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Insufficient consensus regarding circle size and bone loss width using the ratio—“best fit circle”—method even with three-dimensional computed tomography

  • Lucca Lacheta
  • Elmar Herbst
  • Andreas Voss
  • Sepp Braun
  • Pia Jungmann
  • Peter J. Millett
  • Andreas Imhoff
  • Frank MartetschlägerEmail author
SHOULDER
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Abstract

Purpose

Glenoid bone integrity is crucial for shoulder stability. The purpose of this study was to investigate a non-invasive method for quantifying bone loss regarding reliability and accuracy to detect glenoid bone deficiency in standard two-dimensional (2D) and three-dimensional (3D) computed tomography (CT) measurements at different time points. It was hypothesized that the diameter of the circle used would significantly differ between raters, rendering this method inaccurate and not allowing for an exact estimation of glenoid defect size.

Methods

Fifty-two shoulder CTs from 26 patients (26 2D-CTs; 26 3D-CTs) with anterior glenoid bone defects were evaluated by 6 raters at time 0 (T0) and at least 3 weeks after (T1) to assess the glenoid bone defect using the ratio method (“best fit circle”). Inter- and intra-rater differences concerning circle dimensions (circle diameter), measured width of bone loss and calculated percentage of bone loss (length-width-ratio) were compared in 2D- versus 3D-CT scans. The intraclass coefficient (ICC) was used to determine the inter- and intra-rater agreement.

Results

The mean circle diameter difference in 2D-CT was 2.0 ± 1.9 mm versus 1.8 ± 1.5 mm in 3D-CT, respectively (p < 0.01). Mean width of bone loss in 2D-CT was 1.9 ± 1.7 mm compared to 1.7 ± 1.5 mm in 3D-CT, respectively (p < 0.01). The mean difference of bone loss percentage was 5.1 ± 4.8% in 2D-CT and 4.8 ± 4.5% in 3D-CT (p < 0.01). No significant differences concerning circle diameter, bone loss width and bone loss percentage were detected comparing T0 and T1. Circle diameter, bone loss width and bone loss percentage measurements in 3D-CT were significantly smaller compared to 2D-CT at T0 and T1 (p < 0.01). Agreement (ICC) was fair to good for all indicators of circle diameter (range 0.76–0.83), bone loss width (range 0.76–0.86) and percentage of bone loss (range 0.85–0.91). Overall, 3D-CT showed superior agreement compared to 2D-CT.

Conclusion

The ratio method varies in all glenoid parameters and is not valid for consistently quantifying glenoid bone defects even in 3D computed tomography. This must be taken into consideration when determining proper surgical treatment. The degree of glenoid bone loss alone should not be used to decide for or against a bony procedure. Rather, it is more important to define a defect size as “critical” and to also take other patient-specific factors into consideration so that the best treatment option can be undertaken. Application of the “best fitting circle” is a source of error when using the ratio method; therefore, care should be taken when measuring the circle diameter.

Level of evidence

III.

Keywords

Glenoid defect Shoulder instability Three-dimensional measurement Two-dimensional measurement Scapula Shoulder Ratio method Best fit circle 

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

Frank Martetschläger and Sepp Braun have received consulting fees from Arthrex. Andreas Imhoff has received consulting fees from Arthrex, Arthrosurface and Medi Bayreuth. Peter J. Millett has received consulting fees from Arthrex, Medbridge, Springer Publishing and royalties from Arthrex. Peter J. Millett has stock options in VuMedi and GameReady. Research activities at Steadman Philippon Research Institute are supported by Vail Valley Medical Center and corporate sponsorships by Smith&Nephew, Arthrex, Siemens and Össur. Elmar Herbst, Andreas Voss, Pia Jungmann and Lucca Lacheta declare no conflict of interests.

Ethical approval

The study is in accordance with the institutional ethic guidelines and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

