Validating the Glenoid Track Concept Using Dynamic Arthroscopic Assessment

Mustafa S Rashid; Saho Tsuchiya; Kristie D More; Justin LeBlanc; Aaron J Bois; Cory A Kwong; Ian K Y Lo

doi:10.1177/23259671241226943

Validating the Glenoid Track Concept Using Dynamic Arthroscopic Assessment

Orthop J Sports Med. 2024 Feb 21;12(2):23259671241226943. doi: 10.1177/23259671241226943. eCollection 2024 Feb.

Authors

Mustafa S Rashid¹, Saho Tsuchiya¹, Kristie D More², Justin LeBlanc¹, Aaron J Bois¹, Cory A Kwong¹, Ian K Y Lo¹

Affiliations

¹ Department of Surgery, Section of Orthopedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada.
² University of Calgary Sport Medicine Centre, Calgary, Alberta, Canada.

Abstract

Background: Failure after isolated Bankart repair has led surgeons to consider when to address the Hill-Sachs lesion, which is thought to be a contributor to recurrent instability. One approach utilizes the glenoid track concept to determine whether a Hill-Sachs lesion is classified as "off-track," suggesting that the addition of a remplissage procedure may aid stability. However, the accuracy and reliability of using this approach require validation using an appropriate reference.

Purpose: To determine the accuracy and reliability of using the glenoid track concept against dynamic arthroscopic assessment of Hill-Sachs lesion engagement.

Study design: Cohort study (diagnosis); Level of evidence, 3.

Methods: A total of 49 patients undergoing arthroscopic Bankart repair surgery for recurrent traumatic anterior shoulder instability were enrolled in this diagnostic validation study. Shoulders were classified as on-track or off-track using 3-dimensional computed tomography (3DCT) and static arthroscopic measurements. These classifications were compared with dynamic arthroscopic assessment (engagement of the Hill-Sachs lesion on the anterior glenoid rim in the 'athletic position') to determine their accuracy and reliability.

Results: The 3DCT-based measurements to determine glenoid track status had a higher positive predictive value (66% vs 42%), higher specificity (47% vs 42%), and higher accuracy (65% vs 59%) compared with static arthroscopic measurements. Static arthroscopic measurements to determine glenoid track status had a higher negative predictive value (96% vs 64%) and higher sensitivity (96% vs 81%) compared with 3DCT-based measurements. Interrater reliability (Krippendorff α) was 'fair' for determining the glenoid track status using 3DCT (0.368; 95% CI, 0.217-0.519) and 'moderate' for static arthroscopic measurements (0.523; 95% CI, 0.364-0.666). Intrarater reliability (intraclass correlation coefficient [ICC] 3,k) was 'moderate' for 3DCT measurements (0.660; 95% CI, 0.444-0.798) and 'good' for static arthroscopic measurements (0.769; 95% CI, 0.629-0.862).

Conclusion: Determining glenoid track status using either 3DCT or static arthroscopic measurements yielded moderate accuracy and reliability. Surgeons using the glenoid track concept to aid surgical decision-making in traumatic recurrent anterior shoulder instability should utilize 3DCT or static arthroscopic measurements with caution.

Keywords: dislocation; glenoid track; instability; recurrence; shoulder.