Challenging the Current Concept of Critical Glenoid Bone Loss in Shoulder Instability: Does the Size Measurement Really Tell It All?

2019 ◽  
Vol 47 (3) ◽  
pp. 688-694 ◽  
Author(s):  
Philipp Moroder ◽  
Philipp Damm ◽  
Guido Wierer ◽  
Elisabeth Böhm ◽  
Marvin Minkus ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Measurement Techniques ◽  
Defect Size ◽  
Glenoid Bone Loss ◽  
Anterior Shoulder Instability ◽  
Glenoid Defect ◽  
Element Analysis ◽  
Anterior Glenoid ◽  
Biomechanical Effect

Background: Bone loss at the anterior glenoid rim is a main reason for failure of soft-tissue based surgical stabilization procedures in patients with anterior shoulder instability. Purpose: To evaluate the capability of conventional glenoid bone loss measurement techniques to provide an adequate estimation of the actual biomechanical effect of glenoid defects. Study Design: Descriptive laboratory study. Methods: Thirty consecutive patients with unilateral anterior shoulder instability and varying degrees of glenoid defect were included. Patient-specific computer tomography–based 3-dimensional shoulder models of the affected and unaffected sides were created. The bony shoulder stability ratio (SR) was determined in various potential dislocation directions with finite element analysis. Values obtained from conventional glenoid defect size measurement techniques (Pico and Sugaya) were correlated with the finite element analysis results. Additionally, a mathematical model was developed to theoretically analyze the correlation between glenoid defect size measurements and the SR. Results: The authors found substantial interindividual differences of the SR of the unaffected shoulders in all directions of measurement. Bone loss at the anterior glenoid rim significantly reduced the SR in the 2-o’clock ( P = .011), 3-o’clock ( P < .001), and 4-o’clock ( P < .001) directions referring to a right shoulder. The correlation between the defect size measurements and the SR for the 2-o’clock (rho = −0.522 and −0.580), 3-o’clock (rho = −0.597 and −0.580), and 4-o’clock (rho = −0.527 and −0.522) directions was statistically significant. However, it showed only moderate strength and was nonlinear as well as dependent on the inherent shape of the concavity. As shown by the mathematical model, bone loss has the most considerable effect at the edge of the glenoid rim, and an increasingly concave-shaped glenoid leads to an increase in loss of SR provoked by the same extent of bone loss. Conclusion: Current glenoid bone loss measurements are unable to provide an adequate estimation on the actual biomechanical effect of glenoid defects because (1) the relation between the glenoid defect size and its biomechanical effect is nonlinear and (2) patients with shoulder instability have constitutional biomechanically relevant glenoid concavity shape differences. Clinical Relevance: These findings challenge the current concept of setting a general threshold for critical glenoid bone loss, which requires bony reconstruction surgery.

Reporting of glenoid bone loss measurement in clinical studies and the need for standardization

2022 ◽  
Vol 104-B (1) ◽  
pp. 12-18
Author(s):  
Simon Weil ◽  
Magnus Arnander ◽  
Yemi Pearse ◽  
Duncan Tennent
Keyword(s):  
Systematic Review ◽  
Bone Loss ◽  
Shoulder Instability ◽  
Clinical Studies ◽  
Imaging Modality ◽  
Measurement Techniques ◽  
Specific Treatment ◽  
Glenoid Bone Loss ◽  
Anterior Shoulder Instability ◽  
Significant Heterogeneity

Aims The amount of glenoid bone loss is an important factor in deciding between soft-tissue and bony reconstruction when managing anterior shoulder instability. Accurate and reproducible measurement of glenoid bone loss is therefore vital in evaluation of shoulder instability and recommending specific treatment. The aim of this systematic review is to identify the range methods and measurement techniques employed in clinical studies treating glenoid bone loss. Methods A systematic review of the PubMed, MEDLINE, and Embase databases was undertaken to cover a ten-year period from February 2011 to February 2021. We identified clinical studies that incorporated bone loss assessment in the methodology as part of the decision-making in the management of patients with anterior shoulder instability. The Preferred Reporting Items for Systematic Reviews (PRISMA) were used. Results A total of 5,430 articles were identified from the initial search, of which 82 studies met the final inclusion criteria. A variety of imaging methods were used: three studies did not specify which modality was used, and a further 13 used CT or MRI interchangeably. There was considerable heterogeneity among the studies that specified the technique used to quantify glenoid bone loss. A large proportion of the studies did not specify the technique used. Conclusion This systematic review has identified significant heterogeneity in both the imaging modality and method used to measure glenoid bone loss. The recommendation is that as a minimum for publication, authors should be required to reference the specific measurement technique used. Without this simple standardization, it is impossible to determine whether any published paper should influence clinical practice or should be dismissed. Cite this article: Bone Joint J 2022;104-B(1):12–18.