References

  1. 1.
    Bishop JY, Jones GL, Rerko MA, Donaldson C, Group MS (2013) 3-D CT is the most reliable imaging modality when quantifying glenoid bone loss. Clin Orthop Relat Res 471:1251–1256CrossRefGoogle Scholar
  2. 2.
    Boileau P, Villalba M, Hery JY, Balg F, Ahrens P, Neyton L (2006) Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Jt Surg Am 88:1755–1763CrossRefGoogle Scholar
  3. 3.
    Bois AJ, Fening SD, Polster J, Jones MH, Miniaci A (2012) 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 40:2569–2577CrossRefGoogle Scholar
  4. 4.
    Burkhart SS, De Beer JF (2000) Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill–Sachs lesion. Arthroscopy 16:677–694CrossRefGoogle Scholar
  5. 5.
    Chuang TY, Adams CR, Burkhart SS (2008) Use of preoperative three-dimensional computed tomography to quantify glenoid bone loss in shoulder instability. Arthroscopy 24:376–382CrossRefGoogle Scholar
  6. 6.
    Edwards TB, Boulahia A, Walch G (2003) Radiographic analysis of bone defects in chronic anterior shoulder instability. Arthroscopy 19:732–739CrossRefGoogle Scholar
  7. 7.
    Frank RM, Golijanin P, Vopat BG, Gross DJ, Chauhan V, Romeo AA et al (2018) Impact of sagittal rotation on axial glenoid width measurement in the setting of glenoid bone loss. Am J Orthop (Belle Mead NJ) 47:6Google Scholar
  8. 8.
    Gerber C, Nyffeler RW (2002) Classification of glenohumeral joint instability. Clin Orthop Relat Res 400:65–76CrossRefGoogle Scholar
  9. 9.
    Griffith JF, Antonio GE, Tong CW, Ming CK (2003) Anterior shoulder dislocation: quantification of glenoid bone loss with CT. AJR Am J Roentgenol 180:1423–1430CrossRefGoogle Scholar
  10. 10.
    Griffith JF, Antonio GE, Yung PS, Wong EM, Yu AB, Ahuja AT et al (2008) Prevalence, pattern, and spectrum of glenoid bone loss in anterior shoulder dislocation: CT analysis of 218 patients. AJR Am J Roentgenol 190:1247–1254CrossRefGoogle Scholar
  11. 11.
    Gross DJ, Golijanin P, Dumont GD, Parada SA, Vopat BG, Reinert SE et al (2016) The effect of sagittal rotation of the glenoid on axial glenoid width and glenoid version in computed tomography scan imaging. J Shoulder Elbow Surg 25:61–68CrossRefGoogle Scholar
  12. 12.
    Itoi E, Lee SB, Berglund LJ, Berge LL, An KN (2000) The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: a cadaveric study. J Bone Jt Surg Am 82:35–46CrossRefGoogle Scholar
  13. 13.
    Kubicka AM, Stefaniak J, Lubiatowski P, Dlugosz J, Dzianach M, Redman M et al (2016) Reliability of measurements performed on two dimensional and three dimensional computed tomography in glenoid assessment for instability. Int Orthop 40:2581–2588CrossRefGoogle Scholar
  14. 14.
    Lacheta L, Siebenlist S, Imhoff AB, Willinger L (2018) Recurrent instability and instability arthropathy. Unfallchirurg 121:142–151CrossRefGoogle Scholar
  15. 15.
    Lo IK, Burkhart SS (2004) Arthroscopic revision of failed rotator cuff repairs: technique and results. Arthroscopy 20:250–267CrossRefGoogle Scholar
  16. 16.
    Mologne TS, Provencher MT, Menzel KA, Vachon TA, Dewing CB (2007) Arthroscopic stabilization in patients with an inverted pear glenoid: results in patients with bone loss of the anterior glenoid. Am J Sports Med 35:1276–1283CrossRefGoogle Scholar
  17. 17.
    Parada SA, Eichinger JK, Dumont GD, Parada CA, Greenhouse AR, Provencher MT et al (2018) Accuracy and reliability of a simple calculation for measuring glenoid bone loss on 3-dimensional computed tomography scans. Arthroscopy 34:84–92CrossRefGoogle Scholar
  18. 18.
    Porcellini G, Campi F, Paladini P (2002) Arthroscopic approach to acute bony Bankart lesion. Arthroscopy 18:764–769CrossRefGoogle Scholar
  19. 19.
    Provencher MT, Bhatia S, Ghodadra NS, Grumet RC, Bach BR Jr, Dewing CB et al (2010) Recurrent shoulder instability: current concepts for evaluation and management of glenoid bone loss. J Bone Jt Surg Am 92(Suppl 2):133–151CrossRefGoogle Scholar
  20. 20.
    Rerko MA, Pan X, Donaldson C, Jones GL, Bishop JY (2013) Comparison of various imaging techniques to quantify glenoid bone loss in shoulder instability. J Shoulder Elbow Surg 22:528–534CrossRefGoogle Scholar
  21. 21.
    Shaha JS, Cook JB, Song DJ, Rowles DJ, Bottoni CR, Shaha SH et al (2015) Redefining “critical” bone loss in shoulder instability: functional outcomes worsen with “subcritical” bone loss. Am J Sports Med 43:1719–1725CrossRefGoogle Scholar
  22. 22.
    Sugaya H, Moriishi J, Dohi M, Kon Y, Tsuchiya A (2003) Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Jt Surg Am 03(Suppl 85):878–884CrossRefGoogle Scholar
  23. 23.
    Sugaya H (2014) Techniques to evaluate glenoid bone loss. Curr Rev Musculoskelet Med 7:1–5CrossRefGoogle Scholar
  24. 24.
    Sugaya H, Moriishi J, Kanisawa I, Tsuchiya A (2005) Arthroscopic osseous Bankart repair for chronic recurrent traumatic anterior glenohumeral instability. J Bone Jt Surg Am 87:1752–1760Google Scholar
  25. 25.
    Sugaya H, Moriishi J, Kanisawa I, Tsuchiya A (2006) Arthroscopic osseous Bankart repair for chronic recurrent traumatic anterior glenohumeral instability. Surgical technique. J Bone Jt Surg Am 88(Suppl 1 Pt 2):159–169CrossRefGoogle Scholar
  26. 26.
    Yamamoto N, Itoi E, Abe H, Kikuchi K, Seki N, Minagawa H et al (2009) Effect of an anterior glenoid defect on anterior shoulder stability: a cadaveric study. Am J Sports Med 37:949–954CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic Sports MedicineTechnical University of MunichMunichGermany
  2. 2.Gelenkpunkt-Sports and Joint Surgery InnsbruckInnsbruckAustria
  3. 3.Department of Trauma-, Hand- and Reconstructive SurgeryWestfaelian-Wilhelms University of MuensterMünsterGermany
  4. 4.Department of RadiologyUniversity Medical Center FreiburgFreiburgGermany
  5. 5.The Steadman ClinicVailUSA
  6. 6.Steadman Philippon Research InstituteVailUSA
  7. 7.Department of Shoulder and Elbow SurgeryATOS Clinic MunichMunichGermany
  8. 8.Department of Trauma SurgeryUniversity Hospital RegensburgRegensburgGermany

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