Abstract
PurposeThe aim of the study was to compare two measurement methods of humeral head defects in patients with shoulder instability. Intra- and inter-observer reliability of humeral head parameters were performed with the use of 2D and 3D computed tomography.MethodsThe study group was composed of one hundred humeral heads measured with the use of preoperative 2D and 3D computed tomography by three independent observers (two experienced and one inexperienced). All observers repeated measurements after 1 week. The intra-class correlation coefficient (ICC) and the minimal detectable change with 95% confidence (MDC95%) were used for statistical analysis of diagnostic agreement.ResultsFor 3D inter-observer reliability, ICC values were “excellent” for all parameters and MDC95% values were “excellent” or “reasonable.” All intra-observer ICC and MDC95% values for 3D were “excellent” for experienced and inexperienced observers. For 2D-CT, ICC values were usually “good” or “moderate” with MDC95% values higher than 10 or 30%.ConclusionsThree-dimensional CT measurements are more reliable than 2D for humeral head and Hill-Sachs lesion assessment. This study showed that 2D measurements, even performed by experienced observers (orthopaedic surgeons), are burdened with errors. The 3D reconstruction decreased the risk of error by eliminating inaccuracy in setting the plane of the measurements.
Highlights
Shoulder instability is a common condition affecting 25 in every 100.000 people a year
MDC95% value was higher than 30% (74.99)
For 2D measurements, minimal detectable change with 95% confidence (MDC95%)values were excellent for circle area of humeral head and humeral head height (5.29– 9.76) and “reasonable” for Hill-Sachs depth, humeral head length, and anatomical neck width (23.94–24.73)
Summary
Shoulder instability is a common condition affecting 25 in every 100.000 people a year. It affects mainly young people, especially men (3:1) [1]. In people under 20 years of age, the risk of recurrent instability after the first dislocation can be up to 90% [2]. The humeral head is displaced in front of the glenoid and its posterior surface is Poznań, Poland wedged into the anterior edge of the glenoid. The resulting bone impression, called Hill-Sachs defect, is the common diagnosis in patients with recurrent shoulder instability. The presence of a Hill-Sachs defect may predispose to a conflict between the humeral head and glenoid, and to the dislocation of the shoulder joint [3]
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