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When measuring distances in areas with physical obstructions, such as a lake in a field, surveyors must employ techniques to calculate accurate lengths without direct line measurements. One effective method is the offset technique, which allows for precise distance estimation over inaccessible stretches.In this scenario, a surveyor must measure a side of an area that crosses a lake. Since the measuring tape cannot span the lake, the surveyor begins by establishing a baseline that aligns with...
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How to Measure Glenoid Track and Hill-Sachs Interval and Distance to Dislocation.

Jillian L Mazzocca1, Madeline M McGovern1, Sercan Yalcin1

  • 1Mass General Brigham, Department of Orthopaedics, Harvard Medical School, Boston, Massachusetts, USA.

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The glenoid track (GT) method accurately assesses anterior shoulder instability using MRI, identifying off-track Hill-Sachs lesions (HSLs) to predict recurrence risk. This technique aids in surgical planning for better patient outcomes.

Keywords:
distance-to-dislocationglenoid trackhill-sachs intervalinstabilityshoulder

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Area of Science:

  • Orthopedic Surgery
  • Radiology
  • Sports Medicine

Background:

  • Anterior shoulder instability frequently involves glenoid and humeral head bone lesions.
  • The glenoid track (GT) method is a validated tool for assessing instability risk due to bone loss.
  • While CT is standard, MRI offers a lower-radiation alternative for evaluating GT and bipolar bone loss.

Purpose of the Study:

  • To illustrate the calculation of the glenoid track (GT), Hill-Sachs interval (HSI), and distance to dislocation (DTD) using MRI.
  • To demonstrate the utility of MRI in conjunction with the GT method for preoperative evaluation of anterior shoulder instability with bipolar bone loss.
  • To highlight the significance of identifying off-track Hill-Sachs lesions (HSLs) preoperatively.

Main Methods:

  • The GT method defines the humeral head contact area on the glenoid during abduction and external rotation.
  • Calculations involve the glenoid diameter (D) and defect diameter (d) for GT: GT = (0.83 * D) - d.
  • HSI is measured from the medial edge of the HSL to the rotator cuff insertion; DTD = HSI - GT.

Main Results:

  • MRI with the GT method demonstrated 84.2% accuracy in evaluating patients with anterior shoulder instability and bipolar bone loss.
  • Statistical analysis confirmed the GT method's significance as a predictor of instability.
  • An 'off-track' HSL, where the lesion is more medial than the GT, indicates a higher risk of recurrence.

Conclusions:

  • The GT technique is crucial for treatment planning in anterior shoulder instability.
  • Glenoid bone loss and off-track HSLs are predictors of recurrent instability, even after prior surgery.
  • For off-track lesions, procedures like remplissage or bone grafting are recommended to improve stability.