Background
Methods
Study design
Selection criteria
Search strategies
Study selection
Data extraction
Results
Article selection
Article summary
Study | Modality | Details | Quantification Technique | Findings |
---|---|---|---|---|
Charousset et al. [47]: Retrospective case series | Radiography; 2DCT | 31 patients |
True AP radiography:
|
Loss of sclerotic line (ICC):
|
Assessment:
| Loss of sclerotic line | Inter-observer 0.44-0.47 | ||
True AP view; 2DCT arthrogram; 3 observers measured twice | CT: | Intra-observer 0.66-0.93 | ||
Outcome:
|
Griffiths Index (ICC):
| |||
Reliability | Inter-observer 0.68-0.71 | |||
Intra-observer 0.78-0.90 | ||||
Best-fit circle width loss (ICC): | ||||
Inter-observer 0.74 | ||||
Intra-observer 0.90-0.95 | ||||
Itoi et al. [18]: Cadaveric study | Radiography; 2DCT | 12 cadavers | Radiography: |
21 % glenoid length defect:
|
Assessment:
| West Point & axillary views | 18.6 % on West Point view 2.3 % on axillary view | ||
45 ° angle defects created at 0, 9, 21, 34, & 46 % of glenoid length; radiography at each cut; 1 observer measured twice |
CT:
| 50 % loss of width on CT | ||
Outcome: | Width of the inferior ¼ of the glenoid measured in a single axial slice | |||
Correlation, reliability | Correlation coefficients: | |||
0.905-0.993 | ||||
Coefficients of variance: | ||||
0.5-3.6 % | ||||
Jankauskas et al. [45]: Retrospective case–control study | Radiography; 2DCT | 86 patients | Superoinferior length of bone defect |
Detecting bone lesion:
|
Assessment:
| Sensitivity 54-65 % | |||
True AP radiography; 2 observers on radiography; 1 observer on CT | Specificity 100 % | |||
Outcome:
| Inter-rater reliability: kappa = 0.88 | |||
Reliability; sensitivity; specificity |
Radiography
vs.
CT:
| |||
9 shoulders with mean 8.2 ± 3.5 mm glenoid bone loss on CT were missed on radiography | ||||
Sommaire et al. [46]: Retrospective cohort study | Radiography; 2DCT | 77 patients |
Radiography:
|
Radiographic D1/D2 ratio (p = 0.003):
|
Assessment:
| Bernageau view of both shoulders to calculate D1/D2 ratio (Fig. 4) | 4.2 % patients without recurrence | ||
Pre-operative Bernageau radiographs & 2DCT of unilateral shoulder before arthroscopic Bankart repair; 1 observer measured once |
CT:
| |||
Outcome:
| Gerber‘s X index (Fig. 7) | 5.1 % in patients with recurrence | ||
CT:
| ||||
Recurrence Rate (p = 0.004): | ||||
Gerber X index < 40 % =20 % | ||||
Need for revision correlated with imaging | Gerber X Index >40 % =12.7 % | |||
Note: Reliability not assessed | ||||
Murachovsky et al. [43]: Prospective case–control study | Radiography; 3DCT | 10 patients; 50 healthy subjects |
Radiography:
|
Reliability:
|
Assessment:
| Bernageau view (D1/D2) ratio (Fig. 4) | Intra-observer ICC 0.897-0.965 | ||
Bilateral radiography (all subjects) & CT (instability subjects); 1 radiologist measured CT; 3 orthopaedic surgeons measured 3 times each |
3DCT:
| Inter-observer ICC 0.76-0.81 | ||
Outcome:
| Glenoid AP width measured bilaterally to calculate % bone loss | Difference between radiography & CT non-significant (2.28 %) | ||
Reliability |
Study | Modality | Details | Quantification Technique | Findings |
---|---|---|---|---|
Barchilon et al. [20]: Prospective case series | 2DCT; 3DCT | 13 patients |
Best-fit circle surface area:
|
Method 1 with method 2:
|
Assessment:
| Approximation based on intact posteroinferior edge of ipsilateral glenoid | R2 = 0.91 | ||
2DCT & 3DCT using 3 methods | (1) Software directly measured area of circle and area of missing area using 2DCT (gold standard) |
Method 1 with method 3:
| ||
Outcome:
| (2) Mathematical formula to calculate % surface area loss using 2DCT based on circle radius & defect depth with software | R2 = 0.60 | ||
