Difference In Glenoid Version Research Articles

Posterior Shoulder Instability but Not Anterior Shoulder Instability Is Related to Glenoid Version

To assess and compare glenoid version in patients with anterior shoulder instability (ASI), posterior shoulder instability (PSI), and a control group. The operative notes of all patients that had undergone arthroscopic shoulder instability repair between January 2017 and May 2022 were retrospectively reviewed. Magnetic resonance imaging scans were then analyzed, and glenoid version was measured by a single blinded observer. A P value <.05 was considered statistically significant. There were 100 patients included in the ASI group, 65 in PSI group, and 100 in the control group. The mean glenoid versions for the ASI group were-16°,-9.1°, and-9.2° for the vault version, simplified vault version, and chondrolabral version, respectively. The mean glenoid versions for the PSI group were-21°,-13.4°, and-16.6° for the vault version, simplified vault version, and chondrolabral version, respectively. The mean versions for the control group were-17.8°,-9.5°, and-9.8° for the vault version, simplified vault version and chondrolabral version, respectively. ANOVA testing and post hoc comparisons revealed the PSI group to be significantly more retroverted than both other groups P < .001. The ASI group's degree of glenoid version was not significantly different to that of the control P= .009. Patients with PSI have a higher degree of retroversion in comparison to those with ASI and control. There is no significant difference in glenoid version among patients with ASI when compared with control. Level III, retrospective comparative study.

Failure of Posterior Capsulolabral Repair is Correlated with Percent of Glenoid Bone Loss

Objectives:The purpose of this study was to evaluate previously described advanced MRI measures specific to posterior bone loss on both standard and manually reformatted MRIs in patients who underwent posterior shoulder capsulolabral repair. It was hypothesized that those who failed surgical repair would have increased posterior glenoid bone loss and decreased glenoid width.Methods:Athletes greater than 18 years of age with unidirectional posterior instability treated with arthroscopic repair were evaluated at 2 year minimum follow-up. Traditional MRIs measurements from nineteen patients who failed arthroscopic posterior shoulder capsulolabral repair were compared with 56 patients who did not. MRIs were then manually reformatted and these measurements were repeated as well as recently described measures of defect slope, bone loss angle, and defect length.Results:Glenoid width loss and percent glenoid bone loss were significantly greater on both the corrected and non-corrected MRI images (25.5 mm vs 28.8 mm, p<0.001; 6.8% vs 4.6%, p=0.008) in those that failed surgery. There was no difference in glenoid version or other measurements between the failures and non-failures. On non-corrected MRIs, percentage glenoid bone loss was significantly overestimated by 2% when compared to the corrected scans (p<0.0001, 95% CI [-2.7, -1.1]). A critical amount of 11% glenoid bone loss resulted in a 10 times higher surgical failure rate while 15% bone loss resulted in a 25 times higher failure rate.Conclusions:Risk factors for failure of arthroscopic posterior shoulder capsulolabral repair include greater glenoid bone width loss and greater glenoid bone loss percentage. Failure to appropriately align axial MRI rotation affects the characteristics of the sagittal images, leading to overestimation of glenoid bone loss percentage which may have surgical implications. Although 11% glenoid bone loss implicated a 10 times higher surgical failure rate and 15% bone loss has a 25 times higher failure rate, posterior capsulolabral repair is an overall successful intervention.

