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