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Anterior Shoulder Instability: Accuracy of MR Arthrography in the Classification of Anteroinferior Labroligamentous Injuries¹

¹ From the Departments of Radiology (S.W., M.B., E.J.R., K.W.) and Sports Orthopedics (A.B., A.B.I.), Technische Universität München, Klinikum rechts der Isar, Ismaninger Str 22, D-81675 Munich, Germany. Received August 18, 2004; revision requested October 28; revision received November 16; accepted December 24. Address correspondence to S.W. (e-mail: waldt{at}roe.med.tu-muenchen.de).

PURPOSE: To retrospectively evaluate the accuracy of magnetic resonance (MR) arthrography in the classification of anteroinferior labroligamentous injuries by using arthroscopy as the reference standard.

MATERIALS AND METHODS: Ethical committee approval and informed consent were obtained. MR arthrograms obtained in 205 patients, including a study group of 104 patients (74 male and 30 female; mean age, 28.2 years) with arthroscopically proved labroligamentous injuries and a control group of 101 patients (65 male and 36 female; mean age, 31.4 years) with intact labroligamentous complex, were reviewed in random order. MR arthrograms were analyzed for the presence and type (Bankart, anterior labral periosteal sleeve avulsion [ALPSA], Perthes, glenolabral articular disruption [GLAD], or nonclassifiable lesion) of labroligamentous injuries by two radiologists in consensus. Results were compared with arthroscopic findings. Sensitivity, specificity, accuracy, and corresponding 95% confidence intervals for the detection and classification of anteroinferior labroligamentous lesions with MR arthrography were calculated.

RESULTS: At arthroscopy, 104 anteroinferior labroligamentous lesions were diagnosed, including 44 Bankart lesions, 22 ALPSA lesions, 12 Perthes lesions, and three GLAD lesions. Twenty-three labral lesions were nonclassifiable at arthroscopy, all of which occurred after a history of chronic instability. Nineteen (83%) of these 23 lesions were also nonclassifiable at MR arthrography. With arthroscopy used as the reference standard, labroligamentous lesions were detected and correctly classified at MR arthrography with sensitivities of 88% and 77%, specificities of 91% and 91%, and accuracies of 89% and 84%, respectively. Bankart, ALPSA, and Perthes lesions were correctly classified in 80%, 77%, and 50% of cases, respectively. The three GLAD lesions were all correctly assessed.

CONCLUSION: MR arthrography is accurate in enabling classification of acute and chronic anteroinferior labroligamentous injuries, although correct interpretation of Perthes lesions remains difficult.

© RSNA, 2005

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