New concepts of radiologic preoperative evaluation of anterior shoulder instability: on-track and off-track lesions

Gulati, Achal; Dessouky, Riham; Wadhwa, Vibhor; Sanders, Drew; Chhabra, Avneesh

doi:10.1177/0284185117745573

Cited by 13 publications

(23 citation statements)

References 39 publications

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“…The humeral interval is the width of the Hill Sachs deformity together with the adjacent bone bridge between the Hill Sachs deformity and the rotator cuff tendon insertion (17,19). The insertion of the rotator cuff tendons, which in this case refers to the teres minor and infraspinatus tendons, is difficult to define on CT images, even on a soft- tissue window setting, so one has to estimate this insertion.…”

Section: Glenoid Trackmentioning

confidence: 99%

Measuring glenoid and humeral bone loss in shoulder dislocation

Griffith

2019

Quant. Imaging Med. Surg

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Section: Glenoid Trackmentioning

confidence: 99%

Measuring glenoid and humeral bone loss in shoulder dislocation

Griffith

2019

Quant. Imaging Med. Surg

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“…5,20,26,31 Imaging plays an increasingly important role in the preoperative identification of the significant bone lesions at risk for engagement. 9 Although multiple imaging modalities exist to quantify humeral as well as glenoidal bone loss, computed tomography (CT) scan has been demonstrated to be the most accurate and reliable. 7,17,24,28,33,35 To assess glenoid width and quantify glenoid bone loss, many studies have shown that CT can be considered the gold standard.…”

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confidence: 99%

Determining On-/Off-track Lesions in Glenohumeral Dislocation Using Multiplanar Reconstruction Computed Tomography Is Easier and More Reproducible Than Using 3-dimensional Computed Tomography

Mulleneers¹,

Rompaey²,

Haloui³

et al. 2020

Am J Sports Med

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Background: The glenoid track is a useful tool to predict engagement and therefore the risk of recurrence of dislocation in the presence of Hill-Sachs and/or bony Bankart lesions. To assess the glenoid track preoperatively, only methods using 3-dimensional reconstruction (3DR) have been described, but these lack a standardized, reliable, and easy description. Purpose/Hypothesis: To evaluate a new method for determining the glenoid track using computed tomography (CT) scan with multiplanar reconstruction (MPR) in comparison with using 3DR images. Our hypothesis was that the MPR method would be easier to standardize and more reproducible. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 52 patients whose arthro-CT scan revealed a Hill-Sachs lesion, whether in combination with a bony Bankart lesion or not, were included. Digital Imaging and Communications in Medicine data from the 52 CT scans were all analyzed using open source image analysis software. Glenoid width, with or without associated bony defect, and the Hill-Sachs interval (HSI) were measured on MPR as well as on 3DR images. All measurements obtained using both methods were directly compared and evaluated for intra- and interobserver reliability. Results: In absolute values, only small differences were seen between the MPR and 3DR methods, amounting to a maximal difference of 0.07 cm for the HSI and 0.04 cm for the glenoid width. For glenoid measurements, both methods were similar. For humeral measurements, the MPR method demonstrated higher inter- and intraobserver reliability than did the 3DR method. Conclusion: The newly described MPR method for the assessment of the glenoid track and HSI is at least as accurate as the published 3DR method, with better intra- and interobserver reliability. Because MPRs are also easier to obtain, this method could be recommended in daily practice.

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“…Os estabilizadores estáticos são ativados nas posições extremas do movimento. Além destes, inclui-se a pressão intra-articular negativa, que permite manter a coesão do líquido articular, impedindo translações do úmero (WEN, 1999;OMOUMI et al, 2011;GONÇALVES;GUTIERRES, 2017;GULATI et al, 2017).…”

Section: Estabilizadores Estáticos Do Ombrounclassified

“…Independente de fatores culturais, sabemos que as imagens desempenham um papel importante na avaliação pré-operatória de pacientes com instabilidade anterior traumática, uma vez que estimam a perda óssea glenoumeral (lesões uni ou bipolares), além de possibilitarem a avaliação dos tecidos moles, de forma a identificar pacientes em risco para recorrência de lesões. A quantificação da perda óssea é a chave para diferenciar o "engaging" encaixe versus o não-encaixe "no engaging" das lesões de Hill Sachs e Bankart óssea; enquanto que novos conceitos "on track" versus "off track" são discutidos para determinar a abordagem cirúrgica requerida (GULATI et al, 2017;SKUPIŃSKI et al, 2017).…”

Section: Indicações Cirúrgicas -Radiologiaunclassified

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Classificação morfológica da borda anterior da glenóide em imagens de tomografia computadorizada

Silva¹

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Introduction: Among radiological exams, tomographic exams are considered by several authors as the gold standard for assessing bone loss of the glenoid. The anteroinferior quadrant of the glenoid, in addition to be the most frequent place for insertion of anchors and screws. No studies have been identified in the literature related to the classification of the morphology of the anterior border of the glenoid based on subtypes so far. Objective: To describe a new tomographic classification of the anterior border of the glenoid based on the assessment of tomographic images (CT) of the shoulder of adult patients, in addition to evaluating the intraobserver (Kappa simple) and interobserver (Kappa Fleiss) agreement of the proposed classification.Methods: Cross-sectional observational study, approved by the institution's Research Ethics Committee. The sample analyzed in the study consisted of 80 shoulder CT scans with normal glenoids, that is, without bone changes. Regarding age, the sample had an average age of 45 (± 15.10) years. 45 examinations were observed in male and 35 female patients. As for laterality, 47 on the left and 33 on the right. Four examiners made the classification of the anterior border of the glenoid on CT images, independently and blindly; two specialists in shoulder surgery, examiner (A and C), and two musculoskeletal radiologists, examiner (B and D). The examiners used anonymized digital images of shoulder CT scans, in DICOM format, using the Horos system (Nimble Co, Annapolis, USA). After 30 days, new blind assessments were performed to calculate the intraobserver agreement. The positions 3:00h and 4:30h, in axial sections, were evaluated separately for the classification of the morphology of the anterior border of the glenoid after oblique correction. During the classification, the examiners had at their disposal illustrative drawings of the four proposed subtypes in addition to a videoconference with guidance on the study. Results: Regarding the agreement between the moments (intraobserver) that evaluated the edges of the glenoid, in the first and second evaluation, in the position 4: 30h and in the position 3: 00h, the examiners' evaluations obtained a simple Kappa almost perfect, close to 1, 0.The agreement between the examiners (interobserver) was reasonable at the 3:00h position and moderate at the 4:30h position at both times. Conclusion: Four subtypes of morphology of the anterior border of the glenoid were identified, with no statistically significant relationship with sex, laterality and age group. The intraobserver agreement was almost perfect for assessing the classification of the anterior border of the glenoid.The interobserver assessment was reasonable to moderate. The proposed classification has the potential to contribute to glenohumeral instability surgeries.

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New concepts of radiologic preoperative evaluation of anterior shoulder instability: on-track and off-track lesions

Cited by 13 publications

References 39 publications

Measuring glenoid and humeral bone loss in shoulder dislocation

Measuring glenoid and humeral bone loss in shoulder dislocation

Determining On-/Off-track Lesions in Glenohumeral Dislocation Using Multiplanar Reconstruction Computed Tomography Is Easier and More Reproducible Than Using 3-dimensional Computed Tomography

Classificação morfológica da borda anterior da glenóide em imagens de tomografia computadorizada

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