Abstract
An innovative research study from Rush University Medical Center has established a new and rapidly identifiable pattern for detecting subcritical bone loss in the shoulder joint. This breakthrough, published in the Arthroscopy journal, is set to bolster the diagnostic precision of orthopedic surgeons, potentially leading to more targeted and effective treatments for patients with anterior shoulder instability.
Introduction
‘Shoulder instability is a debilitating condition that often results from subcritical bone loss at the glenoid, the socket part of the shoulder joint. Understanding the extent of this bone loss is crucial for orthopedic surgeons in planning appropriate surgical or non-surgical interventions. A recent study conducted at the Rush University Medical Center in Chicago, IL, and documented in the Arthroscopy journal, aims to refine the current diagnostic methods, creating a new paradigm in the evaluation of glenoid bone loss.
The Study
The study, led by Dr. Drew Lansdown from the University of California, San Francisco, with colleagues Kevin Wang, Adam B. Yanke, Gregory P. Nicholson, Brian J. Cole, and Nikhil N. Verma from Midwest Orthopedics at Rush University Medical Center, involved the detailed analysis of computed tomography (CT) scans from cadaveric shoulder specimens. The researchers aimed to identify a visual pattern that could quickly indicate subcritical bone loss.
Methodology
31 shoulder CT scans of cadaveric specimens were reconstructed in three dimensions. Subjects above 65 years old or displaying evidence of glenoid fractures or arthritis were excluded to maintain the integrity of the study. The team then developed en face images of each glenoid, and measurements were taken of various anatomical features, including the area and chord length of the inferior glenoid, as well as its relationship to a vertical reference line set on the superior glenoid. Using these measurements, the researchers could estimate bone loss relative to this reference.
Key Findings
The study’s findings illustrate that a flat appearance of the anterior glenoid corresponds to a bone loss of approximately 12.8% relative to the best-fit circle, a measure for the inferior glenoid, aligning with established thresholds for subcritical bone loss. These numbers were emblematic, given that a bone loss exceeding 10% can be a determining factor for surgical intervention. The study also noted that this flat appearance could predict more than 10% bone loss in around 80% of subjects and would have a high negative predictive value for more substantial bone loss.
Clinical Implications
Understanding the subtleties of subcritical glenoid bone loss is critical for orthopedic professionals managing anterior shoulder instability. With this innovative pattern recognition, the necessity for complex and time-consuming calculations may be reduced, facilitating quicker and potentially more accurate assessments.
DOI and References
DOI: 10.1016/j.arthro.2018.12.034
1. Lansdown, D. A., Wang, K., Yanke, A. B., Nicholson, G. P., Cole, B. J., & Verma, N. N. (2019). A Flat Anterior Glenoid Corresponds to Subcritical Glenoid Bone Loss. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 35(6), 1788-1793.
2. Cole, B. J., Yanke, A., & Provencher, M. T. (2009). Nonarthroplasty Treatment of Glenohumeral Cartilage Lesions. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 25(8), 821-830.
3. Itoi, E., Lee, S. B., Amrami, K. K., & Wenger, D. E. (2003). Quantitative assessment of classic anteroinferior bony Bankart lesions by radiography and computed tomography. The American Journal of Sports Medicine, 31(1), 112-118.
4. Provencher, M. T., et al. (2008). A Critical Analysis of the Literature and the Use of Bankart Repair in Athletes. Sports Medicine and Arthroscopy Review, 16(1), 48-62.
5. Burkhart, S. S., & De Beer, J. F. (2000). Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 16(7), 677-694.
Keywords
1. Subcritical Glenoid Bone Loss
2. Anterior Shoulder Instability
3. Orthopedic Diagnostic Imaging
4. Shoulder Instability Pattern Recognition
5. CT Scans Glenoid Assessment
Conclusion
The research conducted at Rush University Medical Center represents a significant step forward in the diagnostic approach for patients suffering from anterior shoulder instability due to subcritical glenoid bone loss. By identifying a flat anterior glenoid as a key indicator of this condition, orthopedic surgeons can now make more informed clinical decisions, ensuring that patients receive timely and effective treatment for their shoulder instability. This study not only arms clinicians with valuable diagnostic information but also paves the way for new research on preventative and rehabilitative strategies for shoulder injuries.