Intra-method comparison | (3) Manually measured defect depth & circle radius using 3DCT & femoral head gauge; formula to calculate % surface area | Note: BCSA methods can be applied without computer software | ||
Hantes et al. [65]: Cadaveric study | 3DCT | 14 cadavers |
Best-fit circle surface area:
|
Reliability:
|
Assessment:
| Sugaya Method | Coefficient of variation 2.2-2.5 % | ||
CT scan following 3 serial osteotomy’s; 1 observer measured 5 times for 2 glenoids | ||||
Outcome:
| ||||
Reliability | ||||
Huijsmans et al. [21]: Cadaveric study | 3DCT; MRI | 14 cadavers |
Best-fit circle surface area:
|
Difference with digital picture:
|
Assessment:
| Circle approximated based on ipsilateral glenoid; software used | CT −0.81 % to −1.21 % | ||
Digital picture, CT, & MRI before/after osteotomy (random size) on anterior glenoid; 2 observers measured 3 times | MRI 0.61 % to 0.74 % (non-significant) | |||
Outcome:
|
CT:
| |||
Reliability | Inter-observer r2 = 0.94 | |||
Intra-observer r2 = 0.97 (observer 1) and 0.90 (observer 2) | ||||
MRI:
| ||||
Inter-observer r2 = 0.87 | ||||
Intra-observer r2 = 0.93 (observer 1) and r2 = 0.92 (observer 2) | ||||
Digital image:
| ||||
Inter-observer r2 = 0.97 | ||||
Lee et al. [52]: Prospective case series | 2DCT; MRI | 65 patients |
1)
Best-fit circle surface area (Pico method)
|
Inter-observer ICC:
|
Assessment:
|
2) Best-fit circle width method
| 0.95 for best-fit circle width | ||
CT (bilateral) & MRI followed by arthroscopy; 1 observer measured CT once; 3 observers measured MRI once; 1 observer measured MRI 3 times | Arthroscopy with bare-area technique (used as gold standard) | 0.90 for area (Pico method) | ||
Outcome:
|
Intra-observer reliability ICC:
| |||
Reliability | 0.98 width | |||
0.97 area | ||||
Correlation:
| ||||
CT & MRI 0.83 | ||||
CT & arthroscopy 0.91 | ||||
MRI & arthroscopy 0.84 | ||||
Magarelli et al. [32]: Prospective case series | 2DCT | 40 patients |
Best-fit circle surface area method:
|
Intra-observer reliability:
|
Assessment:
| Pico method based on contralateral glenoid | ICC 0.94 | ||
Bilateral CT; 1 observer measured 3 times; 1observer measured once | SEM 1.1 %. | |||
Outcome:
|
Inter-observer reliability:
| |||
Reliability | ICC 0.90 | |||
SEM 1.0 %. | ||||
Note: No comparison to other methods | ||||
Magarelli et al. [57]: Prospective cohort study | 2DCT; 3DCT | 100 patients |
Best-fit circle surface area:
|
Mean difference:
|
Assessment:
| Pico method based on contralateral glenoid | 0.62 %+/−1.96 % | ||
Bilateral CT; 2 observers measured once | Note: No reliability measurement | |||
Outcome:
| ||||
Agreement between 2D & 3D CT | ||||
Nofsinger et al. [35]: Retrospective case series | 3DCT | 23 patients |
Best-fit circle surface area:
|
Normal shoulder:
|
Assessment:
| Anatomic Glenoid Index: circle matched to postero-inferior glenoid of contralateral glenoid; software measured area of circle | Circle fit true glenoid closely −100.5 %, SD 2.2 %. | ||
Bilateral pre-op CT followed by surgical repair (12 Bankart, 11 |
Mean AGI for Bankart group:
| |||
Latarjet); 3 blinded observers measured once | (A1); circle manually adjusted to fit defect & area again calculated by software (A2); area loss = A2/A1 x 100 | 92.1 %+/−5.2 % | ||
Outcome:
|
Mean AGI for Latarjet:
| |||
Surgical decision based on size >25 % at arthroscopy; reliability | 89.6 %+/−4.7 % | |||
Inter-rater reliability (Pearson correlation coefficient):
| ||||
0.60-0.84 | ||||
Note: Did not have the power to separate the two surgical groups | ||||
Park et al. [60]: Retrospective case series | 2DCTA | 30 patients |
Best-fit circle surface area:
|
Intra-observer reliability:
|
Assessment:
| Pico method based on ipsilateral glenoid | ICC 0.96-1.00; | ||
