Glenoid Diameter Is an Inaccurate Method for Percent Glenoid Bone Loss Quantification: Analysis and Techniques for Improved Accuracy

Assessment and Evaluation of Glenoid Bone Loss

“…The diameter method is another commonly used method to evaluate glenoid bone loss, which we also demonstrate in this technical note. The line drawn within ImageJ that represents the diameter of the circle was drawn perpendicular to the defect border according to similar findings by Altan et al 12 The diameter method is frequently used because of its ease of use; however, Bhatia et al 13 reported that determining the percentage of glenoid bone loss based on the glenoid diameter is inconsistent with a surface areaebased method. They found that the diameter method calculation overestimated glenoid bone loss by approximately 4% when compared with the geometric calculation of surface area of a circular segment.…”

“…When practicing orthopaedic surgeons use these techniques to assess glenoid bone loss, they must consider the measurement differences between the diameter-based method and surface area method when making treatment recommendations for patients. May overestimate percentage of glenoid bone loss 13 Represents deficit in anteroposterior width of glenoid only 13 Maximum error occurs at 20% of glenoid diameter (common threshold used to determine open bone graft procedure v arthroscopic stabilization) 13 …”

“…May be more accurate representation of percentage of glenoid bone loss 13 More complex measurements needed for calculation 13 More accurate calculation allows for more informed decision making regarding treatment options 13 Difficult to apply intraoperatively 17 …”

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

“…24 CT measurements can be performed via both linear-and area-based methods. [25][26][27] In addition, they can be performed on both 2-dimensional CT slices and 3-dimensional osseous scapular reconstructions with subtraction of the humeral head to allow an en face view. [28][29][30][31] As CT involves radiation and additional cost, there has been significant interest in determining whether these measurements could be made accurately and reliably using magnetic resonance imaging (MRI) alone.…”

Shoulder Problems Motivate Innovative Solutions

“…[12][13][14][15][16][17] We note the original scientific article "Short-Term Outcomes of Glenoid Bone Block Augmentation for Complex Anterior Shoulder Instability in a High-Risk Population" by Waterman et al 18 from El Paso, Texas, and Boston, Massachusetts, with commentary by Associate Editor Nikhil Verma, 19 whose editorial acumen is impressive and who is well published on the topic of shoulder instability including glenoid reconstruction using bone grafts. [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Lastly, we note "Humeral Avulsion of the Glenohumeral Ligaments: A Systematic Review" by Longo et al 35 from Rome. Humeral avulsion of the glenohumeral ligament (HAGL) is an uncommon, but not rare, cause of shoulder instability, and as the orthopaedic adage goes, we may not have seen a HAGL, but it has seen us.…”