Anterior Shoulder Instability: The Role of Advanced Shoulder Imaging in Preoperative Planning

Abstract

Despite advances in the understanding of anterior shoulder instability, recurrence rates after arthroscopic and open surgery have been reported to be as high as 30%. A successful operative outcome for patients with anterior shoulder instability requires the surgeon to perform a complete preoperative evaluation based on a thorough physical examination and advanced imaging techniques. In addition to the Bankart lesion, the treating surgeon must be aware of other copathologies, such as bony lesions of the glenoid or humeral head, humeral avulsion of the glenohumeral ligament, and articular cartilage defects that can occur in concert with capsular pathology and may necessitate a change in surgical strategy. This article focuses specifically on the osseous, labroligamentous, cartilage, and rotator cuff lesions demonstrated on preoperative imaging that are important to recognize in the preoperative work-up to optimize surgical outcomes for anterior instability.

Keywords

shoulder - instability - arthrography - computed tomography - MR imaging

• References

• 1 Blum A, Coudane H, Molé D. Gleno-humeral instabilities. Eur Radiol 2000; 10 (1) 63-82
• 2 Boileau P, Villalba M, Héry JY, Balg F, Ahrens P, Neyton L. Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Joint Surg Am 2006; 88 (8) 1755-1763
• 3 Balg F, Boileau P. The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation. J Bone Joint Surg Br 2007; 89 (11) 1470-1477
• 4 Provencher MT, Ghodadra N, Romeo AA. Arthroscopic management of anterior instability: pearls, pitfalls, and lessons learned. Orthop Clin North Am 2010; 41 (3) 325-337
• 5 Bankart A. The pathology and treatment of recurrent dislocation of the shoulder joint. Br J Surg 1938; 26: 23-29
• 6 Helfet AJ. Coracoid transplantation for recurring dislocation of the shoulder. J Bone Joint Surg Br 1958; 40-B (2) 198-202
• 7 Snyder SJ, Strafford BB. Arthroscopic management of instability of the shoulder. Orthopedics 1993; 16 (9) 993-1002
• 8 Purchase RJ, Wolf EM, Hobgood ER, Pollock ME, Smalley CC. Hill-Sachs “remplissage”: an arthroscopic solution for the engaging Hill-Sachs lesion. Arthroscopy 2008; 24 (6) 723-726
• 9 Cerciello S, Edwards TB, Walch G. Chronic anterior glenohumeral instability in soccer players: results for a series of 28 shoulders treated with the Latarjet procedure. J Orthop Traumatol 2012; 13 (4) 197-202
• 10 Voos JE, Livermore RW, Feeley BT , et al; HSS Sports Medicine Service. Prospective evaluation of arthroscopic Bankart repairs for anterior instability. Am J Sports Med 2010; 38 (2) 302-307
• 11 Bessiere C, Trojani C, Pélégri C, Carles M, Boileau P. Coracoid bone block versus arthroscopic Bankart repair: a comparative paired study with 5-year follow-up. Orthop Traumatol Surg Res 2013; 99 (2) 123-130
• 12 Hobby J, Griffin D, Dunbar M, Boileau P. Is arthroscopic surgery for stabilisation of chronic shoulder instability as effective as open surgery? A systematic review and meta-analysis of 62 studies including 3044 arthroscopic operations. J Bone Joint Surg Br 2007; 89 (9) 1188-1196
• 13 Bencardino JT, Gyftopoulos S, Palmer WE. Imaging in anterior glenohumeral instability. Radiology 2013; 269 (2) 323-337
• 14 Waldt S, Burkart A, Imhoff AB, Bruegel M, Rummeny EJ, Woertler K. Anterior shoulder instability: accuracy of MR arthrography in the classification of anteroinferior labroligamentous injuries. Radiology 2005; 237 (2) 578-583
• 15 O'Brien J, Grebenyuk J, Leith J, Forster BB. Frequency of glenoid chondral lesions on MR arthrography in patients with anterior shoulder instability. Eur J Radiol 2012; 81 (11) 3461-3465
• 16 Tian CY, Cui GQ, Zheng ZZ, Ren AH. The added value of ABER position for the detection and classification of anteroinferior labroligamentous lesions in MR arthrography of the shoulder. Eur J Radiol 2013; 82 (4) 651-657