CTA taken pre-op, at 3 months, and 1 year after bony Bankart repair; 1 observer measured 6 times | Positive relationship between number of dislocations & defect size | |||
Outcome:
| ||||
Reliability | ||||
Sugaya et al. [11]: Case–control study | 3DCT | 100 patients, 10 healthy volunteers |
Best-fit circle surface:
| Normal glenoid did not differ significantly from contralateral glenoid; inferior portion of glenoid approximates a true circle; did not compare measurements to arthroscopic measurements; no reliability measurements |
Assessment:
| Sugaya Method with bone fragment manually outlined | Note: Technique would not work in case of attritional bone loss without a Bankart fragment | ||
Bilateral CT; defects categorized as: small (<5 %), medium (5-20 %), or large (>20 %); patients also had arthroscopy: 1 observer measured once | ||||
Outcome:
| ||||
Comparison to normal glenoid |
Study | Modality | Details | Quantification Technique | Findings |
---|---|---|---|---|
Charousset et al. [47]: Retrospective case series | Radiography; 2DCT | 31 patients |
True AP radiography:
|
Loss of sclerotic line:
|
Assessment:
| loss of sclerotic line | Inter-observer ICC 0.44-0.47 | ||
True AP radiography & 2DCT arthrogram; 3 observers measured twice |
CT:
| Intra-observer ICC 0.66-0.93 | ||
Outcome:
|
Griffiths Index:
| |||
Reliability | Inter-observer ICC 0.68-0.71 | |||
Intra-observer ICC 0.78-0.9 | ||||
Best-Fit Circle Width Loss: | ||||
Inter-observer ICC 0.74 | ||||
Intra-observer ICC 0.9-0.95; | ||||
Chuang et al. [68]: Retrospective case series | 3DCT | 25 patients |
CT:
| Glenoid Index correctly categorized 96 % of patients |
Assessment:
| Glenoid Index (Fig. 5) | Glenoid Index: | ||
Bilateral 3DCT followed by diagnostic arthroscopy: >25 % glenoid width loss (Latarjet); <25 % glenoid width loss (arthroscopic Bankart) |
Arthroscopy:
| Latarjet group: mean 0.668 | ||
Outcome:
| Bare area method | Bankart group: mean 0.914 | ||
Ability to predict type of surgery offered | ||||
Griffith et al. [33]: Case–control study | 2DCT; 3DCT | 40 patients (46 shoulders); 10 healthy subjects |
Measurements:
| Healthy subjects: |
Assessment:
| Width & cross-sectional surface area on axial slice; length; width; length:width ratio; glenoid surface area by point tracing; flattening of anterior glenoid curvature | No significant difference in side-side measurements | ||
Bilateral CT;1 observer measured once |
Instability Subjects:
| |||
Outcome:
| Width (3 mm difference; 10.8 % width loss); length:width ratio, & cross-sectional area significantly different side-to-side | |||
Glenoid comparison with healthy subjects on en face glenoid view | ||||
Griffith et al. [58]: Prospective case series | 2DCT | 50 patients |
Width Measurement:
|
CT correlation with arthroscopy:
|
Assessment:
| Griffiths Index (Fig. 1) | Pearson Correlation Coefficient r = 0.79 | ||
Bilateral CT followed by arthroscopy; compared to measurements made during arthroscopy (bare spot method); 1 observer measured once | ||||
Outcome:
| Sensitivity 92.7 % | |||
Correlation, PPV, NPV | Specificity 77.8 % | |||
PPV 95 %; NPV 70 %. | ||||
Mean bone loss(p = 0.17): | ||||
CT 11.0 %+/−8.1 % | ||||
Arthroscopy 12.3 %+/−8.8 % | ||||
Griffith et al. [62]: Case–control study | 2DCT | 218 patients; 56 healthy subjects |
Width measurement:
Griffith Index (Fig. 1) | Normal side-to-side glenoid width difference small (0.46 mm); |
Assessment:
| Note: Glenoid bone loss not calculated on bilateral subjects |
Reliability:
| ||
Bilateral CT; 1 observer measured all subjects; 2 observers measured 40 patients twice | Inter-observer reliability ICC 0.91 | |||
Outcome:
| Intra-observer reliability ICC 0.95 | |||
Reliability | ||||
Gyftopoulos et al. [48]: Cadaveric study | 2DCT; 3DCT; MRI | 18 cadavers |
Width method:
|
Intra-observer concordance correlation coefficient (CCC):
