Archives of Orthopaedic and Trauma Surgery

, Volume 133, Issue 2, pp 219–226 | Cite as

The importance of CT for the pre-operative surgical planning in recurrent anterior shoulder instability

  • Philipp Moroder
  • Herbert Resch
  • Silke Schnaitmann
  • Thomas Hoffelner
  • Mark Tauber
Arthroscopy and Sports Medicine



MRI is the current pre-operative imaging standard in recurrent anterior shoulder instability; however, CT has increasingly gained interest due to its advantages in the detection of bony glenoid defects. This study compares the value of CT imaging and MRI for pre-operative surgical planning in recurrent anterior shoulder instability.


Between 2006 and 2009, 83 patients presented to the author’s department with recurrent anterior shoulder instability. For 48 patients, both, pre-operative MRI and CT images were available. The respective patho-morphological descriptions were retrospectively compared with the intra-operative findings. The effect of each imaging technique on the pre-operative surgical planning was analyzed and the accuracy in predicting the necessity of open versus arthroscopic surgery was compared.


In determining the necessity of open versus arthroscopic surgery CT imaging rendered an inaccurate prediction in 4.8 % of the cases which is less than the 25.0 % calculated for MRI. (p = 0.019). MRI showed a low sensitivity (35.3 %) in the detection of significant glenoid bone defects (≥20 % of the glenoid width measured on en-face views using a best-fit circle technique) while CT imaging provided an accurate prediction of the intra-operative finding in all cases.


Despite the advantages of MRI in the detection of soft tissue damages in recurrent anterior shoulder instability CT imaging proved to be more important for pre-operative planning by prevailing in the detection of glenoid defects. Therefore, the replacement of MRI as preoperative imaging standard with CT imaging is recommended.


