Classifications of Osteoarthritis of the shoulder

13.1 Grading of chondromalacia according to Outerbridge [106]

Outerbridge described in 1961 the macroscopic aspect of changes of the articular cartilage for the articular surface of the patella. Meanwhile this classification is generally used for the description of articular cartilage lesions.

The macroscopic changes of chondromalacia can be classified into four grades:

■ In grade 1 there are softening and swelling of the cartilage.

■ In grade 2 there are fragmentation and fissuring in an area half an inch or less in diameter.

■ Grade 3 is the same as grade 2 but an area more than half an inch in diameter is involved.

■ In grade 4 there is erosion of cartilage down to bone.

13.2 Classification of glenoid morphology in primary glenohumeral osteoarthritis according to Walch et al. [134]*

The authors classified the glenoid morphology into three types base on the CT scan findings out of 113 patients (Fig. 53). Intraobserver reproducibility and interobserver reliability were good with a kappa index that ranged from 0.65 to 0.70.

■ Type A (59%): the humeral head was centred, and the resultant strengths were equally distributed against the surface of the glenoid. Glenoid retroversion averaged 11.5° (standard deviation [SD], 8.8°). The erosion may be minor - type A1 (43%) - or major - type A2

Humeral Head Retroversion
Fig. 53. Different morphological types of the glenoid in primary glenohumeral osteoarthritis

(16%) marked by a central erosion that led to a centred glenoid cupula. In advanced cases, the humeral head protruded into the glenoid cavity.

■ Type B (32%): the humeral head was subluxated posteriorly, and the distributed loads were asymmetric. The CT scan revealed numerous anatomic changes, more pronounced on the posterior margin of the glenoid. The retroversion averaged 18° (SD, 7.2°). Two subgroups were identified: B1 (17%) showed narrowing of the posterior joint space, subchondral sclerosis, and osteophytes, and B2 (15%) demonstrated a posterior cupula that gave an unusual biconcave aspect of the glenoid. In type B2, there was an excessive retroversion of the glenoid according to Friedman et al. [41], but the value of the retroversion does not explain the biconcavity of the glenoid.

■ Type C (9%): this type of glenoid morphology was defined by a gle-noid retroversion of more than 25°, regardless of the erosion. The retroversion was of dysplastic origin, and the humeral head was well centred or slightly subluxated posteriorly. The average retroversion was 35.7° (SD, 5.9°).

13.3 Assessment of humeral head subluxation according to Walch et al. [134]

The position of the humeral head with respect to the glenoid was evaluated using an index of subluxation, which is the relative part of the humeral head posterior to the bisecting line of the glenoid (Fig. 54). An index between 45 and 55% represents a centred humeral head, 0% is an anterior dislocation, and 100% is a posterior dislocation.

Rotator Cuff Osteoarthrosis Pictures

INDEXc ^

Fig. 54. Method used to evaluate the humeral head subluxation. A Line tangent to the anterior and posterior edges of the glenoid fossa. B Line bisecting the glenoid. C Line parallel to A transecting the medial third of the humeral head. D Relative part of the humeral head posterior to B. E Diameter of the humeral head on line C. D, E, Index of subluxation. An index between 45 and 55% indicates a well-centred humeral head. An index of more than 55% indicates posterior subluxation and below 45% indicates anterior subluxation

13.4 Classification of vertical glenoid morphology according to Habermeyer [51a]*

In the true antero-posterior view the authors identified four different types of inclination deformity of the glenoid due to a vertical line perpendicular to the inferior border of the X-ray film along the lateral base of the coracoid (coracoid baseline) and along the superior and inferior glenoid rim (glenoid line).

In this investigation the coracoid baseline is reproducible because the ap-view is taken into a standardized standing position of the patient, so that the inferior border of the X-ray film is parallel to the bottom and the lateral base of the coracoid does not change with rotation of the scapula.

