title: Radiographic sclerotic contour loss in the identification of glenoid bone loss.
abstract: OBJECTIVE
  Quantification of glenoid bone loss guides surgical management in the setting of anterior shoulder instability. Glenoid defects resulting in ≥20 % articular area loss require bony reconstruction. The objective of this study was to evaluate the utility of sclerotic glenoid contour loss on true anteroposterior radiography in the detection of varying quantities of simulated glenoid bone loss using a cadaveric model.
  
  
  METHODS
  Eight cadaveric scapulae with full radiographic sclerotic contour were osteotomized to produce glenoid surface area reductions of 10-50 %. Radiography was performed initially and following each osteotomy, and assessed by an orthopedic surgeon and radiologist twice. Quantity of glenoid loss was compared using Fisher's exact test. Sensitivity, specificity, and reliability analyses were performed.
  
  
  RESULTS
  On the first radiographic review, sclerotic contour loss was detected in 6 out of 8 scapulae with 50 % area loss, but only 1 out of 8 scapulae with 20 % area loss. There was a significantly higher proportion of radiographs containing sclerotic contour loss for defects with 50 % area loss compared to those with 0-25 % loss (p ≤ 0.02). In the detection of ≥20 % area loss, sclerotic contour loss had a sensitivity of 33-43 % and specificity of 88-100 %. Moderate inter-observer reliability (Cohen's kappa value of 0.42-0.53) and intra-observer reliability (kappa value of 0.46-0.58) were found.
  
  
  CONCLUSIONS
  Radiographic sclerotic contour loss is commonly observed in radiographs of scapulae with 40-50 % glenoid area loss and less often with smaller lesions. However, this finding lacks utility in discerning specific quantifications of glenoid bone loss. In a clinical setting, sclerotic contour loss suggests the presence of a large glenoid defect that may require bony reconstruction. However, an intact sclerotic contour does not rule out significant bone loss.
authors.affiliation: Division of Orthopaedic Surgery, University of Alberta, 6-110B Clinical Sciences Building, 8440-112 Street NW, Edmonton, AB, T6G-2B7, Canada.
authors.forename: Troy D
authors.initials: TD
authors.lastname: Bornes
authors.affiliation: Department of Radiology and Diagnostic Imaging, University of Alberta, 2A2.41 Walter Mackenzie Centre, 8440-112 Street NW, Edmonton, AB, T6G-2B7, Canada.
authors.forename: Jacob L
authors.initials: JL
authors.lastname: Jaremko
authors.affiliation: Division of Orthopaedic Surgery, University of Alberta, 6-110B Clinical Sciences Building, 8440-112 Street NW, Edmonton, AB, T6G-2B7, Canada.|Department of Physical Therapy, University of Alberta, 3-48 Corbett Hall, 8205-114 Street NW, Edmonton, AB, T6G-2G4, Canada.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Beaupre
authors.affiliation: Division of Orthopaedic Surgery, University of Alberta, 6-110B Clinical Sciences Building, 8440-112 Street NW, Edmonton, AB, T6G-2B7, Canada. bouliane@me.com.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Bouliane
mesh_terms: D000369:Aged, 80 and over; D001862:Bone Resorption / Q000000981:diagnostic imaging*; D002102:Cadaver; D061165:Glenoid Cavity / Q000000981:diagnostic imaging*; D006801:Humans; D007593:Joint Instability / Q000150:complications; D008875:Middle Aged; D015203:Reproducibility of Results; D012783:Shoulder Dislocation / Q000150:complications
keywords: Glenohumeral instability; Glenoid bone loss; Radiography; Sclerotic contour loss