scholarly journals Glenoid concavity has a higher impact on shoulder stability than the size of a bony defect

2021 ◽  
Author(s):  
Jens Wermers ◽  
Benedikt Schliemann ◽  
Michael J. Raschke ◽  
Philipp A. Michel ◽  
Lukas F. Heilmann ◽  
...  
Keyword(s):  
Bone Loss ◽  
Linear Model ◽  
Goodness Of Fit ◽  
Clinical Decision Making ◽  
Defect Size ◽  
Glenoid Bone Loss ◽  
Bony Defect ◽  
Stability Ratio ◽  
Anterior Glenoid ◽  
Shoulder Stability

Abstract Purpose Surgical treatment of shoulder instability caused by anterior glenoid bone loss is based on a critical threshold of the defect size. Recent studies indicate that the glenoid concavity is essential for glenohumeral stability. However, biomechanical proof of this principle is lacking. The aim of this study was to evaluate whether glenoid concavity allows a more precise assessment of glenohumeral stability than the defect size alone. Methods The stability ratio (SR) is a biomechanical estimate of glenohumeral stability. It is defined as the maximum dislocating force the joint can resist related to a medial compression force. This ratio was determined for 17 human cadaveric glenoids in a robotic test setup depending on osteochondral concavity and anterior defect size. Bony defects were created gradually, and a 3D measuring arm was used for morphometric measurements. The influence of defect size and concavity on the SR was examined using linear models. In addition, the morphometrical-based bony shoulder stability ratio (BSSR) was evaluated to prove its suitability for estimation of glenohumeral stability independent of defect size. Results Glenoid concavity is a significant predictor for the SR, while the defect size provides minor informative value. The linear model featured a high goodness of fit with a determination coefficient of R2 = 0.98, indicating that 98% of the SR is predictable by concavity and defect size. The low mean squared error (MSE) of 4.2% proved a precise estimation of the SR. Defect size as an exclusive predictor in the linear model reduced R2 to 0.9 and increased the MSE to 25.7%. Furthermore, the loss of SR with increasing defect size was shown to be significantly dependent on the initial concavity. The BSSR as a single predictor for glenohumeral stability led to highest precision with MSE = 3.4%. Conclusion Glenoid concavity is a crucial factor for the SR. Independent of the defect size, the computable BSSR is a precise biomechanical estimate of the measured SR. The inclusion of glenoid concavity has the potential to influence clinical decision-making for an improved and personalised treatment of glenohumeral instability with anterior glenoid bone loss.

scholarly journals Clinical Outcomes of Shoulder Stabilization in Females With Glenoid Bone Loss

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110075
Author(s):  
Rachel M. Frank ◽  
Hytham S. Salem ◽  
Catherine Richardson ◽  
Michael O’Brien ◽  
Jon M. Newgren ◽  
...  
Keyword(s):  
Bone Loss ◽  
Clinical Outcomes ◽  
Shoulder Instability ◽  
Glenoid Bone Loss ◽  
Anterior Shoulder Instability ◽  
Latarjet Procedure ◽  
Shoulder Stabilization ◽  
Simple Shoulder Test ◽  
Female Patients

