Skip to main content
SpringerLink
Log in

Intra-observer and interobserver reliability of the ‘Pico’ computed tomography method for quantification of glenoid bone defect in anterior shoulder instability

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

To evaluate the intra-observer and interobserver reliability of the ‘Pico’ computed tomography (CT) method of quantifying glenoid bone defects in anterior glenohumeral instability.

Materials and methods

Forty patients with unilateral anterior shoulder instability underwent CT scanning of both shoulders. Images were processed in multiplanar reconstruction (MPR) to provide an en face view of the glenoid. In accordance with the Pico method, a circle was drawn on the inferior part of the healthy glenoid and transferred to the injured glenoid. The surface of the missing part of the circle was measured, and the size of the glenoid bone defect was expressed as a percentage of the entire circle. Each measurement was performed three times by one observer and once by a second observer. Intra-observer and interobserver reliability were analyzed using intraclass correlation coefficients (ICCs), 95% confidence intervals (CIs), and standard errors of measurement (SEMs).

Results

Analysis of intra-observer reliability showed ICC values of 0.94 (95% CI = 0.89–0.96; SEM = 1.1%) for single measurement, and 0.98 (95% CI = 0.96–0.99; SEM = 1.0%) for average measurement. Analysis of interobserver reliability showed ICC values of 0.90 (95% CI = 0.82–0.95; SEM = 1.0%) for single measurement, and 0.95 (95% CI = 0.90–0.97; SEM = 1.0%) for average measurement.

Conclusion

Measurement of glenoid bone defect in anterior shoulder instability can be assessed with the Pico method, based on en face images of the glenoid processed in MPR, with a very good intra-observer and interobserver reliability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Lazarus MD, Sidles JA, Harryman DT 2nd, Matsen FA 3rd. Effect of a chondral-labral defect on glenoid concavity and glenohumeral stability: a cadaveric model. J Bone Joint Surg Am. 1996;78:94–102.

    Article  CAS  Google Scholar 

  2. Bigliani LU, Newton PM, Steinmann SP, Connor PM, McIlveen SJ. Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. Am J Sports Med. 1998;26:41–5.

    Article  CAS  Google Scholar 

  3. Burkhart SS, Danaceau SM. Articular arc length mismatch as a cause of failed bankart repair. Arthroscopy. 2000;16:740–4.

    Article  CAS  Google Scholar 

  4. Itoi E, Lee SB, Berglund LJ, Berge LL, An KN. The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: a cadaveric study. J Bone Joint Surg Am. 2000;82:35–46.

    Article  CAS  Google Scholar 

  5. Gerber C, Nyffeler RW. Classification of glenohumeral joint instability. Clin Orthop. 2002;400:65–78.

    Article  Google Scholar 

  6. Greis PE, Scuderi MG, Mohr A, Bachus KN, Burks RT. Glenohumeral articular contact areas and pressures following labral and osseous injury to the anteroinferior quadrant of the glenoid. J Shoulder Elbow Surg. 2002;11:442–51.

    Article  Google Scholar 

  7. Kim SH, Ha KI, Cho YB, Ryu BD, Oh I. Arthroscopic anterior stabilization of the shoulder. Two to six-year follow-up. J Bone Joint Surg Am. 2003;85:1511–7.

    Article  Google Scholar 

  8. Tauber M, Resch H. Reason for failure after surgical repair of anterior shoulder instability. J Shoulder Elbow Surg. 2004;13:278–85.

    Article  Google Scholar 

  9. Boileau P, Villalba M, Henry JY, Balg F, Ahrens P, Neyton L. Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Joint Surg Am. 2006;88:1755–63.

    Article  Google Scholar 

  10. Balg F, Boileau P. The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br. 2007;89:1470–7.

    Article  CAS  Google Scholar 

  11. Mologne TS, Provencher MT, Menzel KA, Vachon TA, Dewing CB. Arthroscopic stabilization in patients with an inverted pear glenoid. Results in patients with bone loss of the anterior glenoid. Am J Sports Med. 2007;35:1276–83.

    Article  Google Scholar 

  12. Chen AL, Hunt SA, Hawkins RJ, Zuckerman JD. Management of bone loss associated with recurrent anterior glenohumeral instability. Am J Sports Med. 2005;33:912–25.

    Article  Google Scholar 

  13. Bushnell BD, Creighton RA, Herring MM. Bony instability of the shoulder. Arthroscopy. 2008;24:1061–73.

    Article  Google Scholar 

  14. Rowe CR, Patel D, Southmayd WW. The Bankart procedure: a long-term end result study. J Bone Joint Surg Am. 1978;60:1–16.

    Article  Google Scholar 

  15. Pavlov H, Warren RF, Weiss CB Jr. The roentgenographic evaluation of anterior shoulder instability. Clin Orthop. 1985;194:153–8.

    Google Scholar 

  16. Burkhart SS, De Beer JF. 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. 2002;16:677–94.

    Article  Google Scholar 

  17. Edwards TB, Boulahia A, Walch G. Radiographic analysis of bone defects in chronic anterior shoulder instability. Arthroscopy. 2003;19:732–9.

    Article  Google Scholar 

  18. Griffith JF, Antonio GE, Tong CW, Ming CK. Anterior shoulder dislocation: quantification of glenoid bone loss with CT. AJR Am J Roentgenol. 2003;180:1423–30.

    Article  Google Scholar 

  19. Sugaya H, Moriishi J, Dohi M, Kon Y, Tsuchiya A. Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Joint Surg Am. 2003;85:878–84.

