Semiautomatic measurements to help shoulder surgery planning
Hill-Sachs defects are bony lesions on the posterior aspect of the humeral head that occur due to anterior shoulder dislocations. These defects can engage with the glenoid rim, leading to recurrent instability. The glenoid track concept is commonly used to assess whether a Hill-Sachs defect is at risk of engaging, but its reliability is limited due to variations in individual soft tissue structures. A newly proposed method, the global track concept, aims to improve assessment by measuring the angular distance of the defect from the center of the humeral head. However, accurately obtaining these measurements manually is challenging, leading to inconsistencies in clinical evaluations.
In this project, we partnered up with Dr. Philipp Moroder, Dr. Katrin Karpinski and colleagues to develop a prototype to partially automate these assessments. It significantly improved the reliability of Hill-Sachs defect measurements by automating calculations and reducing variability between raters. While manual methods showed good agreement for bony measurements, they were less reliable for soft tissue-based and reference point-based parameters, such as the Hill-Sachs interval and glenoid track. The automated approach achieved good reliability for the glenoid track concept and excellent reliability for the global track concept, making it a more consistent and clinically viable tool. By enhancing measurement precision, the software has the potential to improve preoperative planning and surgical decision-making for patients with shoulder instability.
Related Publications
2024
Reliability of Manual Measurements Versus Semiautomated Software for Glenoid Bone Loss Quantification in Patients With Anterior Shoulder Instability
Katrin Karpinski, Doruk Akguen, Henry Gebauer, Alp Paksoy, Mattia Lupetti, Viktoria Markova, Oliver Zettinig, and Philipp Moroder
Background: The presence of glenoid bone defects is indicative in the choice of treatment for patients with anterior shoulder instability. In contrast to traditional linear- and area-based measurements, techniques such as the consideration of glenoid concavity have been proposed and validated. Purpose: To compare the reliability of linear (1-dimensional [1D]), area (2-dimensional [2D]), and concavity (3-dimensional [3D]) measurements to quantify glenoid bone loss performed manually and to analyze how automated measurements affect reliability. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Computed tomography images of 100 patients treated for anterior shoulder instability with differently sized glenoid defects were evaluated independently by 2 orthopaedic surgeons manually using conventional software (OsiriX; Pixmeo) as well as automatically with a dedicated prototype software program (ImFusion Suite; ImFusion). Parameters obtained included 1D (defect diameter, best-fit circle diameter), 2D (defect area, best-fit circle area), and 3D (bony shoulder stability ratio) measurements. Mean values and reliability as expressed by the intraclass correlation coefficient [ICC]) were compared between the manual and automated measurements. Results: When manually obtained, the measurements showed almost perfect agreement for 1D parameters (ICC = 0.83), substantial agreement for 2D parameters (ICC = 0.79), and moderate agreement for the 3D parameter (ICC = 0.48). When measurements were aided by automated software, the agreement between raters was almost perfect for all parameters (ICC = 0.90 for 1D, 2D, and 3D). There was a significant difference in mean values between manually versus automatically obtained measurements for 1D, 2D, and 3D parameters ( P \textless .001 for all). Conclusion: While more advanced measurement techniques that take glenoid concavity into account are more accurate in determining the biomechanical relevance of glenoid bone loss, our study showed that the reliability of manually performed, more complex measurements was moderate.
The Global Track Concept for Assessment of Engaging Hill-Sachs Defects in Anterior Shoulder Instability
Philipp Moroder, Doruk Akguen, Alp Paksoy, Henry Gebauer, Nicolas Barthod-Tonnot, Mattia Lupetti, Viktoria Markova, Oliver Zettinig, Stephen Parada, and Katrin Karpinski
Background: The glenoid track concept is used to determine preoperatively whether a Hill-Sachs defect is engaging or not. Currently, the glenoid track concept relies on measurements of bony structures as well as on the confines and elasticity of the rotator cuff as a reference point, which varies extensively among individuals and therefore limits the reliability and accuracy of this concept. Purpose: To evaluate the reliability of the global track concept, which determines the angular distance of the Hill-Sachs defect from the center of the articular surface of the humeral head as a new reference point with the help of an automated image analysis software and 3-dimensional analysis of the humeral head. Study Design: Controlled laboratory study. Methods: Computed tomography scans of 100 patients treated for anterior shoulder instability with different sizes of Hill-Sachs defects were evaluated manually by 2 orthopaedic surgeons independently using the software OsiriX as well as automatically by using a dedicated prototype software (ImFusion). Obtained manual and automated measurements included the Hill-Sachs length, Hill-Sachs width, and Hill-Sachs depth of the defect; the Hill-Sachs interval (HSI); and the glenoid width for the glenoid track concept, as well as the angular distance of the Hill-Sachs defect from the center of the articular surface of the humeral head (global track concept). The reliability of the different measurement techniques was compared by calculating intraclass correlation coefficients (ICCs). Results: There was a significant difference for all obtained parameters comparing manual and automatic measurements. For manually obtained parameters, measurements referring to bony boundaries (glenoid width, Hill-Sachs length, and Hill-Sachs width) showed good to excellent agreement (ICC, 0.86, 0.82, and 0.62, respectively), while measurements referring to soft tissue boundaries (HSI and glenoid track; ICC, 0.56 and 0.53, respectively) or not directly identifiable reference points (center of articular surface and global track) only showed fair reliability (ICC middle excursion, 0.42). When the same parameters were measured with the help of an automated software, good reliability for the glenoid track concept and excellent reliability for the global track concept in the middle excursion were achieved. Conclusion: The present study showed that the more complex global track measurements of humeral defects are more reliable than the current standard HSI and glenoid track measurements. However, this is only true when automated software is used to perform the measurements. Clinical Relevance: Future studies using the new proposed method in combination with an automated software need to be conducted to determine critical threshold values for defects prone to engagement.
