Back to Search Start Over

Does Bone Loss Imaging Modality, Measurement Methodology, and Interobserver Reliability Alter Treatment in Glenohumeral Instability?

Authors :
Chalmers PN
Christensen G
O'Neill D
Tashjian RZ
Source :
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association [Arthroscopy] 2020 Jan; Vol. 36 (1), pp. 12-19.
Publication Year :
2020

Abstract

Purpose: To determine, in the context of measuring bone loss in shoulder instability, whether measurement differences between magnetic resonance imaging (MRI) and computed tomography (CT), linear-based and area-based methods, and observers altered the proposed treatment when a standardized algorithm was applied.<br />Methods: This was a retrospective, comparative imaging study of preoperative patients with anterior shoulder instability with both an MRI and CT scan within 1 year of one another. On parasagittal images reoriented en face to the glenoid, 2 attending orthopaedic surgeons measured glenoid width, glenoid area, glenoid defect width, and glenoid defect area. On axial images maximal Hill-Sachs width was measured. From these, linear percent glenoid bone loss (%GBL) and area %GBL were calculated, and on-versus off-track was determined. With these results, a recommended treatment was determined by applying a standardized algorithm, in which the Latarjet procedure was selected for %GBL >20%, arthroscopic labral repair and remplissage for off-track lesions with %GBL <20%, and arthroscopic labral repair on-track shoulders with %GBL <20%.<br />Results: In total, 53 patients with mean ± standard deviation 45 ± 83 days between scans were include with a CT linear %GBL of 23.5 ± 9.6% (range 0%-47%). CT lead to larger measurements of %GBL than MRI (linear P = .008, area P = .003), and fewer shoulders being considered on-track (33.0% vs 40.5%), which would alter treatment in 25% to 34%. Linear measurements produced larger values for %GBL (CT, P < .001; MRI, P < .001), which would alter treatment in 25%. For %GBL, inter-rater reliability was good, with intraclass correlation coefficients varying from 0.727 to 0.832 and Kappa varying from 0.57 to 0.62, but these inter-rater differences would alter treatment in 31%.<br />Conclusions: The significant differences in bone loss measurement between imaging modality, measurement method, and observers may lead to differences in treatment in up to 34% of cases. Linear CT measurements resulted in the most aggressive treatment recommendations.<br />Level of Evidence: Retrospective Comparative Study: Diagnostic, Level III.<br /> (Copyright © 2019 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Details

Language :
English
ISSN :
1526-3231
Volume :
36
Issue :
1
Database :
MEDLINE
Journal :
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association
Publication Type :
Academic Journal
Accession number :
31864563
Full Text :
https://doi.org/10.1016/j.arthro.2019.06.025