Defining Critical Glenoid Bone Loss in Posterior Shoulder Capsulolabral Repair

Background: Although critical bone loss for anterior instability is well defined, a clinically significant threshold of posterior bone loss has not been elucidated. Hypothesis: Patients with failed arthroscopic posterior shoulder capsulolabral repair will have increased posterior glenoid bone loss with a defined critical threshold. Study Design: Case control study; Level of evidence, 3. Methods: Athletes older than 18 years with unidirectional posterior instability treated with arthroscopic repair were evaluated at 2-year minimum follow-up. Failure was defined as revision surgery, American Shoulder and Elbow Surgeons (ASES) score of <60, or subjective stability score of >5. Magnetic resonance imaging (MRI) measurements from 19 patients with failed arthroscopic posterior shoulder capsulolabral repair were compared with 56 patients whose surgery was successful. MRI measures included glenoid version, labral version, glenoid width, labral width, percentage bone loss using the circle technique, labral height, percent subluxation, and recently described measures of defect slope, bone loss angle, and defect length. The P value threshold was set at .05, and a multivariable logistic regression analysis was performed for evaluation of risk of surgical failure. Results: Smaller glenoid width and greater percentage glenoid bone loss (25.5 ± 0.68 mm vs 28.8 ± 0.47 mm; P < .001; 6.8% ± 0.64% vs 4.6% ± 0.43%; P = .008) were seen in those patients with failed surgery. There was no difference in glenoid version or other measurements between the failures and nonfailures. A cutoff of 11% glenoid bone loss resulted in a 10.4 times statistically higher surgical failure rate, while a 15% bone loss resulted in a 24.4 times statistically higher failure rate. Six patients had >11% bone loss (range, 11.1 to 19.3) and 1 patient had >15% bone loss. Conclusion: Risk factors for failure of arthroscopic posterior shoulder capsulolabral repair include smaller glenoid bone width and greater percentage of glenoid bone loss. A threshold of 11% posterior glenoid bone loss implicated a 10 times higher surgical failure rate, while a threshold of 15% led to a 25 times higher surgical failure rate. Surgical failure of posterior capsulolabral repair, however, is relatively rare as it is an overall successful intervention.

Decreased Glenoid Retroversion Is a Risk Factor for Failure of Primary Arthroscopic Bankart Repair in Individuals With Subcritical Bone Loss Versus No Bone Loss

To determine whether glenoid retroversion is an independent risk factor for failure after arthroscopic Bankart repair. This was a retrospective review of patients with a minimum 2-year follow-up. In part 1 of the study, individuals with no glenoid bone loss on magnetic resonance imaging (MRI) and who failed arthroscopic Bankart repair (cases) were compared with individuals who did not fail Bankart repair (controls). In part 2 of the study, cases with subcritical (<20%) glenoid bone loss as measured on sagittal T1 MRI sequences who failed arthroscopic Bankart repair were compared with controls who did not. For each part of the study, glenoid version was measured using axial T2 MRI sequences. Positive angular measurements were designated to represent glenoid anteversion, whereas negative measurements were designated to represent glenoid retroversion. Independent t tests were conducted to determine the association between glenoid version and failure after arthroscopic Bankart repair. There were 20 cases and 40 controls in part 1 of the study. In part 2, there were 19 cases and 21 controls. There was no difference in baseline characteristics between cases and controls. Among individuals with no glenoid bone loss, there was no difference in glenoid version between cases and controls (cases: 6.0° ± 8.1° vs controls: 5.1° ± 7.8°, P= .22). Among individuals with subcritical bone loss, cases (3.8° ± 4.4°) were associated with significantly less mean retroversion compared with controls (7.1° ± 2.8°, P= .0085). Decreased retroversion (odds ratio 1.34; 95% confidence interval 1.05-1.72, P= 20) was a significant independent predictor of failure using univariable logistic regression. While glenoid retroversion is not associated with failure after arthroscopic Bankart repair in individuals with no glenoid bone loss, decreased retroversion is associated with failure in individuals with subcritical bone loss. Level 3: Retrospective review.

Long-term Evaluation of Teres Major to Infraspinatus Transfer for Treatment of Shoulder Sequelae in Obstetrical Brachial Plexus Palsy.

The long-term results of soft tissue rebalancing procedures of the shoulder in obstetric brachial plexus palsy have been scarcely reported. The effect of this procedure on the evolution of secondary bone changes has been a subject of controversy. Twenty-six children are included in this study. All initially had postganglionic C5-6 or C5-7 (Narakas types I and II) obstetric brachial plexus palsy, which spontaneously recovered. Children included are those who had persistent external rotation weakness with or without internal rotation contracture, nondysplastic glenohumeral joint, and functioning teres major. All had anterior shoulder release and teres major to infraspinatus transfer to correct internal rotation deformity and/or increase active shoulder external rotation. Patients were 18 males and 8 females. The right upper limb was affected in 16 patients, and the left in 10. Surgery was performed at an average age of 3.01 years (range, 1-10 years). Follow-up averaged 8.2 years (range, 5-16 years). Eight cases (30%) were followed up for 10 years or greater. Age at final follow-up averaged 10.5 years (range, 6-17.8 years). The results showed to be significant: 67 degrees (63%), 71.3 degrees (412%), and -32 degrees (-35%), respectively. There was no single recurrence of internal rotation deformity. Global Mallet score averaged 20 ± 2.7. Global abduction and external rotation averaged 3.5 ± 0.8 and 4 ± 0.3, respectively. Shoulder abduction range included an average of 45 degrees glenohumeral and 65 degrees scapulothoracic motion. Postoperative internal rotation in adduction was limited to 55.96 ± 25.65 degrees and was significantly lower that the preoperative value. Radiological measurements showed no significant differences between the operated and normal sides. We conclude that the long-term results after soft tissue rebalancing, combined with open reduction when required, demonstrated significant improvement of abduction and external rotation and significant loss of internal rotation. The difference in glenoid version and humeral head subluxation continued to be insignificant compared with the normal side.

