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Extremities Feature

Source: Wikimedia Commons

Glenoid Bone Loss Estimates…Unreliable

Elizabeth Hofheinz, M.P.H., M.Ed. • Thu, January 11th, 2018

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A multicenter study has found that when it comes to anterior shoulder instability, surgeons aren’t always “spot on” in determining the ideal surgical treatment. The research, “Accuracy and Reliability of a Simple Calculation for Measuring Glenoid Bone Loss on 3-Dimensional Computed Tomography Scans,” appears in the January 2018 edition of Arthroscopy.

Co-author Stephen A. Parada, M.D. with the Department of Orthopaedic Surgery at Eisenhower Army Medical Center in Fort Gordon, Georgia, told OTW, “Recent literature has taught us that bone loss on the glenoid is increasing responsible for poor outcomes after a soft tissue procedure (Bankart repair), however, no one agrees on how we should be measuring the amount of glenoid bone loss and the most widely used system currently in place has known deficits when measuring smaller percentages of bone loss due to the circular shape of the inferior glenoid.”

“There are very complicated systems that are very accurate, however this requires the surgeon to download an image and upload it into a different software, something that is just not feasible to do in clinic. Our goal was to come up with a simple, reproducible, accurate method that the surgeon could perform realistically in a busy clinic.”

“The CLM or Circle-Line Method is our take on the simplest version of measuring glenoid bone loss that remains accurate.”

“The math is nothing new, it's basically algebraic geometry that we can apply to the glenoid because of its circular shape. Different versions of calculating bone loss exist, we just hoped to find a method to make it easier for the surgeon to calculate and compared it to a ‘gold-standard’ of tracing the exact pattern of the glenoid by hand.”

“We found that it was reproducible among residents, fellows and attendings and remained more accurate than either estimations or calculations made with the more historical measurement system.”

“One of the interesting findings was that orthopaedic surgeons are not great at estimating glenoid bone loss. This makes it all the more necessary to use a system that allows for an accurate calculation of bone loss, especially as newer literature suggests that glenoid reconstructions, such as the Latarjet should be considered with even smaller amounts of glenoid bone loss than previously reported.”

“This is a quick, accurate and reproducible solution to measuring glenoid bone loss. It can be measured in under a minute and calculated in any type of spreadsheet. It may not change the procedure that you have planned for your patient, but at least you will have the most accurate information when deciding on how to proceed.”

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