Geometric analysis of the humeral head and glenoid in the Indian population and its clinical significance

Shoulder MRI parameters in anticipating anterior shoulder dislocation: Are they a reliable and reproducible tool in clinical practice?

BACKGROUND

Anterior shoulder dislocation (ASD) is a frequently observed musculoskeletal injury that is often encountered in the context of sports activities or as a result of trauma. Several magnetic resonance imaging (MRI) parameters have been previously investigated for the purpose of characterizing the anatomical features, which could potentially be responsible for the episodes of instability. These measurements have the potential to identify patients who are susceptible to dislocation. Consequently, ensuring the reliability and consistency of these measurements is crucial in the diagnosis and the management of athletic or traumatic shoulder injuries.

METHODS

A group of four students, who had no previous experience in reading MRI series, were selected to perform radiographic measurements on specific parameters of MRI scans. These parameters were glenoid version, glenoid depth, glenoid width, humeral head diameter, humeral containing angle, and the ratio of humeral head diameter to glenoid diameter. The four participants conducted two distinct readings on a total of 28 sets of shoulder MRI scans. Simultaneously, the aforementioned measures were assessed by a consultant shoulder surgeon.

RESULTS

A total of 1512 measurements were categorized into nine sets: eight from students' measurements (two per student) and one from the consultant. Intra-rater reliability assessed by the intra-class correlation (ICC) test indicated excellent or good reliability for all parameters (p < 0.05), with glenoid depth showing the highest (0.925) and humeral-containing angles the lowest (0.675) ICC value. Inter-rater correlation, also evaluated using ICC, demonstrated strong correlation (p < 0.05), with glenoid diameter having the highest ICC score (0.935) and glenoid depth the lowest (0.849). Agreement analysis, expressed by Cohen's Kappa test, revealed substantial agreement (p < 0.05) for all parameters, with humeral head diameter having the highest agreement (0.90) and humeral-containing angle the lowest (0.73).

CONCLUSION

In this study, intra- and inter-rater MRI parameters are substantially concordant. Credibility comes from these reliability and agreement analyses' statistical significance. Glenoid diameter and depth are the most reliable intrarater and interrater, respectively. Best agreement was with the humeral-containing angle. These data demonstrate repeatability and clinical relevance.

LEVEL OF EVIDENCE

Level IV.

Comparison of Glenoid Dimensions Between 3D Computed Tomography and 3D Printing

INTRODUCTION

Glenoid dimensions can be measured in vivo with various imaging methods including two-dimensional (2D) and three-dimensional computed tomography (CT) and magnetic resonance imaging scans. Printing of three-dimensional (3D) models of the glenoid using imaging data is feasible and can be used to better understand skeletal trauma and complex skeletal deformations such as glenoid bone loss in patients with shoulder instability. The purpose of this study was to compare measurements of glenoid dimensions on 3D CT scan reconstructed models and 3D printed models of the glenoid.

METHODS

CT scans from 62 young, male adults acquired for non-trauma-related causes were evaluated. Following volume rendering, a stereolithography model of each scapula was constructed and a 3D model was printed. Additionally, 3D CT models of each glenoid were reconstructed using dedicated software. Measurements of the maximum glenoid height and width were performed on both the 3D printed and the 3D reconstructed models. To assess intra- and interrater reliability, measurements of 15 glenoids were repeated by two observers after three weeks. The measurements of the 3D printed and 3D reconstructed models were compared.

RESULTS

Inter- and intra-rater reliability was excellent or perfect. Analysis of height and width values demonstrated a strong correlation of 0.91 and 0.89 respectively (p<0.001) for both the 3D printed models and the 3D reconstructed models. There was a strong correlation between the height and width, but no significant difference between the glenoid width and height in both models. There was no statistical significance between height and width when measurements on the two models were examined (p=0.12 and 0.23 respectively).

CONCLUSION

3D printed glenoid models can be used to evaluate the glenoid dimensions, width, and height, as they provide similar accuracy with 3D reconstructed models as provided from CT scan data.

Average Indian Glenoid Sizes Are Smaller than All Commercially Available Glenoid Components: A Systematic Review

Background

Despite the variability in glenoid sizes geographically, most of the currently available commercial glenoid component designs are based on the glenoid parameters of the Caucasian population which may not be suitable for the Indian population due to a mismatch between the prosthesis and native anatomy. The aim of the present study is to systematically review the literature to determine the average glenoid anthropometric parameters in the Indian population.

Methods

A comprehensive literature search was conducted using preferred reporting items for systematic reviews and meta-analyses guidelines in the PubMed, EMBASE, Google Scholar, and Cochrane Library databases from the date of inception to May 2021. Any observational study conducted on the Indian population measuring the glenoid diameters, glenoid index, version, inclination, or any other glenoid measurements were included in the review.