• 17 Lecouvet FE, Dorzée B, Dubuc JE, Vande Berg BC, Jamart J, Malghem J. Cartilage lesions of the glenohumeral joint: diagnostic effectiveness of multidetector spiral CT arthrography and comparison with arthroscopy. Eur Radiol 2007; 17 (7) 1763-1771
• 18 Lecouvet FE, Simoni P, Koutaïssoff S, Vande Berg BC, Malghem J, Dubuc JE. Multidetector spiral CT arthrography of the shoulder. Clinical applications and limits, with MR arthrography and arthroscopic correlations. Eur J Radiol 2008; 68 (1) 120-136
• 19 Omoumi P, Bafort AC, Dubuc JE, Malghem J, Vande Berg BC, Lecouvet FE. Evaluation of rotator cuff tendon tears: comparison of multidetector CT arthrography and 1.5-T MR arthrography. Radiology 2012; 264 (3) 812-822
• 20 Acid S, Le Corroller T, Aswad R, Pauly V, Champsaur P. Preoperative imaging of anterior shoulder instability: diagnostic effectiveness of MDCT arthrography and comparison with MR arthrography and arthroscopy. AJR Am J Roentgenol 2012; 198 (3) 661-667
• 21 Burkhart SS, De Beer JF. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy 2000; 16 (7) 677-694
• 22 Tauber M, Resch H, Forstner R, Raffl M, Schauer J. Reasons for failure after surgical repair of anterior shoulder instability. J Shoulder Elbow Surg 2004; 13 (3) 279-285
• 23 Lo IK, Parten PM, Burkhart SS. The inverted pear glenoid: an indicator of significant glenoid bone loss. Arthroscopy 2004; 20 (2) 169-174
• 24 Mologne TS, Provencher MT, Menzel KA, Vachon TA, Dewing CB. Arthroscopic stabilization in patients with an inverted pear glenoid: results in patients with bone loss of the anterior glenoid. Am J Sports Med 2007; 35 (8) 1276-1283
• 25 Griffith JF, Yung PS, Antonio GE, Tsang PH, Ahuja AT, Chan KM. CT compared with arthroscopy in quantifying glenoid bone loss. AJR Am J Roentgenol 2007; 189 (6) 1490-1493
• 26 Bois AJ, Fening SD, Polster J, Jones MH, Miniaci A. Quantifying glenoid bone loss in anterior shoulder instability: reliability and accuracy of 2-dimensional and 3-dimensional computed tomography measurement techniques. Am J Sports Med 2012; 40 (11) 2569-2577
• 27 Rerko MA, Pan X, Donaldson C, Jones GL, Bishop JY. Comparison of various imaging techniques to quantify glenoid bone loss in shoulder instability. J Shoulder Elbow Surg 2013; 22 (4) 528-534
• 28 Saito H, Itoi E, Sugaya H, Minagawa H, Yamamoto N, Tuoheti Y. Location of the glenoid defect in shoulders with recurrent anterior dislocation. Am J Sports Med 2005; 33 (6) 889-893
• 29 Huysmans PE, Haen PS, Kidd M, Dhert WJ, Willems JW. The shape of the inferior part of the glenoid: a cadaveric study. J Shoulder Elbow Surg 2006; 15 (6) 759-763
• 30 Yamamoto N, Itoi E, Abe H , et al. Contact between the glenoid and the humeral head in abduction, external rotation, and horizontal extension: a new concept of glenoid track. J Shoulder Elbow Surg 2007; 16 (5) 649-656
• 31 Saito H, Itoi E, Minagawa H, Yamamoto N, Tuoheti Y, Seki N. Location of the Hill-Sachs lesion in shoulders with recurrent anterior dislocation. Arch Orthop Trauma Surg 2009; 129 (10) 1327-1334
• 32 Gyftopoulos S, Yemin A, Beltran L, Babb J, Bencardino J. Engaging Hill-Sachs lesion: is there an association between this lesion and findings on MRI?. AJR Am J Roentgenol 2013; 201 (4) W633-8
• 33 Levine WN, Flatow EL. The pathophysiology of shoulder instability. Am J Sports Med 2000; 28 (6) 910-917
• 34 Baran S, Krych AJ, Dahm DL. Arthroscopic repair of the floating posterior-inferior glenohumeral ligament lesion. Arthrosc Tech 2013; 2 (3) e209-e212
• 35 Ogawa K, Yoshida A, Matsumoto H, Takeda T. Outcome of the open Bankart procedure for shoulder instability and development of osteoarthritis: a 5- to 20-year follow-up study. Am J Sports Med 2010; 38 (8) 1549-1557