Preoperative Imaging of Anterior Shoulder Instability: Diagnostic Effectiveness of MDCT Arthrography and Comparison With MR Arthrography and Arthroscopy

Abstract

MDCT arthrography showed better accuracy than did MR arthrography in the detection of osseous, cartilage, and labroligamentous injuries related to anterior shoulder instability. Because MDCT arthrography was particularly reliable for the detection of glenoid rim fractures and humeral avulsion of the inferior glenohumeral ligament lesions, which represent crucial findings in the preoperative planning, this technique may beneficially affect treatment by means of selecting the proper surgical treatment.

Diagnostic performance of CT-arthrography and 1.5T MR-arthrography for the assessment of glenohumeral joint cartilage: a comparative study with arthroscopic correlation

“…Pairwise comparisons between the diagnostic performance of techniques (CTA vs. MRA) and readers (reader 1 vs. reader 2) showed statistically significant differences for all comparisons: diagnostic performance of CTA was statistically significantly higher than MRA for reader 1 and 2 for the evaluation of all, glenoidal or humeral head cartilage lesions for both readers (all p≤0.04) [28]. One study by Acid et al, focusing on instability lesions, compared the diagnostic performance of CTA and MRA in assessing glenoid cartilage lesions in the same series of 40 patients [17]. The authors concluded to the better diagnostic performance of CTA (sensitivity 82 %, specificity 89 %) compared to MRA (sensitivity 73 %, specificity 94 %) for the diagnosis of glenoid cartilage lesions in anterior shoulder instability.…”

“…Furthermore, we considered the entire glenohumeral cartilage and divided each articular surface into nine areas for comparison. Most studies evaluating the diagnostic performance of imaging took into account the worst lesion of each articular surface, which might artificially increase diagnostic performance by correlating lesions that might be observed in different areas of the articular surface [3,4,8,17,27]. Although not perfect, we considered this visual division of the cartilage surface as the best practical way to enable a comparison of the same lesions between imaging and arthroscopy.…”

“…Their accuracy has been previously compared in the same patients for the assessment of rotator cuff tears and shoulder instability lesions, with the diagnostic performance of CTA being similar or better compared to MRA [11,17].…”

Review of Arciero's article (1994) on arthroscopic Bankart repair versus non-operative treatment for acute, initial anterior shoulder dislocations: does the same hold true in 2016?

“…More recently, variations of Bankart lesions, including anterior labroligamentous periosteal sleeve avulsion (ALPSA) and humeral avulsion of the glenohumeral ligament (HAGL), have been described, which can be accurately identified on MR and MDCT arthrography 31 32. Occult lesions of these labroligamentous structures further predispose the patient to greater frequency of recurrent dislocations and serve as indications that favour acute repair 30 33–35…”

Multidetector CT arthrography in shoulder instability and its comparison with MR arthrography and arthroscopy

“…1 There are 46%-100% incidence of recurrent dislocation for patients aged less than 40 years without surgical intervention, which decreases to 7%-15% after surgical stablization. 1 To improve the pre-operative planning and post-operative result of surgery, exact diagnosis of pathology and anatomy of labroligamentous structure is essential.…”