|
Assessment:
| Best-fit circle width method based on ipsilateral glenoid | 2DCT 0.95 | ||
Defects created along anterior and antero-inferior glenoid; 3 observers measured defect size once; 1 observer re-measured at 4 weeks; gold standard was digital photograph | 3DCT 0.95 | |||
Outcome:
| MRI 0.95 | |||
Reliability, PE |
Inter-observer CCC:
| |||
2DCT −0.28-0.88 | ||||
3DCT 0.82-0.93 | ||||
MRI 0.70-0.96 | ||||
Percent error:
| ||||
2DCT 2.22-17.11 % | ||||
3DCT 2.17-3.50 % | ||||
MRI 2.06-5.94 % | ||||
Lee et al. [52]: Prospective cohort study | 2DCT; MRI | 65 patients |
1) Best-fit circle surface area:
|
Inter-observer reliability (ICC)
|
Assessment:
| Pico Method | Best-fit circle width R = 0.95 | ||
CT (bilateral) & MRI followed by arthroscopy; 1 observer measured CT once; 3 observers measured MRI once; 1 observer measured MRI 3 times;arthroscopy was gold standard using bare-area technique | 2) Best-fit circle width method: | Area (Pico method) R = 0.90 | ||
Outcome:
| Based on contralateral glenoid |
Intra-observer reliability:
| ||
Reliability, correlation | Width R = 0.98, area R = 0.97 | |||
Correlation:
| ||||
CT-MRI r = 0.83 | ||||
CT-arthroscopy r = 0.91 | ||||
MRI-arthroscopy r = 0.84 | ||||
Moroder et al. [50]: Retrospective case series | 3DCT, MRI | 48 patients |
Width method:
|
CT for glenoid lesion:
|
Assessment:
| Best-fit circle width method | Sensitivity 100 % | ||
Pre-op CT & MRI evaluated after failed instability surgery; findings at initial operation were comparators; 1 observer measured significant glenoid defects (>20 % of width) | Specificity 100 % | |||
Outcome:
|
MRI for significant lesion:
Sensitivity 35.3 % | |||
Sensitivity, specificity | Specificity 100 % | |||
CT would have misled treatment in only 4.2 % | ||||
Tian et al. [51]: Prospective cohort study | 2DCT; MRA | 41 patients; 15 control patients |
Width method:
| No significant size measurements between MRA (10.48 %+/−8.71 %) & CT (10.96 %+/−9.0 %; p = 0.288). |
Assessment:
| Best-fit circle width method based on ipsilateral glenoid (Fig. 10) |
Correlation between methods:
| ||
CT & MRA; 2 observers measured once | Pearson correlation coefficient r = 0.921; SD 3.3 % | |||
Outcomes:
| ||||
Correlation |
Study | Modality | Details | Quantification Technique | Findings |
---|---|---|---|---|
Bishop et al. [42]: Cadaveric study | Radiography; 2DCT; 3DCT; MRI | 7 cadavers | Observers measured bone loss using his/her usual approach (Methods not specified) |
Overall agreement with gold standard (kappa score):
|
Assessment:
| 3DCT 0.5 | |||
Serial imaging of shoulder after osteotomies of 0 %, <12 %, 12-25 %, 25-40 %; manually measured glenoid width through bare area using a digital caliper (gold standard); 12 observers measured twice | CT 0.4 | |||
Outcome:
| MRI 0.28 | |||
Reliability | Radiography 0.15 | |||
Intra-observer reliability (kappa):
| ||||
3DCT 0.59 | ||||
CT 0.64 | ||||
MRI 0.51 | ||||
Radiography 0.45 | ||||
Note: 3DCT highest agreement & 2nd highest intra-observer reliability; radiography lowest agreement & reliability | ||||
Bois et al. [63]: Laboratory study | 2DCT; 3DCT | Sawbones:1 model for anterior defect; 1 model for anteroinferior defect |
2DCT & 3DCT:
|
2D CT methods (ICC, PE):
|
Assessment:
| Indicators: linear width/length (W/L) ratio; defect length; quantifiers: glenoid index (injured glenoid inferior circle diameter relative to uninjured glenoid diameter) | Defect length: 0.81, 7.68 | ||
Osteotomies made at 0, 15 %, and 30 % of inferior glenoid circle diameter; gold standard measurement (3D laser scanner of model); 6 observers measured all 7 techniques |
3DCT:
| W/L ratio: 0.50, −16.34 | ||
Outcome:
| Quantifiers: linear ratio (d/R; d = radius to defect, R = circle radius); Pico method (3 variations): | Glenoid index, 0.3, −4.13 | ||
