Rotational humeral osteotomy for recurrent anterior dislocation of the shoulder associated with a large Hill-Sachs lesion.
Caption: Figure 1 Axillary radiograph showing Hill-Sachs lesion in the posterolateral humeral head.
Caption: Figure 3 Location of the Hill-Sachs lesion within the glenoid track (A) or medial to the glenoid track (B) will determine whether the lesion is engaging and therefore prone to instability.
Measurement is determined on CT as the angle between the axis of the deepest groove of the Hill-Sachs Lesion and the longitudinal axis of the humeral shaft.
Caption: Figure 5 Humeral head allograft sized matched to Hill-Sachs lesion to restore articular arc and prevent engagement.
As previously noted, the internal rotation view is especially helpful in identifying Hill-Sachs lesions.
23) Patients with engaging Hill-Sachs lesions or glenoid bone loss may complain of pain, crepitation, a sensation of catching, or gross instability as the defect is encountered.
20,44) With Hill-Sachs lesions involving less than 20% of the articular surface or glenoid bone loss of less than 20%, surgery to restore soft tissue integrity by capsulolabral (Bankart) repair is generally sufficient; thus obviating the need to address the osseous injuries.
This procedure is indicated for large (up to 45%) Hill-Sachs lesions in younger patients for whom prosthetic replacement is less desirable, particularly after other surgical treatments have failed to adequately address instability.
Rotational humeral osteotomy to address large Hill-Sachs lesions associated with recurrent anterior dislocation was first described in 1969.
Prosthetic replacement is recommended for patients with Hill-Sachs lesions more than 45% of the articular surface, severe cartilage damage, marked osteopenia, or underlying degenerative changes.