Posttraumatic anterior shoulder instability is associated with anterior glenoid bone loss, contributing to recurrence. Accurate preoperative quantification of bone loss is paramount to avoid failure of a soft tissue stabilization procedure as bone reconstruction is recommended for glenoid defects greater than 20% to 27%.
We determined whether radiography, MRI, or CT was most reliable to quantify glenoid bone loss in recurrent anterior shoulder instability.
Seven intact fresh-frozen human cadaveric shoulders were imaged with radiography, MRI, CT, and three-dimensional (3-D) CT. Three sequential anterior glenoid defects then were created, measured, and the shoulders reimaged after each defect. Defect sizes were less than 12%, 12% to 25%, and 25% to 40%. The gold standard measurement was determined by comparing measurements taken on the cadaver by two surgeons using digital calipers with the measurements determined by using electronic digital calipers on the 3-D CT. This measurement was used for comparison of all estimations by the evaluators. Twelve independent blinded evaluators reviewed the 112 image sets and estimated the percent of glenoid bone loss. Images were scrambled and rereviewed by the same observers 2 months later to determine intraobserver reliability. We determined reliability with kappa values.
Kappa values between predicted bone loss versus true loss (determined by our gold standard measurements) across all 12 raters for each modality were: 3-D CT, 0.50; CT, 0.40; MRI, 0.27; and radiographs, 0.15. Interobserver agreement (kappa) values were: 3-D CT, 0.54; CT, 0.47; MRI, 0.31; and radiographs, 0.15. The intraobserver agreement (kappa) values were: 3-D CT, 0.59; CT, 0.64; MRI, 0.51; and radiographs, 0.45.
Three-dimensional CT was the most reliable imaging modality for predicting glenoid bone loss. Regular CT was the second most reliable and reproducible modality.
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We thank the New Albany Surgical Hospital Foundation for donating the cadaveric specimens used in this study. The imaging facilities were provided by The Ohio State University Department of Radiology. The participating members of the MOON group were: Bruce Miller MD, Charles Cox MD, Robert Brophy MD, Rick Wright MD, Brian Wolf MD, Benjamin Ma MD, Matthew Smith MD, Joseph Abboud MD, Keith Baumgarten MD, and Jed Kuhn MD.
The institution of one of the authors (GJ) has received, during the study period, funding from Genzyme (Cambridge, MA, USA) and Biomet (Warsaw, IN, USA).
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
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Bishop, J.Y., Jones, G.L., Rerko, M.A. et al. 3-D CT is the Most Reliable Imaging Modality When Quantifying Glenoid Bone Loss. Clin Orthop Relat Res 471, 1251–1256 (2013). https://doi.org/10.1007/s11999-012-2607-x
- Bone Loss
- Gold Standard Measurement
- Glenoid Bone Loss
- Anterior Shoulder Instability
- Glenoid Defect