Results

A total of 38 studies were included in this review. The glenoid parameters were assessed on intact cadaveric scapulae in 33 studies, on 3DCT in three studies, and 2DCT in one study. The pooled average of glenoid dimensions are as the following- the superoinferior diameter or height was 34.65 mm, anteroposterior1 diameter or maximum width was 23.72 mm, anteroposterior2 diameter or maximum width of the upper part of the glenoid was 17.05 mm, the glenoid index was 67.88, and the glenoid version was 1.75-degree retroversion. Males were having a mean height of 3.65 mm and maximum width of 2.74 mm larger than the females. A subgroup analysis revealed no significant difference between different parts of India in glenoid parameters.

Conclusion

The glenoid dimensions in the Indian population are smaller compared to the average European and American populations. The average glenoid maximum width of the Indian population is 1.3 mm smaller than the minimum glenoid baseplate size available in reverse shoulder arthroplasty. Glenoid components specific to the Indian market need to be designed to reduce glenoid failure attributable to the above findings.

Level of evidence

III.

Three-dimensional morphometric analysis of glenoid in the Indonesian population and its clinical significance

Background

Understanding glenoid morphometry is important in shoulder prosthetic replacement surgery. In total and reverse shoulder arthroplasty, the size of the implants has to be determined according to the morphometry of the shoulder. However, there has been no known data on glenoid morphometry in the Indonesian population.

Methods

Seventy-four computed tomography scans of asymptomatic shoulders were obtained from the medical databases of a third referral hospital in Jakarta. Mimics Research 21.0 was used to reconstruct 3D models of the scapula from the DICOM files. The morphometry parameters included were glenoid fossa height (GFH), maximum glenoid fossa width (MGW), glenoid width at center of the glenoid fossa (CGW), vertical distance between maximum width and center (VDMC), glenoid version angle (GVA), glenoid inclination (GI), glenopolar angle (GPA), glenoid vault depth (GVD), coracoid length (CL), coracoid midpoint length (CML), coracoid tip height (CTH) and width (CTW), and coracoid midpoint height (CMH) and width (CMW).

Results

Our study found the average Indonesian GFH was 30.24 mm, the MGW was 24.03 mm, the CGW was 22.46 mm, the VDMC was 3.67 mm, the GPA was 42.76°, the GVD 18.8 mm, the GVA was 2.39° retroverted, the GI was 3.15° superiorly inclined, the CL was 37.76 mm, the CML was 18.89 mm, the CTW was 13.31 mm, the CTH was 8.52 mm, the CMW was 14.21 mm, and the CMH was 10.46 mm. All parameters except VDMC, GVA, and GI showed significant differences between male and female subjects Meanwhile, there was no significant difference in dimension and orientation of the glenoid and coracoid between the right and left shoulder.

Conclusion

Our study showed a lower value of MGW, GFH, and GVD compared to other Asian ethnicities. These results may be helpful in designing smaller prostheses suitable for Indonesian glenoids.

Anatomy features of the shoulder joint in asymptomatic chinese Han adults

BACKGROUND

To evaluate the shoulder anatomical characteristics in asymptomatic Chinese adults.

METHODS

The prospective study enrolled individuals without shoulder pain at Beijing Tiantan Hospital Affiliated to Capital Medical University between January 2019 and January 2020. Six radiographic parameters were measured and analyzed, including glenoid plane to the acromion (GA), glenoid plane to the lateral aspect of the humeral head (GH), acromion index (AI), lateral acromial angle (LAA), acromion-humeral interval (AHI), and critical shoulder angle (CSA).

RESULTS

103 participants (51 males and 52 females) were enrolled. The mean values of GA, GH, AI, CSA, LAA, and AHI were 32.88 ± 5.68 mm, 47.16 ± 4.82 mm, 0.70 ± 0.11, 37.45 ± 6.00°, 6.32 ± 3.99°, and 9.611.86 mm, respectively. Females had lower GA (30.78 ± 5.06 vs. 35.01 ± 5.51 mm, P < 0.001) and GH (44.28 ± 3.67 vs. 50.11 ± 4.02 mm, P < 0.001) than males and LAA was significantly smaller in the Bigliani flat type compared with the curved type and the hooked type (5.07 ± 2.31° vs 12.33 ± 5.46°vs 10.00 ± 3.37, P = 0.001).

CONCLUSIONS

Females had lower GA and GH than males in asymptomatic Chinese Han adults. Asymptomatic Chinese Han subjects with Bigliani flat type had lower LAA. CSA appears lager in Chinese Han individuals. Curve type of acromion performed lager LAA. The results may help establish an anatomical model of the shoulder joint and elucidate the anatomy features of the shoulder joint in asymptomatic Chinese Han adults.

Morphology of Humeral Head and Glenoid in Normal Shoulder of Indonesian Population

Purpose

Shoulder prostheses designed and used around the world may not fit an Asian shoulder. Normal shoulder morphology in Asian population had been reported, ie, Chinese, Indian, Japanese, and Thai populations, but no data from the Indonesian population. The aim of this study was to evaluate the three-dimensional (3D) morphology of the glenohumeral joint in the normal Indonesian population, identify its normal values, and compare them with those of other populations in the literature.