Magnetic Resonance Imaging Correlates With Computed Tomography for Glenoid Version Calculation Despite Lack of Visibility of Medial Scapula

To assess the accuracy of measuring glenoid version on magnetic resonance imaging (MRI) in the presence of varying amounts of the medial scapula body as compared with the gold standard of glenoid version measured on computed tomography (CT) imaging, including the entire scapula in a cohort of young patients with shoulder instability and without glenohumeral arthritis. A retrospective review was performed on instability patients with preoperative MRI and CT imaging. Measurements of available scapular width and glenoid version were performed using the Cobb angle method to measure the angle between the plane of the glenoid fossa to Friedman's line on axial images. Intra- and interrater reliability analysis was performed using intraclass correlation coefficients to assess agreement between MRI and CT measurements. Paired t tests were used to compare measurement differences between MRI and CT. Thirty-two patients with both MRI and CT scans were assessed. Intra- and inter-rater assessment revealed strong agreement for scapular width measurement. For glenoid version measurement, intra-rater agreement was excellent and inter-rater agreement was moderate on CT and good on MRI. The mean available scapular body width was 24.7mm longer on CT as compared with MRI (95% confidence interval 17.5-31.9, P < .0001; 109.8 ± 8.2mm vs 85.1 ± 16.9mm, respectively), with MRI having an average of 78.2% (±17.6%) of the CT scapular width shown on CT. No significant difference in glenoid version was found between MRI and CT (95% confidence interval-0.87 to 1.75, P= .499; MRI-2.57° vs CT-2.13°). MRI provided significantly shorter available scapular widths when compared with CT imaging in a cohort of patients with glenohumeral instability and without arthritis. However, this failed to produce a significant difference of ≥5° in measured glenoid version compared with CT measurements when 75% (8cm) of the scapular width was present on MRI. Measuring glenoid version on MRI does not appear to be significantly affected when the entirety of the medial border of the scapula is not included in the imaging field. Level III; study of diagnostic test.

Comparison of Glenoid Version and Posterior Humeral Subluxation in Patients With and Without Posterior Shoulder Instability

To evaluate glenoid version and humeral subluxation on preoperative multiplanar imaging of patients who underwent surgery for posterior glenohumeral instability compared with a matched group of patients who had shoulder surgery for other pathology. All patients over a 2-year period who underwent surgery for posterior instability had preoperative magnetic resonance (MR) imaging or MR arthrogram reviewed. Patients undergoing shoulder surgery for reasons other than instability were identified as a control group and matched by sex, laterality, and age. Measurement of glenoid version and percentage of humeral subluxation was performed by 2 reviewers after completing a tutorial. Reviewers were blinded to diagnosis and to whether or not the patients were in the experimental or control group. There were 41 patients in each group. The average glenoid version in the control group was 5.6° of retroversion (standard deviation [SD] 3.0), and the average humeral subluxation was 54% (SD 5.1%). In the experimental group, the average glenoid version was 8.1° of retroversion (SD 5.0). The average humeral subluxation in the experimental group was 56% (SD 6.8%). Student t test revealed a statistically significant difference in glenoid version (P=.009) but not humeral subluxation (P= .25). Intra- and inter-rater reliability was measured by the intraclass correlation coefficient and found to have an excellent Fleiss rating with regard to both measurements. Glenoid retroversion is significantly increased in patients with symptomatic posterior labral tears compared with a control group. However, there was no statistically significant difference between the groups with regard to posterior humeral subluxation and, therefore, is not a reliable indicator of the presence or absence of symptomatic posterior shoulder instability. Level III, retrospective comparative study.

