Original Article|Articles in Press

Area Measurement Percentile of 3-Dimensional Computed Tomography Has the Highest Interobserver Reliability When Measuring Anterior Glenoid Bone Loss

Published:January 13, 2023DOI:


      To determine the accuracy of glenoid bone loss measurement and the difference between 3 methods of measurement, as well as the measurements application to previously published studies.


      A list of patients with anterior bony glenoid defects was created through a search of electronic medical records. Three surgeons reviewed each patient’s advanced imaging (computed tomography [CT], 3-dimensional [3D] CT, or magnetic resonance imaging), and glenoid bone loss was measured by 3 different methods: (1) linear measurement percentile (LMP), (2) area measurement percentile (AMP), and (3) circle-line method (CLM). The intraclass correlation coefficients between reviewers and mathematical differences between measurement techniques were calculated.


      The images of 125 patients with anterior glenoid bone loss were measured. For all imaging studies, the intraclass correlation coefficient was greatest with the AMP (0.738) and CT with 3D reconstruction (0.735). Within the entire sample, average bone loss measured 21.3% (range, 5.6%-43.5%) by the LMP method, 15.7% (range, 1.6%-42.2%) by the CLM, and 16.5% (range, 2.3%-40.3%) by the AMP method. On average, the difference between the LMP and AMP methods was 4.8%. When the AMP and LMP methods were compared, the greatest difference in measurement was 5.9%, and this occurred at an LMP of 19.1%, which was an AMP of 13.2%.


      When measuring anterior glenoid bone loss, CT with 3D reconstruction and the AMP method have the greatest interobserver reliability. Furthermore, the greatest difference between the LMP and AMP methods occurs at an LMP between 18.3% and 20.0% and an AMP between 12.4% and 14.2%, with the difference ranging from 5.7% to 5.9%.

      Clinical Relevance

      When measuring anterior glenoid bone loss, evaluation of CT with 3D reconstruction is more reliable than magnetic resonance imaging evaluation. Furthermore, the AMP method has the greatest interobserver reliability when compared with the LMP method and CLM.
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        • Wheeler J.H.
        • Ryan J.B.
        • Arciero R.A.
        • Molinari R.N.
        Arthroscopic versus nonoperative treatment of acute shoulder dislocations in young athletes.
        Arthroscopy. 1989; 5: 213-217
        • Murphy A.I.
        • Hurley E.T.
        • Hurley D.J.
        • Pauzenberger L.
        • Mullett H.
        Long-term outcomes of the arthroscopic Bankart repair: A systematic review of studies at 10-year follow-up.
        J Shoulder Elbow Surg. 2019; 28: 2084-2089
        • Bigliani L.U.
        • Newton P.M.
        • Steinmann S.P.
        • Connor P.M.
        • McLlveen S.J.
        Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder.
        Am J Sports Med. 1998; 26: 41-45
        • Boileau P.
        • Villalba M.
        • Hery J.Y.
        • Balg F.
        • Ahrens P.
        • Neyton L.
        Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair.
        J Bone Joint Surg Am. 2006; 88: 1755-1763
        • Burkhart S.S.
        • De Beer J.F.
        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: 677-694
        • Itoi E.
        • Lee S.B.
        • Berglund L.J.
        • Berge L.L.
        • An K.N.
        The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: A cadaveric study.
        J Bone Joint Surg Am. 2000; 82: 35-46
        • Lo I.K.
        • Parten P.M.
        • Burkhart S.S.
        The inverted pear glenoid: An indicator of significant glenoid bone loss.
        Arthroscopy. 2004; 20: 169-174
        • Shin S.J.
        • Kim R.G.
        • Jeon Y.S.
        • Kwon T.H.
        Critical value of anterior glenoid bone loss that leads to recurrent glenohumeral instability after arthroscopic Bankart repair.
        Am J Sports Med. 2017; 45: 1975-1981
        • Dekker T.J.
        • Peebles L.A.
        • Bernhardson A.S.
        • et al.
        Risk factors for recurrence after arthroscopic instability repair—The importance of glenoid bone loss >15%, patient age, and duration of symptoms: A matched cohort analysis.
        Am J Sports Med. 2020; 48: 3036-3041
        • Gerber C.
        • Nyffeler R.W.
        Classification of glenohumeral joint instability.
        Clin Orthop Relat Res. 2002; : 65-76
        • Dekker T.J.
        • Goldenberg B.
        • Lacheta L.
        • Horan M.P.
        • Millett P.J.
        Anterior shoulder instability in the professional athlete: Return to competition, time to return, and career length.
        Orthop J Sports Med. 2020; 8 (2325967120959728)
        • Parada S.A.
        • Eichinger J.K.
        • Dumont G.D.
        • et al.
        Accuracy and reliability of a simple calculation for measuring glenoid bone loss on 3-dimensional computed tomography scans.
        Arthroscopy. 2018; 34: 84-92
        • Bland J.M.
        • Altman D.G.
        Statistical methods for assessing agreement between two methods of clinical measurement.
        Lancet. 1986; 1: 307-310
        • Shrout P.E.
        • Fleiss J.L.
        Intraclass correlations: Uses in assessing rater reliability.
        Psychol Bull. 1979; 86: 420-428
        • Iannotti J.P.
        • Gabriel J.P.
        • Schneck S.L.
        • Evans B.G.
        • Misra S.
        The normal glenohumeral relationships. An anatomical study of one hundred and forty shoulders.
        J Bone Joint Surg Am. 1992; 74: 491-500
        • Chuang T.Y.
        • Adams C.R.
        • Burkhart S.S.
        Use of preoperative three-dimensional computed tomography to quantify glenoid bone loss in shoulder instability.
        Arthroscopy. 2008; 24: 376-382
        • Miyatake K.
        • Takeda Y.
        • Fujii K.
        • Takasago T.
        • Iwame T.
        Validity of arthroscopic measurement of glenoid bone loss using the bare spot.
        Open Access J Sports Med. 2014; 5: 37-42
        • Shaha J.S.
        • Cook J.B.
        • Song D.J.
        • et al.
        Redefining "critical" bone loss in shoulder instability: Functional outcomes worsen with "subcritical" bone loss.
        Am J Sports Med. 2015; 43: 1719-1725
        • Bois A.J.
        • Fening S.D.
        • Polster J.
        • Jones M.H.
        • 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: 2569-2577
        • Chalmers P.N.
        • Christensen G.
        • O'Neill D.
        • Tashjian R.Z.
        Does bone loss imaging modality, measurement methodology, and interobserver reliability alter treatment in glenohumeral instability?.
        Arthroscopy. 2020; 36: 12-19
        • Rerko M.A.
        • Pan X.
        • Donaldson C.
        • Jones G.L.
        • Bishop J.Y.
        Comparison of various imaging techniques to quantify glenoid bone loss in shoulder instability.
        J Shoulder Elbow Surg. 2013; 22: 528-534
        • Bhatia S.
        • Saigal A.
        • Frank R.M.
        • et al.
        Glenoid diameter is an inaccurate method for percent glenoid bone loss quantification: Analysis and techniques for improved accuracy.
        Arthroscopy. 2015; 31: 608-614.e1