Patients and Methods

Images for analysis were computed tomography (CT) scans of 85 normal shoulders from 71 patients who had CT scans for another diagnosis. Morphometry of the humeral head and glenoid were measured using 3D reconstruction. Gender differences and correlations between age, height, and glenohumeral morphometry were evaluated. Indonesians' glenohumeral morphometry was compared with those of other populations in the literature.

Results

In the normal Indonesian population, the mean of humeral head inclination (HHI), height (HHH), diameter in sagittal plane (DS), diameter in frontal plane (DF), radius of curvature in sagittal plane (RS), and radius of curvature in frontal plane (RF) were 134.1°, 15.6mm, 39.3mm, 41.3mm, 20.4mm, and 21.4mm, respectively. The glenoid height (GH), upper width (GUW), lower width (GLW), inclination (GI), and version (GV) mean values were 34.2mm, 18.4mm, 24.5mm, 74.0mm, and 12.3mm, respectively. There was a significant difference in HHH, DS, DF, RS, RF, GH, GUW, GLW between males and females. Except for HHI and GI, glenohumeral morphometry was correlated with patient height. Age was not correlated with any glenohumeral morphometry.

Conclusion

In the Indonesian population, males had a larger humeral head and glenoid than females, and the size of the humeral head and glenoid was correlated to body height. Indonesians' humeral head and glenoid sizes were smaller than those of Western populations, but close to those of other Asian populations.

In Vivo Anatomical Research by 3D CT Reconstruction Determines Minimum Acromiohumeral, Coracohumeral, and Glenohumeral Distances in the Human Shoulder: Evaluation of Age and Sex Association in a Sample of the Chinese Population

Accurate measurement of the minimum distance between bony structures of the humeral head and the acromion or coracoid helps advance a better understanding of the shoulder anatomical features. Our goal was to precisely determine the minimum acromiohumeral distance (AHD), coracohumeral distance (CHD), and glenohumeral distance (GHD) in a sample of the Chinese population as an in vivo anatomical analysis. We retrospectively included 146 patients who underwent supine computed tomography (CT) examination of the shoulder joint. The minimum AHD, CHD, and GHD values were quantitatively measured using three-dimensional (3D) CT reconstruction techniques. The correlation between minimum AHD, CHD, and GHD value and age with different sexes was evaluated using Pearson Correlation Coefficient. The mean value of minimum AHD in males was greater than that in females (male 7.62 ± 0.98 mm versus female 7.27 ± 0.86 mm, p = 0.046). The CHD among different sexes differed significantly (male 10.75 ± 2.40 mm versus female 8.76 ± 1.38 mm, p < 0.001). However, we found no statistical differences in GHD with different sexes (male 2.00 ± 0.31 mm versus female 1.96 ± 0.36 mm, p > 0.05). In terms of age correlation, a negative curve correlation existed between age and AHD among the different sexes (male R2 = 0.124, p = 0.030, female R2 = 0.112, p = 0.005). A negative linear correlation was found in CHD among the different sexes (male R2 = 0.164, p < 0.001, female R2 = 0.122, p = 0.005). There were no differences between age and minimum GHD in both sexes. The 3D CT reconstruction model can accurately measure the minimum AHD, CHD, and GHD value in vivo and is worthy of further investigation for standard clinical anatomical assessment. Aging may correlate with AHD and CHD narrowing for both sexes.

Open Classic Latarjet Procedure Performed Using Freehand Technique-Surgical Technique and Outcome

INTRODUCTION

Latarjet procedure is commonly performed for recurrent anterior shoulder instability with glenoid side bone loss. Classic Latarjet procedure can be performed using specially designed drill guides, jigs, or by freehand technique. Here we have described a technical note on classic Latarjet procedure performed with freehand technique utilizing simple rulers and caliper. The functional and radiological outcomes of our patients have also been analysed.

MATERIAL AND METHODS

149 open classic Latarjet procedures were performed using our technique between March 2015 and July 2018. The mean age of the patients was 32.95 years (Range 22-59 years). The functional outcome of the patients was measured using Western Ontario Shoulder Instability (WOSI) and Oxford Shoulder Instability Score (OSIS) at 2 years of follow-up. Screw and graft positioning were studied in 24 consecutive patients with a postoperative computed tomography (CT) scan.

RESULTS

There was no incidence of recurrent subluxation or dislocation post-surgery. Mean OSIS score increased from 15.63 ± 3.20 preoperatively to 42.44 ± 3.88 postoperatively (p value < 0.05). WOSI score decreased significantly from 62.54% ± 8.24 to 10.26 ± 6.33 postoperatively at 2-year follow-up (p value < 0.05). Postoperative CT scan also showed satisfactory screw placement in all patients.

CONCLUSION

Open Latarjet procedure performed using freehand technique provides good functional and radiological outcomes in patients with recurrent anterior shoulder instability with glenoid side bone loss.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s43465-021-00385-7.