Area Measurement Percentile of 3-Dimensional Computed Tomography has the Highest Interobserver Reliability when Measuring Anterior Glenoid Bone loss.

Published:January 13, 2023DOI:



      The purpose of this study is to determine the accuracy and difference between 3 methods of measuring glenoid bone loss, and its application to previously published studies.


      A list of patients with anterior bony glenoid defects was created by searching the electronic medical records. Three surgeons reviewed each patient’s advanced imaging (CT, 3D CT, or MRI), and glenoid bone loss was measured using three different methods of measurement: 1) Linear Measurement Percentile (LMP), 2) Area Measurement Percentile (AMP), and 3) Circle-Line Method (CLM). The intraclass correlation coefficients (ICC) between reviewers and mathematical differences between measurement techniques were calculated.


      The images of one-hundred-twenty-five patients with anterior glenoid bone loss were measured. For all imaging studies, the ICC was greatest with the AMP (0.738) and CT with 3D reconstruction (0.735). Of the entire sample, the average bone loss was LMP 21.3% (5.6%-43.5%), CLM 15.7% (1.6%-42.2%), and AMP 16.5% (2.3%-40.3%). On average, the difference between the LMP and AMP was 4.8%. When comparing the AMP and LMP, the greatest difference in measurement was 5.9%, and this occurred at an LMP of 19.1%, which is an AMP of 13.2%.


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


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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
        • LU Bigliani
        • 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.
        • Rosenberg S.I.
        • Murphy C.P.
        • Golijanin P.
        • 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
      1. Dekker TJ, Goldenberg B, Lacheta L, M PH, Millett PJ. Anterior Shoulder Instability in the Professional Athlete: Return to Competition, Time to Return, and Career Length. Orthop J Sports Med 2020;8:2325967120959728. 10.1177/2325967120959728

        • Parada S.A.
        • Eichinger J.K.
        • Dumont G.D.
        • Parada C.A.
        • Greenhouse A.R.
        • Provencher M.T.
        • 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.
        • Rowles D.J.
        • Bottoni C.R.
        • Shaha S.H.
        • 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.
        • Bach Jr., B.R.
        • Cole B.J.
        • Romeo A.A.
        • 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 e601