Abstract
BackgroundGlenohumeral instability is a common problem following traumatic anterior shoulder dislocation. Two major risk factors of recurrent instability are glenoid and Hill-Sachs bone loss. Higher failure rates of arthroscopic Bankart repairs are associated with larger degrees of bone loss; therefore it is important to accurately and reliably quantify glenohumeral bone loss pre-operatively. This may be done with radiography, CT, or MRI; however no gold standard modality or method has been determined. A scoping review of the literature was performed to identify imaging methods for quantifying glenohumeral bone loss.MethodsThe scoping review was systematic in approach using a comprehensive search strategy and standardized study selection and evaluation. MEDLINE, EMBASE, Scopus, and Web of Science were searched. Initial selection included articles from January 2000 until July 2013, and was based on the review of titles and abstracts. Articles were carried forward if either reviewer thought that the study was appropriate. Final study selection was based on full text review based on pre-specified criteria. Consensus was reached for final article inclusion through discussion amongst the investigators. One reviewer extracted data while a second reviewer independently assessed data extraction for discrepancies.ResultsForty-one studies evaluating glenoid and/or Hill-Sachs bone loss were included: 32 studies evaluated glenoid bone loss while 11 studies evaluated humeral head bone loss. Radiography was useful as a screening tool but not to quantify glenoid bone loss. CT was most accurate but necessitates radiation exposure. The Pico Method and Glenoid Index method were the most accurate and reliable methods for quantifying glenoid bone loss, particularly when using three-dimensional CT (3DCT). Radiography and CT have been used to quantify Hill-Sachs bone loss, but have not been studied as extensively as glenoid bone loss.ConclusionsRadiography can be used for screening patients for significant glenoid bone loss. CT imaging, using the Glenoid Index or Pico Method, has good evidence for accurate quantification of glenoid bone loss. There is limited evidence to guide imaging of Hill-Sachs bone loss. As a consensus has not been reached, further study will help to clarify the best imaging modality and method for quantifying glenohumeral bone loss.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-015-0607-1) contains supplementary material, which is available to authorized users.
Highlights
Glenohumeral instability is a common problem following traumatic anterior shoulder dislocation
Selection criteria Studies were included if the following conditions were met: (1) publication after the year 2000; (2) use of human or cadaveric human subjects; (3) evaluation of imaging methods including radiography, computerized tomography (CT), and/or magnetic resonance imaging (MRI); and (4) quantification of glenoid or Hill-Sachs bone loss using these imaging modalities
When provided by the authors, the reliability, accuracy, sensitivity, and specificity are presented in the results section with accompanying tables
Summary
Glenohumeral instability is a common problem following traumatic anterior shoulder dislocation. Higher failure rates of arthroscopic Bankart repairs are associated with larger degrees of bone loss; it is important to accurately and reliably quantify glenohumeral bone loss pre-operatively. This may be done with radiography, CT, or MRI; no gold standard modality or method has been determined. Burkhart et al showed that significant glenoid bone loss, approximately 25-45 % of glenoid width loss, was associated with higher failure rates of arthroscopic Bankart repairs [14, 15]. It is important to keep in mind how one calculates glenoid bone loss, as the threshold for surface area is different than for glenoid width
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