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Qualitative and quantitative analysis of glenoid bone stock and glenoid version: inter-reader analysis and correlation with rotator cuff tendinopathy and atrophy in patients with shoulder osteoarthritis

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A Correction to this article was published on 21 February 2020

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Abstract

Purpose

Glenoid bone stock and morphology and rotator cuff muscle quality and tendon integrity affect the outcome of total shoulder arthroplasty. We hypothesized that glenoid bone loss correlates with rotator cuff muscle fatty infiltration (FI), tendinopathy, and atrophy.

Design

Forty-three 3D CT scans and MRIs of 43 patients (mean age 62 years; SD 13 years; range 22–77 years) referred for primary shoulder pain were evaluated. Measurements of glenoid bone stock, version, and posterior humeral subluxation index (HSI) were assessed on an axial CT image reconstructed in the true scapular plane. Measurements utilized the Friedman line to approximate the pre-pathologic surface. Glenoid morphology was assigned by modified Walch classification. Rotator cuff FI, atrophy, and tendon integrity were assessed on corresponding MRIs.

Results

There was a very strong negative correlation between increasing glenoid version and HSI (r = − 0.908; p < 0.0001). There was a moderately negative correlation between anterior bone loss and HSI (r = − 0.562; p < 0.0001) and a moderately positive correlation between posterior bone loss and HSI (r = 0.555; p < 0.0001). Subscapularis muscle FI correlated moderately with increased anterior and central bone loss and increased humeral head medialization (r = 0.512, p = 0.0294; r = 0.479, p = 0.033; r = 0.494, p = 0.0294; respectively). Inter-observer reliability (intra-class correlation coefficient [ICC] and kappa) was good to excellent for all measurements and grading.

Conclusion

Glenoid anteversion and anterior and posterior bone loss are associated with varying HSI. Subscapularis muscle FI, not tendon integrity, correlates to anterior and central glenoid erosion. The study adds evidence that neither rotator cuff tendinopathy nor muscle atrophy exhibits a significant relationship to HSI.

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  • 21 February 2020

    <Emphasis Type="Bold">Abstract</Emphasis>

    <Emphasis Type="Bold">Purpose</Emphasis> Glenoid bone stock and morphology and rotator cuff muscle quality and tendon integrity affect the outcome of total shoulder arthroplasty. We hypothesized that glenoid bone loss correlates with rotator cuff muscle fatty infiltration (FI), tendinopathy, and atrophy.

    <Emphasis Type="Bold">Design</Emphasis> Forty-three 3-D CT scans and MRIs of 43 patients (mean age 62 years; SD 13 years; range 22–77 years) referred for primary shoulder pain were evaluated. Measurements of glenoid bone stock, version, and posterior humeral subluxation index (HSI) were assessed on an axial CT image reconstructed in the true scapular plane. Measurements utilized the Friedman line to approximate the pre-pathologic surface. Glenoid morphology was assigned by modified Walch classification. Rotator cuff FI, atrophy, and tendon integrity were assessed on corresponding MRIs.

    <Emphasis Type="Bold">Results</Emphasis> There was a very strong negative correlation between increasing glenoid version and HSI (<Emphasis Type="Italic">r</Emphasis> = − 0.908; <Emphasis Type="Italic">p</Emphasis> &lt; 0.0001). There was a moderately negative correlation between anterior bone loss and HSI (<Emphasis Type="Italic">r</Emphasis> = − 0.562; <Emphasis Type="Italic">p</Emphasis> &lt; 0.0001) and a moderately positive correlation between posterior bone loss and HSI (<Emphasis Type="Italic">r</Emphasis> = 0.555; <Emphasis Type="Italic">p</Emphasis> &lt; 0.0001). Subscapularis muscle FI correlated moderately with increased anterior and central bone loss and increased humeral head medialization (<Emphasis Type="Italic">r</Emphasis> = 0.512, <Emphasis Type="Italic">p</Emphasis> = 0.0294; <Emphasis Type="Italic">r</Emphasis> = 0.479, <Emphasis Type="Italic">p</Emphasis> = 0.033; <Emphasis Type="Italic">r</Emphasis> = 0.494, <Emphasis Type="Italic">p</Emphasis> = 0.0294, respectively). Inter-observer reliability (intra-class correlation coefficient [ICC] and kappa) was good to excellent for all measurements and grading.

    <Emphasis Type="Bold">Conclusion</Emphasis> Glenoid anteversion and anterior and posterior bone loss are associated with varying HSI. Subscapularis muscle FI, not tendon integrity, correlates to anterior and central glenoid erosion. The study adds evidence that neither rotator cuff tendinopathy nor muscle atrophy exhibits a significant relationship to HSI.

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Authors and Affiliations

  1. Radiology, UT Southwestern Medical Center, Dallas, TX, USA

    Matthew J. Siebert, Majid Chalian, Arghavan Sharifi, Parham Pezeshk, Yin Xi, Parker Lawson & Avneesh Chhabra

  2. Orthopedics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA

    Avneesh Chhabra

  3. Radiology and Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA

    Avneesh Chhabra

  4. Johns Hopkins University, Baltimore, MD, USA

    Avneesh Chhabra

  5. Walton Center of Neurosciences, Liverpool, UK

    Avneesh Chhabra

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  1. Matthew J. Siebert
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Correspondence to Avneesh Chhabra.

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This was a cross-sectional study performed in compliance with HIPAA regulations and was approved by our tertiary care institutional review board. Informed consent was waived due to the retrospective nature of the study.

Conflict of interest

AC receives royalties from Jaypee and Wolters. AC also serves as consultant with ICON Medical and Treace 3D Medical Inc.

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Siebert, M.J., Chalian, M., Sharifi, A. et al. Qualitative and quantitative analysis of glenoid bone stock and glenoid version: inter-reader analysis and correlation with rotator cuff tendinopathy and atrophy in patients with shoulder osteoarthritis. Skeletal Radiol 49, 985–993 (2020). https://doi.org/10.1007/s00256-020-03377-0

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