Magnetic resonance imaging predictors of shoulder instability in adolescents

• Published in: Pediatric radiology Vol. 49; no. 3; pp. 365 - 371
• Main Authors: Hughes, Jessica L., Kruk, Peter, Bastrom, Tracey P., Edmonds, Eric W.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.03.2019; Springer Nature B.V
• Subjects: Adolescent; Adolescents; Arthroscopy; Athletes; Bone lesions; Bone loss; Computed tomography; Contrast Media; Female; Humans; Humerus; Imaging; Joint Capsule - diagnostic imaging; Joint Capsule - physiopathology; Joint Capsule - surgery; Joint Instability - diagnostic imaging; Joint Instability - physiopathology; Joint Instability - surgery; Lesions; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical imaging; Medical personnel; Medicine; Medicine & Public Health; Neuroradiology; NMR; Nuclear magnetic resonance; Nuclear Medicine; Oncology; Original Article; Patients; Pediatrics; Radiology; Recurrence; Retrospective Studies; Risk analysis; Risk Factors; Shoulder; Shoulder Joint - diagnostic imaging; Shoulder Joint - physiopathology; Shoulder Joint - surgery; Stability; Statistical analysis; Surgical instruments; Teenagers; Treatment Failure; Treatment Outcome; Triiodobenzoic Acids; Ultrasound; Recurrence; Instability; Magnetic resonance imaging; Adolescents; Shoulder; Capsulorrhaphy
• DOI: 10.1007/s00247-018-4318-2
• ISSN: 0301-0449

Background Managing recurrent shoulder instability in an athlete of any age is challenging. The pediatric literature regarding recurrence of instability is difficult to interpret because of the variable treatment protocols and varying ages. The adult literature suggests that bone loss on the humerus, glenoid or both, as detected by CT, has high rates of recurrence following surgical intervention. Objective The purpose of this study was to evaluate risk factors for recurrence following arthroscopic capsulorrhaphy in adolescent athletes using preoperative MR arthrograms. Materials and methods We reviewed a retrospective shoulder instability database for adolescents (age ≤18 years), who underwent an isolated arthroscopic capsulorrhaphy from 2006 to 2011. We recorded preoperative MRI measurements regarding the dimensions of the glenohumeral joint, as well as glenoid, humeral and labral pathologies. We performed statistical analysis to determine MRI findings that might have predicted recurrence of shoulder instability following capsulorrhaphy. Results We reviewed a total of 50 patients (13–18 years) and found 22 patients (44%) to have recurrent instability following capsulorrhaphy. Presence of glenoid bone loss or a bipolar bone lesion (defined as bone loss on both the glenoid and humerus) significantly predicted recurrence of shoulder instability (both P =0.03). There was not a threshold size of glenoid bone loss or bipolar lesion that predicted recurrence. All remaining glenohumeral dimensions or presence or size of an isolated Hill-Sachs did not significantly predict recurrence of instability. Conclusion Athletes ≤18 years old have a high rate of failure following arthroscopic capsulorrhaphy in the presence of glenoid bone loss or a bipolar lesion on MRI. Surgeons should consider addressing these lesions in adolescent athletes with shoulder instability. Additionally, MRI is a valid imaging tool to diagnose and measure osseous lesions of the shoulder.