Recurrent anterior shoulder instability Shoulder instability CT imaging MRI Glenoid bone loss Glenoid defect Labral tear 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Abboud JA, Armstrong AD (2011) Management of anterior shoulder instability: ask the experts. J Should Elb Surg 20(2):173–182CrossRefGoogle Scholar
  2. 2.
    Arrigoni P, Huberty D, Brady PC, Weber IC, Burkhart SS (2008) The value of arthroscopy before an open modified latarjet reconstruction. Arthroscopy 24(5):514–519PubMedCrossRefGoogle Scholar
  3. 3.
    Auffarth A, Schauer J, Matis N, Kofler B, Hitzl W, Resch H (2008) The J-bone graft for anatomical glenoid reconstruction in recurrent posttraumatic anterior shoulder dislocation. Am J Sports Med 36(4):638–647PubMedCrossRefGoogle Scholar
  4. 4.
    Bitzer M, Nasko M, Krackhardt T et al (2004) Direct CT-arthrography versus direct MR-arthrography in chronic shoulder instability: comparison of modalities after the introduction of multidetector-CT technology. Rofo 176(12):1770–1775PubMedCrossRefGoogle Scholar
  5. 5.
    Burkhart SS (2007) The bare spot of the glenoid. Arthroscopy 23(4):449 author reply 449–450PubMedGoogle Scholar
  6. 6.
    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(7):677–694PubMedCrossRefGoogle Scholar
  7. 7.
    Burkhart SS, Debeer JF, Tehrany AM, Parten PM (2002) Quantifying glenoid bone loss arthroscopically in shoulder instability. Arthroscopy 18(5):488–491PubMedCrossRefGoogle Scholar
  8. 8.
    Bushnell BD, Creighton RA, Herring MM (2008) Bony instability of the shoulder. Arthroscopy 24(9):1061–1073PubMedCrossRefGoogle Scholar
  9. 9.
    Cho SH, Cho NS, Rhee YG (2011) Preoperative analysis of the Hill-Sachs lesion in anterior shoulder instability: how to predict engagement of the lesion. Am J Sports Med 39(11):2389–2395PubMedCrossRefGoogle Scholar
  10. 10.
    Chuang TY, Adams CR, Burkhart SS (2008) Use of preoperative three-dimensional computed tomography to quantify glenoid bone loss in shoulder instability. Arthroscopy 24(4):376–382PubMedCrossRefGoogle Scholar
  11. 11.
    Griffith JF, Antonio GE, Tong CW, Ming CK (2003) Anterior shoulder dislocation: quantification of glenoid bone loss with CT. Am J Roentgenol 180(5):1423–1430Google Scholar
  12. 12.
    Griffith JF, Yung PS, Antonio GE, Tsang PH, Ahuja AT, Chan KM (2007) CT compared with arthroscopy in quantifying glenoid bone loss. Am J Roentgenol 189(6):1490–1493CrossRefGoogle Scholar
  13. 13.
    Handoll HH, Almaiyah MA, Rangan A (2004) Surgical versus non-surgical treatment for acute anterior shoulder dislocation. Cochrane Database Syst Rev (1):CD004325Google Scholar
  14. 14.
    Hodler J (2008) Technical errors in MR arthrography. Skeletal Radiol 37(1):9–18PubMedCrossRefGoogle Scholar
  15. 15.
    Kon Y, Shiozaki H, Sugaya H (2005) Arthroscopic repair of a humeral avulsion of the glenohumeral ligament lesion. Arthroscopy 21(5):632PubMedGoogle Scholar
  16. 16.
    Kralinger F, Aigner F, Longato S, Rieger M, Wambacher M (2006) Is the bare spot a consistent landmark for shoulder arthroscopy? A study of 20 embalmed glenoids with 3-dimensional computed tomographic reconstruction. Arthroscopy 22(4):428–432PubMedCrossRefGoogle Scholar
  17. 17.
    Lafosse L, Boyle S (2010) Arthroscopic Latarjet procedure. J Should Elb Surg 19(2 Suppl):2–12CrossRefGoogle Scholar
  18. 18.
    Lazarus MD, Sidles JA, Harryman DT 2nd, Matsen FA 3rd (1996) Effect of a chondral-labral defect on glenoid concavity and glenohumeral stability. A cadaveric model. J Bone Jt Surg Am 78(1):94–102Google Scholar
  19. 19.
    Lecouvet FE, Simoni P, Koutaissoff S, Vande Berg BC, Malghem J, Dubuc JE (2008) Multidetector spiral CT arthrography of the shoulder. Clinical applications and limits, with MR arthrography and arthroscopic correlations. Eur J Radiol 68(1):120–136Google Scholar
  20. 20.
    Magarelli N, Milano G, Sergio P, Santagada DA, Fabbriciani C, Bonomo L (2009) Intra-observer and interobserver reliability of the ‘Pico’ computed tomography method for quantification of glenoid bone defect in anterior shoulder instability. Skeletal Radiol 38(11):1071–1075PubMedCrossRefGoogle Scholar
  21. 21.
    Magee T (2009) 3-T MRI of the shoulder: is MR arthrography necessary? Am J Roentgenol 192(1):86–92CrossRefGoogle Scholar
  22. 22.