The effect of sagittal rotation of the glenoid on axial glenoid width and glenoid version in computed tomography scan imaging

Computed tomography (CT) scans of the shoulder are often not well aligned to the axis of the scapula and glenoid. The purpose of this paper was to determine the effect of sagittal rotation of the glenoid on axial measurements of anterior-posterior (AP) glenoid width and glenoid version attained by standard CT scan. In addition, we sought to define the angle of rotation required to correct the CT scan to optimal positioning. A total of 30 CT scans of the shoulder were reformatted using OsiriX software multiplanar reconstruction. The uncorrected (UNCORR) and corrected (CORR) CT scans were compared for measurements of both (1) axial AP glenoid width and (2) glenoid version at 5 standardized axial cuts. The mean difference in glenoid version was 2.6% (2° ± 0.1°; P = .0222) and the mean difference in AP glenoid width was 5.2% (1.2 ± 0.42 mm; P = .0026) in comparing the CORR and UNCORR scans. The mean angle of correction required to align the sagittal plane was 20.1° of rotation (range, 9°-39°; standard error of mean, 1.2°). These findings demonstrate that UNCORR CT scans of the glenohumeral joint do not correct for the sagittal rotation of the glenoid, and this affects the characteristics of the axial images. Failure to align the sagittal image to the 12-o'clock to 6-o'clock axis results in measurement error in both glenoid version and AP glenoid width. Use of UNCORR CT images may have notable implications for decision-making and surgical treatment.

Changing Glenoid Version After Open Reduction of Shoulders in Children With Obstetric Brachial Plexus Palsy

Twenty-three patients who had obstetric brachial plexus palsy and shoulder subluxation or dislocation that required open reduction and tendon lengthening were entered into a prospective study to evaluate glenoid version after surgery. All the patients had a preoperative computerized axial tomograph and postoperative computed tomography scan of both shoulders at approximately yearly intervals to assess the degree of congruity of the glenohumeral joint and glenoid version. Surgery was performed between 1988 and 1997. There were 11 girls and 12 boys. The mean age was 2 years 5 months (range 8 months-6 years 7 months). The left shoulder was affected in 12 patients and the right shoulder was affected in 11 patients. At mean follow-up of 3 years 7 months, the mean glenoid retroversion for the dislocated shoulder progressively decreased. The difference in glenoid version between the dislocated and the normal side decreased. The angle of glenoid retroversion in the affected shoulders decreased by a mean of 31% after open reduction, and the retroversion continued to improve at 9% per year.

Glenoid size, inclination, and version: An anatomic study

Three hundred forty-four human scapular bones (172 matched pairs) were measured for their glenoid height, width, inclination, and version. The sample consisted of 50 black men, 50 white men, 50 black women, and 22 white women, all of whom were aged 20 to 30 years at the time of death. The mean age of the study group was 25.6 years. No difference in glenoid size was noted between black and white patients. The overall glenoid version for the entire study group was 1.23° of retroversion. The difference in glenoid version between black and white patients was statistically significant. The average glenoid version for black and white patients measured 0.20° and 2.65° of retroversion, respectively (P =.000014). Specifically, the glenoid version for black and white men measured 0.11° and 2.87° of retroversion, respectively (P =.00034). The glenoid version for black and white women measured 0.30° and 2.16° of retroversion, respectively (P =.034). No statistical difference in glenoid version was found between men and women of the same race. No difference was found between measuring the glenoid version based on the transverse axis of the scapula and measuring the glenoid version perpendicular to the glenohumeral joint. No statistical difference was found in the glenoid inclination based on race or sex. The relationships between glenoid size, inclination, and version are important to understand when a surgeon prepares to resurface the glenoid during total shoulder arthroplasty. The knowledge of these values, their variation, and racial differences should help reproduce a more anatomical result. (J Shoulder Elbow Surg 2001;10:327-32.)

The Sprengel deformity

We evaluated scapular dysplasia and malposition in 15 patients with the Sprengel deformity using three-dimensional CT (3D-CT). The shape, height-to-width ratio, the areas of both scapulae, the anterior curvature of the supraspinous portion and glenoid version were assessed on scapular posterior, medial and inferior views. The degree of rotation and superior displacement were measured on the trunk posterior view. The omovertebral connection was also assessed and correlated with the operative findings. Most of the affected scapulae had a characteristic shape with a decrease in the height-to-width ratio and were larger than the contralateral scapulae. There was an inverse relationship between scapular rotation and superior displacement. The typical curve of the supraspinous portion of the scapula was seen in only three cases. There was no significant difference in glenoid version. The point of tethering of the omovertebral connection may determine the shape, rotation and superior displacement of the scapula. 3D-CT was helpful in delineating the deformity in detail, and in planning scapuloplasty.

