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Purpose: To evaluate the reliability of the “perfect-circle” methodology for measurement of glenoid bone loss with magnetic resonance imaging (MRI) in patients with posterior glenohumeral instability. Methods: A prospective chart review was performed on patients who underwent isolated arthroscopic posterior labral repairs in our institution’s electronic medical records between January 1, 2021, and June 30, 2021. Inclusion criteria included isolated posterior shoulder instability with posterior labral repair and corroborated tears on MRI. A total of 9 raters, either sports or shoulder and elbow fellowship-trained orthopaedic surgeons, each evaluated the affected shoulder MRI scans twice, at over 2 weeks apart. Measurements followed the “perfect-circle” technique and included projected anterior-to-posterior (AP) glenoid diameter, amount of posterior bone loss, and percentage of posterior bone loss. Results: Ten consecutive patients between the ages of 17 and 46 years with diagnosed posterior glenohumeral instability were selected. The average age was 28 ± 10 years, and 60% of patients were male. The patient’s dominant arm was affected in 40%, and 50% of cases involved the right shoulder. The average glenoid diameter was 29.62 ± 3.69 mm, and the average measured bone loss was 2.8 ± 1.74 mm. The average percent posterior glenoid bone loss was 9.41 ± 5.78%. The inter-rater reliability was poor for the AP diameter and for the posterior glenoid bone loss with intraclass correlation coefficients at 0.30 (0.12-0.62) and 0.22 (0.07-0.54) respectively. The intrarater reliability was poor for AP diameter and moderate for posterior glenoid bone loss, with intraclass correlation coefficients at 0.41 (0.22-0.57) and 0.50 (0.33-0.64), respectively. Conclusions: Using the “perfect-circle” technique for evaluating posterior glenohumeral bone loss has poor-to-moderate inter- and intrarater reliability from MRI. Level of Evidence: Level IV, prospective diagnostic study.

Purpose: To evaluate the reliability of the perfect circle methodology for measurement of glenoid bone loss in patients with anterior glenohumeral instability. Methods: We performed a chart review of retrospectively collected patients who underwent isolated arthroscopic anterior labral repair between January 1 and June 30, 2021, using our institution’s electronic medical records. The inclusion criteria included isolated anterior shoulder instability with anterior labral repair and corroborated tears on magnetic resonance imaging. A total of 9 raters, either sports or shoulder and elbow fellowship-trained orthopaedic surgeons, each evaluated the affected shoulder magnetic resonance imaging scans twice, with a minimum of 2 weeks between measurements. Measurements followed the “perfect circle” technique and included projected anterior-to-posterior glenoid diameter, amount of posterior bone loss, and percentage of posterior bone loss. Intrarater reliability and inter-rater reliability were then determined by calculating intraclass correlation coefficients (ICCs). Results: Ten consecutive patients meeting the selection criteria were chosen for inclusion in this analysis. Average estimated bone loss for the cohort was 2.45 mm, and the mean estimated glenoid diameter of the involved shoulder was 28.82 mm. The average percentage of bone loss measured 8.54%. The ICC for interobserver reliability was 0.55 for the perfect circle diameter and 0.17 for the anterior bone loss measurement (poorly to moderately reliable). The ICC for intraobserver reliability was 0.69 for the perfect circle diameter and 0.71 for anterior bone loss (moderately reliable). Conclusions: The perfect circle technique for estimating anterior glenoid bone loss on magnetic resonance imaging was found to have moderate intrarater reliability; however, reliability between observers was found to be moderate to poor. Level of Evidence: Level IV, diagnostic case series.

Background:. Recent work has suggested good clinical and functional results with dorsal surface plating of patellar fractures. The primary outcome measurement of this study was reoperation rates for patellar fractures that had been treated with dorsal plating. Methods:. This work consists of a retrospective review of clinical and functional outcome data following repair of patellar fractures with dorsal plates. We obtained institutional review board approval for this study and conducted a review of 9 consecutive years of our group’s trauma practice. We also contacted patients to assess patient-reported outcomes (PROs) after 12 months. Results:. Eighty-five patellar fractures were treated with open reduction and internal fixation (ORIF) via plating over 9 years. Eight (9.41%) of the patients required reoperation. Of the 72 patients with complete follow-up of ≥12 weeks, 3 (4.17%) had nonunion of the fracture site and 4 (5.56%) had loss of reduction of the fracture. The average Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score among our sample was 18.84 (slight symptoms); 72.41% of the patients in our sample had slight or no symptoms at ≥12 months postoperatively. Conclusions:. Our results indicated that plating of comminuted patellar fractures is a safe, viable treatment strategy. The PROs at ≥12 months of follow-up data were promising. Additionally, dorsal plating may allow for early return of function and less postoperative bracing. Level of Evidence:. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.