    Melvin JS, Mackenzie JD, Nacke E, Sennett BJ, Wells L (2008) MRI of HAGL lesions: four arthroscopically confirmed cases of false-positive diagnosis. Am J Roentgenol 191(3):730–734CrossRefGoogle Scholar
  23. 23.
    Millett PJ, Clavert P, Warner JJ (2005) Open operative treatment for anterior shoulder instability: when and why? J Bone Jt Surg Am 87(2):419–432CrossRefGoogle Scholar
  24. 24.
    Nofsinger C, Browning B, Burkhart SS, Pedowitz RA (2011) Objective preoperative measurement of anterior glenoid bone loss: a pilot study of a computer-based method using unilateral 3-dimensional computed tomography. Arthroscopy 27(3):322–329Google Scholar
  25. 25.
    Oh JH, Kim JY, Choi JA, Kim WS (2010) Effectiveness of multidetector computed tomography arthrography for the diagnosis of shoulder pathology: comparison with magnetic resonance imaging with arthroscopic correlation. J Should Elb Surg 19(1):14–20Google Scholar
  26. 26.
    Owens BD, Duffey ML, Nelson BJ, DeBerardino TM, Taylor DC, Mountcastle SB (2007) The incidence and characteristics of shoulder instability at the United States Military Academy. Am J Sports Med 35(7):1168–1173PubMedCrossRefGoogle Scholar
  27. 27.
    Owens BD, Harrast JJ, Hurwitz SR Thompson TL, Wolf JM (2011) Surgical trends in Bankart repair: an analysis of data from the American Board of Orthopaedic Surgery Certification Examination. Am J Sports Med 39(9):1865–1869Google Scholar
  28. 28.
    Rutten MJ, Jager GJ, Kiemeney LA (2010) Ultrasound detection of rotator cuff tears: observer agreement related to increasing experience. Am J Roentgenol 195(6):W440–446Google Scholar
  29. 29.
    Sanders TG, Morrison WB, Miller MD (2000) Imaging techniques for the evaluation of glenohumeral instability. Am J Sports Med 28(3):414–434PubMedGoogle Scholar
  30. 30.
    Scheibel M, Kraus N, Diederichs G, Haas NP (2008) Arthroscopic reconstruction of chronic anteroinferior glenoid defect using an autologous tricortical iliac crest bone grafting technique. Arch Orthop Trauma Surg 128(11):1295–1300PubMedCrossRefGoogle Scholar
  31. 31.
    Shahabpour M, Kichouh M, Laridon E, Gielen JL, De Mey J (2008) The effectiveness of diagnostic imaging methods for the assessment of soft tissue and articular disorders of the shoulder and elbow. Eur J Radiol 65(2):194–200PubMedCrossRefGoogle Scholar
  32. 32.
    Spang JT, Karas SG (2005) The HAGL lesion: an arthroscopic technique for repair of humeral avulsion of the glenohumeral ligaments. Arthroscopy 21(4):498–502PubMedCrossRefGoogle Scholar
  33. 33.
    Steinbach LS (2008) MRI of shoulder instability. Eur J Radiol 68(1):57–71PubMedCrossRefGoogle Scholar
  34. 34.
    Sugaya H, Moriishi J, Dohi M, Kon Y, Tsuchiya A (2003) Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Jt Surg Am 85–A(5):878–884Google Scholar
  35. 35.
    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(8):1752–1760CrossRefGoogle Scholar
  36. 36.
    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 2:159–169Google Scholar
  37. 37.
    Tauber M, Resch H, Forstner R, Raffl M, Schauer J (2004) Reasons for failure after surgical repair of anterior shoulder instability. J Should Elb Surg 13(3):279–285CrossRefGoogle Scholar
  38. 38.
    Yamamoto N, Itoi E, Abe H et al (2009) Effect of an anterior glenoid defect on anterior shoulder stability: a cadaveric study. Am J Sports Med 37(5):949–954PubMedCrossRefGoogle Scholar
  39. 39.
    Yiannakopoulos CK, Mataragas E, Antonogiannakis E (2007) A comparison of the spectrum of intra-articular lesions in acute and chronic anterior shoulder instability. Arthroscopy 23(9):985–990PubMedCrossRefGoogle Scholar
  40. 40.
    Young AA, Maia R, Berhouet J, Walch G Open Latarjet procedure for management of bone loss in anterior instability of the glenohumeral joint. J Should Elb Surg 20(2 Suppl):S61–69Google Scholar
  41. 41.
    Zappia M, Negri G, Grassi S, Pecoraro C, Rotondo A (2008) The CT-arthrography in the antero-inferior glenoid labral lesion: pictorial presentation and diagnostic value. Int J Should Surg 2(1):7–12CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Philipp Moroder
    • 1
  • Herbert Resch
    • 1
  • Silke Schnaitmann
    • 1
  • Thomas Hoffelner
    • 1
  • Mark Tauber
    • 1
    • 2
  1. 1.Department of Traumatology and Sports InjuriesParacelsus Medical UniversitySalzburgAustria
  2. 2.Department of Shoulder and Elbow SurgeryAtos ClinicMunichGermany

Personalised recommendations