    Article  Google Scholar 

  20. Griffith JF, Yung PS, Antonio GE, Tsang PH, Ahuja AT, Chan KM. CT compared with arthroscopy in quantifying glenoid bone loss. AJR Am J Roentgenol. 2007;189:1490–3.

    Article  Google Scholar 

  21. Griffith JF, Antonio GE, Yung PS, Wong EM, Yu AB, Ahuja AT, et al. Prevalence, pattern, and spectrum of glenoid bone loss in anterior shoulder dislocation: CT analysis of 218 patients. AJR Am J Roentgenol. 2008;190:1247–54.

    Article  Google Scholar 

  22. Saito H, Itoi E, Sugaya H, Minagawa H, Yamamoto N, Tuoheti Y. Location of the glenoid defect in shoulders with recurrent anterior dislocation. Am J Sports Med. 2005;33:889–93.

    Article  Google Scholar 

  23. Itoi E, Lee SB, Amrami KK, Wenger DE, An KN. Quantitative assessment of classic anteroinferior bony Bankart lesions by radiography and computed tomography. Am J Sports Med. 2003;31:112–8.

    Article  Google Scholar 

  24. Huijsmans PE, Haen PS, Kidd M, Dhert WJ, van der Hulst VP, Willems WJ. Quantification of a glenoid defect with three-dimensional computed tomography and magnetic resonance imaging: a cadaveric study. J Shoulder Elbow Surg. 2007;16:803–9.

    Article  Google Scholar 

  25. Barchilon VS, Kotz E, Barchilon Ben-Av M, Glazer E, Nyska M. A simple method for quantitative evaluation of the missing area of the anterior glenoid in anterior instability of the glenohumeral joint. Skeletal Radiol. 2008;37:731–6.

    Article  Google Scholar 

  26. Chuang TY, Adams CR, Burkhart SS. Use of preoperative three-dimensional computed tomography to quantify glenoid bone loss in shoulder instability. Arthroscopy. 2008;24:376–82.

    Article  Google Scholar 

  27. Baudi P, Righi P, Bolognesi D, Rivetta S, Rossi Urtoler E, Guicciardi N, et al. How to identify and calculate glenoid bone deficit. Chir Organi Mov. 2005;90:145–52.

    CAS  PubMed  Google Scholar 

  28. Walter SD, Eliasziw M, Donner A. Sample size and optimal designs for reliability studies. Stat Med. 1998;17:101–10.

    Article  CAS  Google Scholar 

  29. Altman DG, Schulz KF, Moher D, Egger M, Davidoff F, Elbourne D, et al. The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med. 2001;134:663–94.

    Article  CAS  Google Scholar 

  30. Nobuhara K. The shoulder: its function and clinical aspects. Singapore: World Scientific; 2003.

    Book  Google Scholar 

  31. De Wilde LF, Berghs BM, Audenaert E, Sys G, Van Maele GO, Barbaix E. About the variability of the shape of the glenoid cavity. Surg Radiol Anat. 2004;26:54–9.

    Article  Google Scholar 

  32. Aigner F, Longato S, Fritsch H, Kralinger F. Anatomical considerations regarding the "bare spot" of the glenoid cavity. Surg Radiol Anat. 2004;26:308–11.

    Article  CAS  Google Scholar 

  33. Kralinger F, Aigner F, Longato S, Rieger M, Wambacher M. Is the bare spot a consistent landmark for shoulder arthroscopy? A study of 20 embalmed glenoids with 3-dimensional computed tomographic reconstruction. Arthroscopy. 2006;22:428–32.

    Article  Google Scholar 

  34. Huysmans PE, Haen PS, Kidd M, Dhert WJ, Willems JW. The shape of the inferior part of the glenoid: a cadaveric study. J Shoulder Elbow Surg. 2006;15:759–63.

    Article  Google Scholar 

  35. Provencher MT, Detterline AJ, Ghodadra N, Romeo AA, Bach BR Jr, Cole BJ, et al. Measurement of glenoid bone loss: a comparison of measurement error between 45° and 0° bone loss models and with different posterior arthroscopy portal locations. Am J Sports Med. 2008;36:1132–8.

    Article  Google Scholar 

  36. Jeske HC, Oberthaler M, Klingensmith M, Dallapozza C, Smekal V, Wambacher M, et al. Normal glenoid rim anatomy and the reliability of shoulder instability measurements based on intrasite correlation. Surg Radiol Anat. 2009; Mar 28. doi:https://doi.org/10.1007/s00276-009-0492-0

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Catholic University, Rome, Italy

    Nicola Magarelli, Pietro Sergio & Lorenzo Bonomo

  2. Department of Orthopaedics, Catholic University, Largo A. Gemelli, 00168, Rome, Italy

    Giuseppe Milano, Domenico A. Santagada & Carlo Fabbriciani

Authors
  1. Nicola Magarelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giuseppe Milano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pietro Sergio
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Domenico A. Santagada
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carlo Fabbriciani
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lorenzo Bonomo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giuseppe Milano.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Magarelli, N., Milano, G., Sergio, P. et al. Intra-observer and interobserver reliability of the ‘Pico’ computed tomography method for quantification of glenoid bone defect in anterior shoulder instability. Skeletal Radiol 38, 1071–1075 (2009). https://doi.org/10.1007/s00256-009-0719-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-009-0719-5

Keywords

Search

Navigation