T. et al. Accuracy and reliability of a simple calculation for measuring glenoid bone loss on 3-dimensional computed tomography scans. Arthroscopy. 2018;34(1):84-92. doi: 10.1016/j.arthro.2017.07.032.
  33. Chuang T.Y., Adams C.R., Burkhart S.S. Use of preoperative three-dimensional computed tomography to quantify glenoid bone loss in shoulder instability. Arthroscopy. 2008;24(4):376-382. doi: 10.1016/j.arthro.2007.10.008.
  34. Gross D.J., Golijanin P., Dumont G.D., Parada S.A., Vopat B.G., Reinert S.E. et al. The effect of sagittal rotation of the glenoid on axial glenoid width and glenoid version in computed tomography scan imaging. J Shoulder Elbow Surg. 2016;25(1):61-68. doi: 10.1016/j.jse.2015.06.017.
  35. Tian C.Y., Shang Y., Zheng Z.Z. Glenoid bone lesions: comparison between 3D Vibe images in MR arthrography and nonarthrographic msct. J Magn Reson Imaging. 2012;(1):231-236. doi: 10.1002/jmri.23622.
  36. Lee R.K., Griffith J.F., Tong M.M., Sharma N., Yung P. Glenoid bone loss: assessment with MR imaging. Radiology. 2013;267(2):496-502.
  37. Hartzler R.U., Bui C.N.H., Jeong W.K., Denard Pj., Burkhart S.S., Lee T.Q. et al. Remplissage of an offtrack hill-sachs lesion is necessary to restore biomechanical glenohumeral joint stability in a bipolar bone loss model. Arthroscopy. 2016;32(12):2466-2476. doi: 10.1016/j.arthro.2016.04.030.

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