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Value of magnetic resonance arthrography in post-traumatic anterior shoulder instability prior to arthroscopy: a prospective evaluation of MRA versus arthroscopy

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

This prospective study was designed to evaluate the value of magnetic resonance arthrography (MRA) after traumatic anterior shoulder instability prior to arthroscopy.

Methods

Patients included had two or more shoulder dislocations, at least the first being traumatic. MRA images were scored for Hill Sachs lesions, superior labral anterior posterior (SLAP) lesions, rotator cuff tears, glenohumeral ligament (GHL) lesions and Bankart lesions. Consequently, a standardized shoulder arthroscopy was performed. Five surgeons were involved in the study, initially blinded to the MRA results. MRA and arthroscopic findings were compared. Interobserver agreement was calculated by using Cohen’s Kappa coefficients (κ).

Results

Eighteen patients (13 male, 5 female) were included (mean age 26.1 years). Hill Sachs lesions demonstrated fair agreement (κ = 0.33) whereas for SLAP lesions moderate agreement was calculated (κ = 0.43). On MRA, four partial thickness rotator cuff lesions were seen, not being stated by arthroscopy. GHL lesions were described on MRA in 15 patients; only two patients turned out to have GHL lesions at arthroscopy. Two arthroscopically diagnosed Bankart lesions which needed surgical treatment were not detected by MRA (moderate agreement, κ = 0.47).

Conclusions

In patients with post-traumatic anterior glenohumeral instability MRA shows many lesions that can not be confirmed by arthroscopy and therefore do not have therapeutical consequences. On the other hand some labral lesions which do need surgical treatment are not detected on MRA. At least from this study, it can be concluded that MRA has limited value prior to the arthroscopic treatment of post-traumatic shoulder instability.

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References

  1. Antonio GE, Griffith JF, Yu AB, Yung PS, Chan KM, Ahuja AT (2007) First-time shoulder dislocation: High prevalence of labral injury and age-related differences revealed by MR arthrography. J Magn Reson Imaging 26:983–991

    Article  PubMed  Google Scholar 

  2. Applegate GR, Hewitt M, Snyder SJ, Watson E, Kwak S, Resnick D (2004) Chronic labral tears: value of magnetic resonance arthrography in evaluating the glenoid labrum and labral–bicipital complex. Arthroscopy 20:959–963

    Article  PubMed  Google Scholar 

  3. Baker CL, Uribe JW, Whitman C (1990) Arthroscopic evaluation of acute initial anterior shoulder dislocations. Am J Sports Med 18:25–28

    Article  PubMed  CAS  Google Scholar 

  4. Bencardino JT, Beltran J (2006) MR imaging of the glenohumeral ligaments. Radiol Clin North Am 44:489–502

    Article  PubMed  Google Scholar 

  5. Burkart AC, Debski RE (2002) Anatomy and function of the glenohumeral ligaments in anterior shoulder instability. Clin Orthop Relat Res 400:32–39

    Article  PubMed  Google Scholar 

  6. Chaipat L, Palmer WE (2006) Shoulder magnetic resonance imaging. Clin Sports Med 25:371–386

    Article  PubMed  Google Scholar 

  7. Chandnani VP, Yeager TD, DeBerardino T et al (1993) Glenoid labral tears: prospective evaluation with MRI imaging, MR arthrography, and CT arthrography. Am J Roentgenol 161:1229–1235

    CAS  Google Scholar 

  8. Dodson CC, Cordasco FA (2008) Anterior glenohumeral joint dislocations. Orthop Clin North Am 39:507–518

    Article  PubMed  Google Scholar 

  9. Goss TP (1988) Anterior glenohumeral instability. Orthopedics 11:87–95

    PubMed  CAS  Google Scholar 

  10. Henry JH, Genung JA (1982) Natural history of glenohumeral dislocation—revisited. Am J Sports Med 10:135–137

    Article  PubMed  CAS  Google Scholar 

  11. Jee WH, McCauley TR, Katz LD, Matheny JM, Ruwe PA, Daigneault JP (2001) Superior labral anterior posterior (SLAP) lesions of the glenoid labrum: reliability and accuracy of MR arthrography for diagnosis. Radiology 218:127–132

    PubMed  CAS  Google Scholar 

  12. Kirkley A, Litchfield R, Thain L, Spouge A (2003) Agreement between magnetic resonance imaging and arthroscopic evaluation of the shoulder joint in primary anterior dislocation of the shoulder. Clin J Sport Med 13:148–151

    Article  PubMed  Google Scholar 

  13. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  PubMed  CAS  Google Scholar 

