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Arthroscopic bare spot method underestimates true bone defect in bony Bankart lesion

Julius Kho, Erica Kholinne, Sungjoon Lim, Hanpyo Hong, Jae-Man Kwak, Yucheng Sun, Kyoung-Hwan Koh, In-Ho Jeon
Archives of Orthopaedic and Trauma Surgery 2019 May 20

INTRODUCTION: The need for precise quantification of the glenoid defect should be emphasized in the choice of surgery for bony Bankart lesion especially in its critical values of 16% to 25. The study aims to verify the validity of bare spot method for arthroscopic quantification of glenoid bone defect using several varieties of posterior portal location.

MATERIALS AND METHODS: Two intact cadaveric glenoids were prepared for the study. The greatest anteroposterior diameter of the perfect circle concept of the glenoid is identified and center of the circle is marked as glenoid bare spot with metal marker. Sixteen percent and 25% defect were sequentially created using a saw at 0° axis parallel to the longitudinal axis of the glenoid. These were confirmed by 3D CT glenoid scan based on glenoid rim distances. Each glenoids were mounted on Sawbone dome holder model simulating neutral version. Quantification of Glenoid bone defects were sequentially measured by glenoid bare spot method arthroscopically by 5 shoulder arthroscopy trained surgeons in 5 varieties of posterior portals in 5 cycles. Paired sample t test was done for arthroscopic over CT scan method of glenoid bone loss quantification. One way ANOVA for portal location analysis was done.

RESULTS: Glenoid bare spot method significantly underestimates 16% and 25% glenoid bone defect to 9% ± 2 (P < 0.001) and 18% ± 2 (P < 0.001), respectively, compared to 3D CT scan method. There was good intra-class correlation coefficient of 0.97 for inter-rater reliability. There was no significant difference in quantification in between five portal sites by one-way ANOVA (P > 0.05).

CONCLUSIONS: Arthroscopic glenoid bare spot method using the anterior viewing portal significantly underestimates glenoid bone loss in critical margin degrees of decision making in shoulder instability surgery. Minimal variation of posterior portal location for the calibrated probe does not cause significant difference in Glenoid bone loss quantification.


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