Reliability, PE | (1) Original circle method |
3D CT (ICC, PE):
| ||
(2) Based on contralateral normal glenoid circle with 3 points of reference | Defect length: 0.90, 0.29 | |||
(3) Based on remaining intact glenoid cortex | W/L ratio: 0.88, −2.41 | |||
Glenoid index: 0.69, 0.01 (0.85, 3.39 with other software platform) | ||||
Linear ratio: 0.97, 29.9 | ||||
Pico (1): 0.98, 4.93 | ||||
Pico (2): 0.84, 7.32 | ||||
Pico (3): 0.86, 12.14 | ||||
Note: Pico method (1) based on the contralateral, intact glenoid and Glenoid Index on 3DCT were most reliable & accurate; Glenoid Index on 2DCT was deemed invalid | ||||
Rerko et al. [44]: Cadaveric study | Radiography; 2DCT; 3DCT; MRI | 7 cadavers | Observers measured bone loss using his/her usual approach (Methods not specified) |
Accuracy (PE):
|
Assessment:
| 3DCT −3.3 %+/−6.6 % | |||
Serial imaging of shoulder with osteotomies grouped as 0 %,<12 %, 12, 25 %, 25-40 %; gold standard defined as glenoid width using digital caliper; 2 radiologists & 2 orthopaedic surgeons measured twice | 2DCT −3.7 %+/−8.0 % | |||
Outcome:
| MRI −2.75 %+/−10.6 % | |||
PE, reliability | Radiography −6.9 % +/− 13.1 % | |||
Intra-observer reliability (ICC):
| ||||
3DCT 0.947 | ||||
2DCT 0.927 | ||||
MRI 0.837 | ||||
Radiography 0.726 | ||||
Inter-observer reliability (ICC):
| ||||
3DCT 0.87-0.93 | ||||
2DCT 0.82-0.89 | ||||
MRI 0.38-0.85 | ||||
Radiography 0.12-0.53 |
Study | Modality | Details | Quantification Technique | Findings |
---|---|---|---|---|
De Filippo et al. [66]: Cadaveric study | 2DCT | 10 cadavers | De Filipo Method: Fig. 6 |
Curved MPR CT:
|
Assessment:
| Note: Curved MPR assessed curved structures very accurate | PE 1.03 %; inter-observer reliability (Cronbach alpha) 0.995 | ||
2 had anteroinferior defects created; 1 re-measured at 3 months; measured glenoid bone area on flat MPR & curved MPR of all 10 cadavers; laser scanner used directly on cadavers as gold standard; 3 radiologists measure once | Intra-observer reliability (ICC) 0.998 | |||
Outcome:
|
Flat MPR CT:
| |||
PE, reliability | PE 16.99 % | |||
Inter-observer reliability (Cronbach alpha) 0.995 | ||||
Note: Authors conclude curved gives more accurate glenoid contour | ||||
Diederichs et al. [59]: Cadaveric study | 3DCT | 5 cadavers; 30 patients with no glenoid injury | Manually traced out border of glenoid; volume and surface area calculated with measurements made manually (to calculate volume, depth was assumed to be 10 mm) |
Coefficient of variation:
|
Assessment:
| Width 1.7 % | |||
Glenoid width, height, surface area, & volume; osteotomy created on one cadaveric glenoid; compared to contralateral for calculation; 1 investigator measured study group; another measured the controls | Volume 1.3 % | |||
Outcome:
| ||||
Coefficient of varaition | ||||
Dumont et al. [49]: Technique description | CT; MRI | Authors describe a new method to calculate surface area loss | Best-fit circle to inferior glenoid; measured angle (alpha) from center of circle between superior and inferior edges of lesion; converted measured angle to percentage area loss = [(alpha-sinalpha)/2π] x 100 | No assessment of reliability or comparison to other methods |
Note: This method avoids issues with defect orientation and is simple to apply without complicated software | ||||
Tauber et al. [56]; Retrospective case series | CT | 10 patients with associated glenoid fracture (>21 % glenoid length) | Fit circle to outer glenoid, measured glenoid length at 45° angle (A), measured length to defect (B); calculated bone loss as: (A x 0.965 – B)/A x 100 |
Inter-observer reliability:
|
Assessment:
| ICC = 0.81 | |||
2 examiners measured once | Average width loss 26.2 % | |||
Outcome:
| ||||
Reliability | ||||
