Accuracy and Reliability of Imaging Modalities for the Diagnosis and Quantification of Hill-Sachs Lesions: A Systematic Review Liam A. Peebles, BA1; Matthew L. Vopat, MD2; Isaak Cirone, BS4; Trevor McBride, BA5; Danielle Rider, BA6; Matthew T. Provencher, MD1,2, CAPT, MC, USNR1Steadman Philippon Research Institute, Vail, CO; 2The Steadman Clinic, Vail, CO; 3University of Kansas School of Medicine—Wichita, Wichita, KS; 4Colorado State University, Fort Collins, CO; 5Sidney Kimmel Medical College, Philadelphia, PA; 6Wake Forest School of Medicine, Winston-Salem, NC

Disclosure Information

CAPT (RET) Matthew T. Provencher, MD MC USNR ahs the following disclosures:

AAOS: Board or committee member

American Orthopaedic Society for Sports Medicine: Board or committee member

American Shoulder and Elbow Surgeons: Board or committee member

Arthrex, Inc: IP royalties; Paid consultant; paid presenter or speaker

Arthroscopy: Editorial or governing board

Arthroscopy Association of North America: Board or Committee Member

Internal Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine: Board or committee member Joint Restoration Foundation (Allosource): Paid consultant

Knee: Editorial or governing board

Orthopaedics: Editorial or governing board

San Diego Shoulder Institute: Board or committee member

SLACK Incorporated: Editorial or governing board; Publishing royalties, financial or material support Society of Military Orthopaedic Surgeons: Board or committee member

The other authors have no actual or potential conflict of interest in relation to this presentation.

Purpose To perform a systematic review evaluating the

accuracy and reliability of various imaging modalities utilized to assess for presence and quantification of Hill-Sachs lesions in patients with anterior shoulder instability

Methods

A systematic review was performed according to the PRISMA guidelines using PubMed, Scopus, Embase, and Cochrane library databases.

Inclusion criteria were clinical trials or cadaver studies that assessed for the accuracy of humeral head bone loss imaging or reliability, and English language.

Exclusion criteria were animal studies, imaging studies without measures of accuracy, reliability, or clinical predictive power, shoulder injuries without humeral head bone loss, editorial articles, abstracts, reviews, case reports, and surveys.

The search terms included “Imaging” OR “Radiographic” OR “CT” OR “MRI” AND “Hill-Sachs” OR “Humeral Head Bone Loss.”

The methodological quality assessment of the included studies was performed by using the original Quality Assessment of Diagnostic Accuracy Studies (QUADAS 1) tool.

Figure 1: Flow chart of the literature search following PRIMSA guidelines

Results• 40 studies (2,560

shoulders) met inclusion criteria and were assessed (Figure 1) .

• Summary of the studies in the quantitative analysis (Table 1).

Results

Table 1: Study Summary of Data Included in Analysis. HSL, Hill-Sachs Lesion; SPE, Specificity; SEN, Sensitivity; ACC, Accuracy; PPV, Positive Predictive Value; NPV, Negative Predictive Value; INTRA, Intraobserver Reliability; INTER, Interobserver Reliability

Results For diagnosing the presence of Hill-Sach Lesions, computed

tomography arthrogram (CTA) was found to have the highest reported accuracy (median = 91%, range = 66-100%) (Table 2).

For the same assessment, CTA was also found to have the greatest reported sensitivity (median = 94%, range = 50-100%)

Results

Table 2: Detecting Presence of Hill-Sachs Lesions with Various Imaging Modalities. PPV, Positive Predictive Value; NPV, Negative Predictive Value

Results

For the quantification of Hill-Sachs lesionparameters, reported intraobserver reliabilities werehighest for 3-dimensional computed tomography (3D CT) (ICC range = 0.916-0.999) followed by 2-dimensional computed tomography (2D-CT) (ICC range = 0.858-0.861), and magnetic resonance imaging (MRI) (ICC range = 0.28-0.97) (Table 3).

For the same quantification parameters,interobserver reliabilities were also reported for 3D CT (ICC range = 0.772-0.996), 2D CT (ICC range = 0.721-0.879), MRI (Kappa range = 0.444-0.700).

Results

Table 3: Quantifying Hill-Sachs Lesion Size with Various Imaging Modalities. PPV, Positive Predictive Value; NPV, Negative Predictive Value.

Results Intraobserver reliabilities for determining glenoid

tracking were only reported for 3D CT (Kappa Range = 0.730-1.00; ICC range = 0.803-0.901) and MRI (ICC range = 0.770-0.790) (Table 4)

ResultsTable 4: Determining if a Hill-Sachs Lesion is On- or Off- Track with Various Imaging Modalities. PPV, Positive Predictive Value; NPV, Negative Predictive Value

Conclusion

This study demonstrates that the current literature supports verity of different imaging modalities that provides clinically acceptable accuracy in diagnosing, quantifying, and determining if a Hill-Sachs Lesions will cause persistent anterior shoulder instability.

Furthermore, this systematic review justifies that further research is needed to help develop a treatment algorithm in the proper imaging modalities needed to help treat patients suffering from anterior shoulder instability that is both reliable and financially acceptable.

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