Type 0 (Fig. 55 a) represents normal glenoids; the coracoid baseline and the glenoid line run parallel. Both lines intersect below the inferior glenoid rim in type 1 (Fig. 55b) glenoids. In type 2 (Fig. 55 c) glenoids,

Seebauer Classification

Fig. 55. Classification of glenoid inclination, a Inclination type 0: the coracoid baseline (red) and the glenoid line (blue) run parallel (the brown line represents the inferior border of the X-ray film), b Inclination type 1: the coracoid baseline and the glenoid line intersect below the inferior glenoid rim, c Inclination type 2: the coracoid baseline and the glenoid line intersect between the inferior glenoid rim and the centre of the glenoid, d Inclination type 3: the coracoid baseline and the glenoid line intersect above the coracoid base

Fig. 55. Classification of glenoid inclination, a Inclination type 0: the coracoid baseline (red) and the glenoid line (blue) run parallel (the brown line represents the inferior border of the X-ray film), b Inclination type 1: the coracoid baseline and the glenoid line intersect below the inferior glenoid rim, c Inclination type 2: the coracoid baseline and the glenoid line intersect between the inferior glenoid rim and the centre of the glenoid, d Inclination type 3: the coracoid baseline and the glenoid line intersect above the coracoid base the coracoid baseline and the glenoid line intersect between the inferior glenoid rim and the centre of the glenoid. In type 3 (Fig. 55 d) glenoids the lines intersect above the coracoid base.

13.5 Classification of osteoarthritis with massive rotator cuff tears according to Favard et al. [38]*

■ Group 1: is characterised by upward migration of the humeral head, superior gleno-humeral joint space narrowing, an acromion changed in shape due to the imprint of the humeral head and subacromial arthritis (Fig. 56 a).

■ Group 2: this group is characterised by central gleno-humeral joint space narrowing and with little alteration in the shape of the acro-mion which does not have a humeral head imprint (Fig. 56b).

■ Group 3: this group is characterised by signs of bony destruction in the form of lysis of either the head or the acromion. The bony elements not affected by the lysis do not undergo any modification in their shape, for example, the greater tuberosity is not eroded and the acromion does not have a humeral head imprint. Gleno-humeral joint space narrowing is either minimal or nonexistent (Fig. 56 c).

Acetabularization The Acromion

Fig. 56. a Group 1. Superior glenohumeral wear: upward migration of the humeral head. Acromion modification with inferior concavity wear. b Group 2. Central narrowing of the glenohumeral joint. Little alteration in the shape of the acromion without humeral head imprint. c Group 3. Lysis of either the humeral head or the acromion

Fig. 56. a Group 1. Superior glenohumeral wear: upward migration of the humeral head. Acromion modification with inferior concavity wear. b Group 2. Central narrowing of the glenohumeral joint. Little alteration in the shape of the acromion without humeral head imprint. c Group 3. Lysis of either the humeral head or the acromion

There was no age difference between the three groups. The acromio-hu-meral joint space narrowing was significantly greater in group 1 than in group 3 and 2.

13.6 Classification of cuff tear arthropathy according to Seebauer et al. [132]

Analysis of cuff tear arthropathy and failed treatment has led to a bio-mechanical classification of cuff tear arthropathy. Four distinct groups have been formed on the basis of the biomechanics and clinical outcomes of arthroplasty. The four types are distinguished by the degree of superior migration from the centre of rotation and the amount of instability of the centre of rotation. This classification (Table 5) has proposed benefits in surgical decision-making for optimal implant type, goals of reconstruction, and outcomes.

Table S. Classification of cuff-tear arthropathy. (From [132])

Type IA:

Intact

Minimal

Dynamic

Acetabularization of

centred

anterior

superior

joint

coracoacromial arch

stable

restraints

migration

stabilization

and femoralization

(Fig. 57a)

of humeral head

Type I B:

Intact

Minimal

Compromised

Medial erosion of the

centred

anterior

superior

dynamic joint

glenoid, acetabulari-

medialized

restraints;

migration

stabilization

zation of coracoacromial

(Fig. 57b)

force couple

arch, and femoralization

intact/

of humeral head

compensated

Type IIA:

Compromised

Superior

Insufficient

Minimum stabilization

decentred

anterior

translation

dynamic joint

by coracoacromial arch,

limited

restraints; com

stabilization

superior-medial erosion

stable

promised force

and extensive

(Fig. 57c)

couple

acetabularization

of coracoacromial arch

and femoralization of

humeral head

Type IIB:

Incompetent

Anterior

Absent

No stabilization by

decentred

anterior

superior

dynamic joint

coracoacromial arch;

unstable

structures

escape

stabilization

deficient anterior

(Fig. 57d)

structures

Cuff Arthropathy Classification
Fig. 57. Biomechanical classification of cuff-tear arthropathy. a Type I A: centred, stable. b Type I B: centred, medialized. c Type IIA: de-centred, limited stabilization. d Type IIB: de-centred unstable. (From [132])

13.7 Classification of cuff tear arthropathy according to Hamada et al. [55] (Fig. 58a-e)

Roentgenographic grades of massive cuff tears were proposed. These were based chiefly on the acromiohumeral interval (AHI), which has been considered in the literature to be a sensitive indicator for the full-thickness cuff tear. Five grades were classified:

■ Grade 3: acetabularization was added to the Grade 2 characteristics (The term acetabularization is defined as a concave deformity of the acromion undersurface. It has two subtypes:

- an excavating deformity of the acromion

- a deformity formed by the excessive spur along the coracoacromial ligament)

Cuff Arthropathie HamadaCuff Tear Hamada
Fig. 58. Radiological classification of cuff-tear arthropathy. A Grade 1; B grade 2; C grade 3; D grade 4; E grade 5. (From [55])

■ Grade 4: narrowing of the glenohumeral joint was added to the Grade 3 features

■ Grade 5: comprised instances of humeral-head collapse, which is characteristic of cuff-tear arthropathy

13.8 Classification of glenoid erosion in glenohumeral osteoarthritis with massive rupture of the cuff according to Sirveaux et al. [120]

Radiological the authors defined four types of glenoid erosion. In type E0, the head of the humerus migrated upwards without erosion of the glenoid. Type El was defined by a concentric erosion of the glenoid. In type E2 there was an erosion of the superior part of the glenoid and in type E3 the erosion extended to the inferior part of the glenoid (Fig. 59).

Rotator Cuff Arthropathy Classification
Fig. 59. Radiological classification of glenoid erosion in osteoarthritis with massive rupture of the cuff. (From [120])

13.9 Radiographic classification of dislocation arthropathy of the shoulder according to Samilson and Prieto [117]

The authors examined seventy-four shoulders with a history of single or multiple dislocations of the shoulder demonstrated radiographic evidence of glenohumeral arthropathy.

Radiographic evidence of arthrosis was graded as mild, moderate, or severe evaluated in the anteroposterior radiograph.

■ Mild arthrosis was indicated by evidence on the anteriorposterior radiograph of either an inferior humeral or glenoid exostosis, or both, measuring less than 3 mm in height (Fig. 60 a).

■ Moderate arthrosis was indicated by evidence on the anteroposterior radiograph of either an inferior humeral or glenoid exostosis, or both, between 3 and 7 mm in height, with slight glenohumeral-joint irregularity (Fig. 60b).

■ Severe arthrosis was indicated by evidence on the anteroposterior radiograph of either an inferior humeral of glenoid exostosis, or both, that was more than 7 mm in height, with narrowing of the glenohumeral joint and sclerosis (Fig. 60 c).

Femoralization

a be

Fig. 60. Radiological classification of dislocation arthropathy. a Mild arthrosis evidence on the anteroposterior radiograph of an inferior humeral or glenoid exostosis, or both, measuring <3 mm. b Moderate arthrosis evidence on the anteroposterior radiograph of an inferior humeral or glenoid exostosis, or both, measuring between 3 and 7 mm, with slight glenohumeral-joint irregularity. c Severe arthrosis evidence on the anteroposterior radiograph of an inferior humeral or glenoid osteosis, or both, measuring >8 mm, with glenohumeral narrowing and sclerosis. (From [117])

a be

Fig. 60. Radiological classification of dislocation arthropathy. a Mild arthrosis evidence on the anteroposterior radiograph of an inferior humeral or glenoid exostosis, or both, measuring <3 mm. b Moderate arthrosis evidence on the anteroposterior radiograph of an inferior humeral or glenoid exostosis, or both, measuring between 3 and 7 mm, with slight glenohumeral-joint irregularity. c Severe arthrosis evidence on the anteroposterior radiograph of an inferior humeral or glenoid osteosis, or both, measuring >8 mm, with glenohumeral narrowing and sclerosis. (From [117])

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Responses

  • tranquillina zito
    What does grade 3 changes to glenohumeral joint osteoartritis?
    6 years ago

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