Van Den Bogaert et al. [69]: Cadaveric study | 2DCT | 20 cadavers |
Glenohumeral index:
|
Glenohumeral Index Compared to Gold Standard:
|
Assessment:
| Maximal AP diameter of humeral head / maximal AP diameter of glenoid (axial images) | Non-significant difference | ||
Diameter measured with a digital caliper in vitro (gold standard) followed by CT quantification; 3 observers measured once | ||||
Outcome:
| ||||
Direct comparison |
Citation | Method | Details | Quantification Method | Findings |
---|---|---|---|---|
Charousset et al. [47]: Retrospective case series | Radiography | 26 patients |
Quantitative assessment:
|
P/R ratio reliability:
|
Assessment:
| P/R ratio on true AP radiography in internal rotation (Fig. 10) | Inter-observer ICC 0.81-0.92 | ||
3 observers measured twice |
Qualitative assessment:
| Intra-observer ICC 0.72-0.97 | ||
Outcome:
| True AP radiograph in external rotation (present or absent lesion) |
Qualitative assessment reliability:
| ||
Reliability | Inter-observer ICC 0–0.30 | |||
Intra-observer ICC 0.06-0.92 | ||||
Note: Simple patient positioning and reliable | ||||
Ito et al. [38]: Retrospective case series | Radiography | 27 patients (30 shoulders) |
Width and depth of Hill-Sachs lesion measured:
|
Width difference
(p > 0.05)
:
|
Assessment:
| Supine position; arm 135 ° flexion, 15 ° internal rotation; radiography beam perpendicular | Dislocation group 13.4 mm+/−2.5 mm | ||
Divided into 2 groups: dislocation (11) and dislocation with recurrent subluxation (19); 1 observer measured once | Note: Patient positioning may be cumbersome and difficult to replicate in a clinical setting | With subluxation group 13.8+/−3.5 mm | ||
Outcome:
|
Depth difference (p < 0.05):
| |||
Width difference | Dislocation group 3.9+/−0.9 mm | |||
With subluxation group 2.1+/−1.0 mm | ||||
Note: Deeper lesions associated with subjective joint laxity but not number of dislocations | ||||
Kralinger et al. [39]: Retrospective cohort study | Radiography | 166 patients |
Hill-Sachs Quotient:
|
Recurrence rate associated with Hill-Sachs Quotient:
|
Assessment:
| Bernageau view and AP view at 60 ° internal rotation (Fig. 8) | Grade I 23.3 % | ||
1 observer measured once | Grade II 16.2 % | |||
Outcome:
| Grade III 66.7 % | |||
Recurrence rate | ||||
Sommaire et al. [46]: Retrospective cohort study | Radiography | 77 patients | d/R ratio: |
Risk of recurrence (p = 0.016):
|
Assessment:
| True AP radiograph in internal rotation (similar to Charousset et al. [2010]; Fig. 9) | 9.6 % in d/R ratio <20 % | ||
Final clinical outcome after arthroscopic Bankart repair and imaging; 1 observer measured once | 40 % in d/R ratio >20 % | |||
Outcome:
| Note: d/R ratio predictive of failure of arthroscopic Bankart repair | |||
Need for revision repair | ||||
Hardy et al. [37]: Retrospective cohort study | Radiography; 2DCT | 59 patients |
Radiograph 45 ° internal rotation view:
| d/R ratio (p < 0.01): |
Assessment:
| Depth of defect/radius of humerus (d/R) ratio (similar to Charousset et al. [2010]) | Good/excellent group: 16.2 % | ||
After arthroscopic stabilization divided into 2 groups based on Duplay clinical functional score: good/excellent (38) fair/poor (21); 1 observer measured all patients once; 10 observers measured 10 patients |
CT:
| Poor/fair group: 21.3 % | ||
Outcome:
| Humeral head radius (best-fit circle to circumference); defect width; defect depth (from edge of circle); defect length (amount of CT slices with the defect); lateralization angle (compared to AP line through center of head) |
Mean volume of lesion (p < 0.001):
| ||
Correlation of clinical score with radiographic findings; surgical failure rate | Note: Radiographic technique easily obtained | Good/excellent group: 640 mm3 | ||
Poor/fair group: 2160 mm3 | ||||
