Download PDFOpen PDF in browserAnterior shoulder stability restoration: quantifying the surgery type decision variability4 pages•Published: December 17, 2024AbstractMethodsWe retrospectively collected 51 shoulder CT scans from 44 patients. Two senior and one junior orthopaedic shoulder surgeons created manual annotations of the glenoid best-fit circle and the maximum distance between the best-fit circle and the glenoid contour. Computed GBL annotations and measurements were obtained with our method. The GBL % ratio was computed from the resulting measurements. The inter-observer variability on the surgical decision of Bankart vs. Latrajet with the 13.5% % ratio cut-off threshold was determined as follows. Each surgeon chose for each scan the required surgery based on their manual annotations. The agreement/disagreement between the surgeons and the effect of replacing the threshold with an interval was then derived. The effect of the selection of the best-fit circle and of the largest radial distance between the glenoid contour and the best-fit circle was determined by presenting four options to the surgeons: the manual annotations of each surgeon and the computed annotation with their respective GBL deficiency %. Each surgeon then chose one of the annotations. Results In the 20 cases in which the GBL % ratio was < 5% or > 25%, all three surgeons agreed on the surgical procedure. For the remaining 31 cases, they disagreeded in 13 cases (42%). When the GBL cut-off of 13.5% was replaced by the interval 12.0-16.5%, the disagreement disappeared. In only ~30% of the cases, the surgeons chose their own annotation. The computed annotations were selected by all at least as often as those of the junior surgeon. Conclusion The established GBL % ratio cut-off of 13.5% may lead to significant discrepancies between surgeons regarding the type of surgery to be performed. Replacing it by the interval 12.0-16.5% may improve decision making by helping identify borderline cases for which there is no consensus. The computed GBL % ratio is within the observer variability and may thus be reliably used to save time and increase decision consistency. Keyphrases: anterior shoulder surgery, automatic glenoid bone loss computation, surgical decision support In: Joshua W Giles and Aziliz Guezou-Philippe (editors). Proceedings of The 24th Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery, vol 7, pages 98-101.
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