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Insufficient consensus regarding circle size and bone loss width using the ratio-"best fit circle"-method even with
Lucca Lacheta1,2, Elmar Herbst3, Andreas Voss1,4
1Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
Summary
The "best fit circle" method for quantifying glenoid bone loss using computed tomography (CT) shows variability and is not reliable for surgical decisions. Three-dimensional (3D) CT offers better agreement than two-dimensional (2D) CT but still presents measurement inconsistencies.
Area of Science:
- Orthopedic surgery
- Radiology
- Biomedical imaging
Background:
- Glenoid bone integrity is essential for shoulder stability.
- Accurate quantification of glenoid bone loss is critical for surgical planning in shoulder instability.
Purpose of the Study:
- To evaluate the reliability and accuracy of a non-invasive method for quantifying glenoid bone loss using 2D and 3D computed tomography (CT).
- To assess inter- and intra-rater variability in measuring glenoid bone defects with the 'best fit circle' ratio method.
Main Methods:
- Fifty-two shoulder CT scans (26 2D, 26 3D) from patients with anterior glenoid bone defects were analyzed by six raters at two time points (T0 and T1).
- The 'best fit circle' ratio method was used to measure circle diameter, bone loss width, and percentage of bone loss.
- Inter- and intra-rater agreement was assessed using the intraclass correlation coefficient (ICC).
Main Results:
- Both 2D and 3D CT measurements showed statistically significant differences (p < 0.01) in circle diameter, bone loss width, and percentage.
- 3D CT demonstrated significantly smaller measurements compared to 2D CT at both time points.
- Inter- and intra-rater agreement (ICC) ranged from fair to good (0.76–0.91), with superior agreement observed in 3D CT.
Conclusions:
- The 'best fit circle' ratio method is not a valid or consistent tool for quantifying glenoid bone defects, even with 3D CT.
- Measurement variability necessitates careful consideration of the 'best fitting circle' application and potential errors.
- Glenoid bone loss alone should not dictate surgical treatment; patient-specific factors and critical defect size are paramount for optimal treatment decisions.