Surgical failure rate:
| ||||
d/R >15 %: 56 % | ||||
d/R < 15 %: 16 % | ||||
Presence of lesion, depth, lateralization angle, lesion, and humeral head volume ratio all non-significant between groups | ||||
Reliability
:
| ||||
Inter-observer reliability for depth and radius measurements non-significant | ||||
Kodali et al. [72]: Laboratory study | 2DCT | 6 anatomic bone substitute models |
Circle fit to humeral head:
|
Inter-observer reliability ICC:
|
Assessment:
| Width and depth measured on sagittal, axial, and coronal planes (similar to Saito et al. (2009) | Depth - 0.879 | ||
Circular humeral head defects created; 2DCT width-depth measurements made in 3 planes and compared to the defect sizes measured by a 3D laser scanner | Width 0.721 | |||
Outcome:
|
Accuracy (PE):
| |||
5 observers measured once | Width: sagittal 10.9+/−8.6 %, axial 10.5+/−4.4 %, coronal 15.9+/−8.6 %; | |||
Depth: sagittal 12.7+/−10.0 %, axial 16.7+/−10.2 %,coronal 22.5+/−16.6 % | ||||
Saito et al. [12]: Retrospective case-controls study | 2DCT | 35 patients; 13 normal | Circle fit to the humeral head on axial slices: |
Mean size of Hill-Sachs lesion:
|
Assessment:
| Depth: greatest length of distance from floor of defect to edge of circle; width: measured between edges of defect | Depth 5.0+/−4.0 mm; width 22+/−6 mm | ||
1 observer measured 3 times |
Intra-observer reliability:
| |||
Outcome:
| Pearson correlation coefficient: 0.954-0.998 | |||
Reliability | Coefficient of variation: 0–7.4 %. | |||
Cho et al. [36]: Prospective cohort study | 3DCT | 104 patients (107 shoulders) |
Fit circle to articular surface of humeral head:
|
Inter-observer reliability:
|
Assessment:
| Axial and coronal planes: width and depth measured on axial and coronal slice where lesion was largest | ICC 0.629-0.992 | ||
evaluated size, orientation, & location as means to predict engagement; engagement defined arthroscopically; 1 observer measured 27 randomly selected shoulders 3 times; 2nd observer measured once |
Intra-observer reliability:
| |||
Outcome:
| ICC 0.845-0.998 | |||
Reliability, size of Hill-Sachs lesion relationship to engaging lesions |
Size of Hill-Sachs lesion (axial):
| |||
Engaging group width 52 % & depth 14 % | ||||
Non-engaging group width 40 % & depth 10 % (both p <0.001) | ||||
Size of Hill-Sachs lesion (coronal):
| ||||
Engaging group width 42 % & depth 13 % | ||||
Non-engaging group width 31 %, & depth 11 % (p = 0.012 & 0.007 respectively). | ||||
Note: Orientation of Hill-Sachs angle significantly higher in engaging lesions | ||||
Kawasaki et al. [73]: Modeling | 3DCT | Evaluated 7 CT scans of bilateral shoulders | Created 3D contour; mirrored the normal shoulder and overlap contours; computer measured defect difference | Proposed a method to calculate humeral head bone loss |
Kirkley et al. [70]: Prospective case series | MRI | 16 patients | Hill-Sachs lesions were categorized as small (<1 cm) or large (>1 cm); |
Presence
vs.
absence of Hill-Sachs lesion:
|
Assessment:
| Note: Did not clarify slice or dimensions measured to determine Hill-Sachs lesion size | Kappa = 1 | ||
MRI followed by arthroscopic evaluation; 2 observers measured once |
Distinguishing small from large lesion:
Kappa = 0.44 | |||
Outcome:
| Not able to accurately quantify size | |||
Reliability | ||||
Salomonsson et al. [71]: Prospective cohort study | MRI | 51 patients | Hill-Sachs depth: |
Size of Hill-Sachs lesion:
|
Assessment:
| Measured on axial slice at largest point | Stable group 5 mm; unstable group 3 mm (non-significant) | ||
MRI immediately and clinical follow-up to 105 months; divided into stable and unstable (recurrent instability); 2 observers measured once | ||||
Outcome:
| ||||
Size of Hill-Sachs lesion correlation with recurrent instability |