The Sprengel deformity. Morphometric analysis using 3D-CT and its clinical relevance.

We evaluated scapular dysplasia and malposition in 15 patients with the Sprengel deformity using three-dimensional CT (3D-CT). The shape, height-to-width ratio, the areas of both scapulae, the anterior curvature of the supraspinous portion and glenoid version were assessed on scapular posterior, medial and inferior views. The degree of rotation and superior displacement were measured on the trunk posterior view. The omovertebral connection was also assessed and correlated with the operative findings. Most of the affected scapulae had a characteristic shape with a decrease in the height-to-width ratio and were larger than the contralateral scapulae. There was an inverse relationship between scapular rotation and superior displacement. The typical curve of the supraspinous portion of the scapula was seen in only three cases. There was no significant difference in glenoid version. The point of tethering of the omovertebral connection may determine the shape, rotation and superior displacement of the scapula. 3D-CT was helpful in delineating the deformity in detail, and in planning scapuloplasty.

Posterior glenoid rim deficiency in recurrent (atraumatic) posterior shoulder instability.

To assess the shape of the posterior glenoid rim in patients with recurrent (atraumatic) posterior instability. CT examinations of 15 shoulders with recurrent (atraumatic) posterior instability were reviewed in masked fashion with regard to abnormalities of the glenoid shape, specifically of its posterior rim. The glenoid version was also assessed. The findings were compared with the findings in 15 shoulders with recurrent anterior shoulder instability and 15 shoulders without instability. For all patients, surgical correlation was available. Fourteen of the 15 (93%) shoulders with recurrent (atraumatic) posterior shoulder instability had a deficiency of the posteroinferior glenoid rim. In patients with recurrent anterior instability or stable shoulders such deficiencies were less common (60% and 73%, respectively). The craniocaudal length of the deficiencies was largest in patients with posterior instability. When a posteroinferior deficiency with a craniocaudal length of 12 mm or more was defined as abnormal, sensitivity and specificity for diagnosing recurrent (atraumatic) posterior instability were 86.7% and 83.3%, respectively. There was a statistically significant difference in glenoid version between shoulders with posterior instability and stable shoulders (P=0.01). Recurrent (atraumatic) posterior shoulder instability should be considered in patients with a bony deficiency of the posteroinferior glenoid rim with a craniocaudal length of more than 12 mm.

Glenoid Version in Children with Obstetric Brachial Plexus Palsy

Glenoid version in a group of 29 children with obstetric brachial plexus paralysis and posterior dislocation of the shoulder was studied by using computed axial tomography (CT). The CT scan in most patients was done before an open release and reduction of the shoulder. A comparison was made between the normal and affected sides in regard to glenoid version and structure. In the study population, there were 16 girls and 13 boys with an average age at the time of initial CT of 2.8 years. Sixteen of the patients had posterior dislocations of the right shoulder, and none was bilateral. In 18 patients, the neurologic lesion was confined to the upper roots of the brachial plexus, with the remaining patients having whole plexus involvement. A significant difference in glenoid version between normal and affected sides was found in these patients. The mean glenoid version for the dislocated side was -29.5 +/- 2.5 degrees and that of the normal side was -6.9 +/- 2.4 degrees. Glenoid structure was different in dislocated shoulders. The glenoid articular surface was observed to be laterally convex in the majority of cases, and in these cases, the posterior rim of the glenoid was often hypoplastic and rounded.

Recurrent anterior glenohumeral joint dislocation and torsion of the humerus

Two computerized axial tomographic sections, one taken just below the coracoid process and the other about 2.5 cm proximal to the interepicondylar line, were used to determine glenoid version and humeral torsion in 19 patients with recurrent anterior glenohumeral joint dislocation and in 23 controls. Analysis of interobserver variation revealed the method to be reliable. There was no difference in glenoid version between the two groups. However, humeral torsion was greater in patients (153 °) than in controls (144 °). It appears that increased humeral torsion may predispose to glenohumeral joint dislocation.