  14. Melvin JS, Mackenzie JD, Nacke E, Sennett BJ, Wells L (2008) MRI of HAGL lesions: four arthroscopically confirmed cases of false-positive diagnosis. AJR Am J Roentgenol 191:730–734

    Article  PubMed  Google Scholar 

  15. Norlin R (1993) Intraarticular pathology in acute, first-time anterior shoulder dislocation: an arthroscopic study. Arthroscopy 9:546–549

    Article  PubMed  CAS  Google Scholar 

  16. Owens BD, Dawson L, Burks R, Cameron KL (2009) Incidence of shoulder dislocation in the United States military: demographic considerations from a high-risk population. J Bone Joint Surg Am 91:791–796

    Article  PubMed  Google Scholar 

  17. Page R, Bhatia DN (2010) Arthroscopic repair of a chondrolabral lesion associated with anterior glenohumeral dislocation. Knee Surg Sports Traumatol Arthrosc 18:1748–1751

    Article  PubMed  Google Scholar 

  18. Palmer WE, Brown JH, Rosenthal DI (1994) Labral–ligamentous complex of the shoulder: evaluation with MR arthrography. Radiology 190:645–651

    PubMed  CAS  Google Scholar 

  19. Parmar H, Jhankaria B, Maheshwari M et al (2002) Magnetic resonance arthrography in recurrent anterior shoulder instability as compared to arthroscopy: a prospective comparative study. J Postgrad Med 48:270–273

    PubMed  CAS  Google Scholar 

  20. Reijnierse M (2009) MR arthrography of the shoulder: glenohumeral ligaments. JBR-BTR 92:48–53

    PubMed  CAS  Google Scholar 

  21. Reuss BL, Schwartzberg R, Zlatkin MB, Cooperman A, Dixon JR (2006) Magnetic resonance imaging accuracy for the diagnosis of superior labrum anterior-posterior lesions in the community setting: eighty-three arthroscopically confirmed cases. J Shoulder Elbow Surg 15:580–585

    Article  PubMed  Google Scholar 

  22. te Slaa RL, Brand R, Marti RK (2003) A prospective arthroscopic study of acute first-time anterior shoulder dislocation in the young: a five-year follow-up study. J Shoulder Elbow Surg 12:529–534

    Article  PubMed  Google Scholar 

  23. Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ (1990) SLAP lesions of the shoulder. Arthroscopy 6:274–279

    Article  PubMed  CAS  Google Scholar 

  24. Taylor DC, Arciero RA (1997) Pathologic changes associated with shoulder dislocations. Arthroscopic and physical examination findings in first-time, traumatic anterior dislocations. Am J Sports Med 25:306–311

    Article  PubMed  CAS  Google Scholar 

  25. Waldt S, Burkart A, Lange P, Imhoff AB, Rummeny EJ, Woertler K (2004) Diagnostic performance of MR arthrography in the assessment of superior labral anteroposterior lesions of the shoulder. Am J Roentgenol 182:1271–1278

    Google Scholar 

  26. Yamaguchi K, Ditsios K, Middleton WD, Hildebolt CF, Galatz LM, Teefey SA (2006) The demographic and morphological features of rotator cuff disease. A comparison of asymptomatic and symptomatic shoulders. J Bone Joint Surg Am 88:1699–1704

    Article  PubMed  Google Scholar 

  27. Yamamoto A, Takagishi K, Osawa T et al (2010) Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg 19:116–120

    Article  PubMed  Google Scholar 

  28. Yiannakopoulos CK, Mataragas E, Antonogiannakis E (2007) A comparison of the spectrum of intra-articular lesions in acute and chronic anterior shoulder instability. Arthroscopy 23:985–990

    Article  PubMed  Google Scholar 

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Acknowledgment

We thank Dr. Henk Groen, epidemiologist, for the statistical analysis of the data.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Medical Center Leeuwarden, P.O. Box 888, 8901 BR, Leeuwarden, The Netherlands

    Hugo C. van der Veen & Paul C. Rijk

  2. Department of Radiology, Medical Center Leeuwarden, Leeuwarden, The Netherlands

    James P. M. Collins

Authors
  1. Hugo C. van der Veen
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  2. James P. M. Collins
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  3. Paul C. Rijk
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Correspondence to Hugo C. van der Veen.

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van der Veen, H.C., Collins, J.P.M. & Rijk, P.C. Value of magnetic resonance arthrography in post-traumatic anterior shoulder instability prior to arthroscopy: a prospective evaluation of MRA versus arthroscopy. Arch Orthop Trauma Surg 132, 371–375 (2012). https://doi.org/10.1007/s00402-011-1423-1

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  • DOI: https://doi.org/10.1007/s00402-011-1423-1

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