GAME CHANGERS IN SHOULDER ARTHROSCOPY: SCAPULA VARIATION INSIGHTS
Bibliographic record
Abstract
Anatomic variations in the acromion and coracoid affect arthroscopic anatomic glenoid reconstruction (AAGR) for shoulder instability. The acromion is crucial for locating the posterior portal, creating the far-medial (Halifax) portal, and facilitating bone graft placement. However, the posterolateral corner's variability is greater than previously known. In addition, the impact of coracoid size and shape on arthroscopic bone graft fixation remains unexplored. These anatomical variations often lead to difficulties in glenoid reconstruction and graft misplacement. Mixed reality (MR) and 3D-printing offer potential solutions, but current understanding of scapular anatomy is insufficient. This study aimed to assess the variability in acromion and coracoid anatomy using 3D models and MR measurements to support MR-based, patient-specific glenoid reconstruction. CT scans of 100 patients requiring an AAGR were analyzed. Scapula's 3D-CT scans were used to create 3D-models displayed on a commercially available surgical MR system (RSQ-HOLO, RSQ Technologies, Poznan, Poland). Using the headset, we measured glenoid height and width and simulated ideal scope position from the posterior portal using a 0.5cm pointer placed along the glenoid surface. Additionally, we measured the superior-to-inferior and medial-to-lateral distances of acromion and coracoid, along with the angle between glenoid face and the acromion. A second rater repeated these measurements on 48 models to determine interrater reliability of the measurements. The acromion had a mean superior-to-inferior distance of 3.89 mm (SD: 6.09) and a mean medial-to-lateral distance of 8.76 mm (SD: 6.06). The position of the coracoid had less variation, reporting a mean superior-to-inferior distance of 21.18 mm (SD: 5.90) and a mean medial-to-lateral distance of 14.41 mm (SD: 4.63). The posterolateral corner showed significant variation. The angle between the glenoid face and acromion varied widely, with a mean angle of 38.42 degrees (SD:8.1312). The intra-class correlation coefficients (ICC) were high for all measurements, except for the angle between the glenoid and acromion (ICC 0.019), speaking to the variations in the anatomy, making these measurements more difficult. There are significant anatomical variations in the anatomy of the acromion and coracoid, making the standard two cm inferior and two cm medial landmarks rarely the ideal position for the posterior portal. This can affect surgical outcomes. We suggest using computer manipulated 3D-modeling, MR, and 3D printing to enhance individualized surgical plans for glenoid reconstruction.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".