Background: Nearly all studies describing shoulder stabilization focus on male patients. Little is known regarding the clinical outcomes of female patients undergoing shoulder stabilization, and even less is understood about females with glenoid bone loss. Purpose: To assess the clinical outcomes of female patients with recurrent anterior shoulder instability treated with the Latarjet procedure. Study Design: Case series; Level of evidence, 4. Methods: All cases of female patients who had recurrent anterior shoulder instability with ≥15% anterior glenoid bone loss and underwent the Latarjet procedure were analyzed. Patients were evaluated after a minimum 2-year postoperative period with scores of the American Shoulder and Elbow Surgeons form, Simple Shoulder Test, and pain visual analog scale. Results: Of the 22 patients who met our criteria, 5 (22.7%) were lost to follow-up, leaving 17 (77.2%) available for follow-up with a mean ± SD age of 31.7 ± 12.9 years. Among these patients, 16 (94.1%) underwent 1.6 ± 0.73 ipsilateral shoulder operations (range, 1-3) before undergoing the Latarjet procedure. Preoperative indications for surgery included recurrent instability with bone loss in all cases. After a mean follow-up of 40.2 ± 22.9 months, patients experienced significant score improvements in the American Shoulder and Elbow Surgeons form, Simple Shoulder Test, and pain visual analog scale ( P < .05 for all). There were 2 reoperations (11.8%). There were no cases of neurovascular injuries or other complications. Conclusion: Female patients with recurrent shoulder instability with glenoid bone loss can be successfully treated with the Latarjet procedure, with outcomes similar to those of male patients in the previously published literature. This information can be used to counsel female patients with recurrent instability with significant anterior glenoid bone loss.

A Clinical Comparison of Linear- and Surface Area–Based Methods of Measuring Glenoid Bone Loss

2018 ◽  
Vol 46 (10) ◽  
pp. 2472-2477 ◽  
Author(s):  
Neil K. Bakshi ◽  
George A. Cibulas ◽  
Jon K. Sekiya ◽  
Asheesh Bedi
Keyword(s):  
Bone Loss ◽  
Surface Area ◽  
Shoulder Instability ◽  
Linear Measurement ◽  
Glenoid Bone Loss ◽  
Area Measurement ◽  
Anterior Shoulder Instability ◽  
3D Ct ◽  
Ct Reconstruction ◽  
Level Of Evidence

Background: The purpose of this study was to determine whether linear-based measurement significantly overestimates glenoid bone loss in comparison with surface area–based measurement in patients with recurrent anterior shoulder instability and glenoid bone loss. Hypothesis: Linear-based measurement will significantly overestimate glenoid bone loss in comparison with surface area–based measurement in patients with anterior shoulder instability and glenoid bone loss. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Thirty patients with anterior shoulder instability underwent preoperative bilateral shoulder computed tomography (CT) scans. Three-dimensional CT (3D-CT) reconstruction with humeral head subtraction was performed to obtain an en face view of the 3D-CT glenoid. Glenoid bone loss was measured with the surface area and linear methods of measurement. Statistical analysis was performed with a paired 2-tailed t test. Results: Twenty-eight patients (5 female and 23 male; mean age, 25.1 years; age range, 15-58 years) were included in the study; 17 patients underwent a glenoid augmentation procedure, and 11 underwent arthroscopic Bankart repair. The mean percentage glenoid bone loss calculated with the surface area and linear methods was 12.8% ± 8.0% and 17.5% ± 9.7% ( P < .0001), respectively. For the 17 patients who underwent glenoid augmentation, mean percentage bone loss with the surface area and linear methods was 16.6% ± 7.9% and 23.0% ± 8.0% ( P < .0001), respectively. Conclusion: Linear measurement of glenoid bone loss significantly overestimates bone loss compared with surface area measurement in patients with anterior glenoid bony defects. These results indicate that these different methods cannot be used interchangeably and cannot be used with the same critical thresholds for glenoid bone loss.

Mapping of glenoid bone loss in recurrent anterior shoulder instability: is there a particular deficit pattern?

2017 ◽  
Vol 26 (9) ◽  
pp. 1676-1680 ◽  
Author(s):  
Benjamin Bockmann ◽  
Arne Johannes Venjakob ◽  
Frank Reichwein ◽  
Marthe Hagenacker ◽  
Wolfgang Nebelung
Keyword(s):  
Bone Loss ◽  
Shoulder Instability ◽  
Glenoid Bone Loss ◽  
Anterior Shoulder Instability ◽  
Recurrent Anterior Shoulder Instability
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