Patients were divided into four groups based on severity of pathology: a glenoid defect of less than 25% and an on-track Hill-Sachs lesion; a glenoid defect of less than 25% and an off-track Hill-Sachs lesion; a glenoid defect greater than 25% and an on-track Hill-Sachs lesion; and a glenoid defect greater than 25% and an off-track Hill-Sachs lesion.
Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy.
Smalley, "Hill-Sachs "remplissage": an arthroscopic solution for the engaging Hill-Sachs lesion
," Arthroscopy, vol.
Arthroscopic Bankart repair is an established option for patients with isolated soft tissue Bankart lesions, yet Burkhart and coworkers reported a near 70% instability recurrence rate following soft tissue stabilization with underlying bony Bankart or Hill-Sachs lesions
. (8) More extensive soft tissue injuries, including capsular attenuation, also have a high association with recurrent instability following Bankart repair.
(1.) Bock P, Kluger R, Hintermann B: Anatomical reconstruction for Reverse Hill-Sachs lesions
after posterior locked shoulder dislocation fracture: a case series of six patients.
If a Hill-Sachs lesion
remains within the glenoid track, then there is no chance of engagement (Fig.
(25) Using MR arthrography on re-evaluation of patients with a failed surgical stabilization has been shown to achieve of 93.3% in detection of Hill-Sachs lesions
, 76.2% for glenoid or humeral cartilage abnormalities, and 87.2% for rotator cuff injury.
In addition, direct bone grafting for large Hill-Sachs lesions
with allograft humeral head or femoral head has recently been advocated for "engaging Hill-Sachs lesions
" as well.
Specialized views include the Stryker notch view, (30) which aids in the evaluation of a Hill-Sachs lesion
; the West Point Axillary view, (31) which is used to evaluate anteroinferior glenoid rim fractures; and the apical oblique view of Garth, (32) which is useful for the identification of anteroinferior glenoid fractures, labral calcifications, and for the evaluation of Hill-Sachs lesions
In a recent biomechanical study, Sekiya and associates (27) evaluated the effect varying sizes of Hill-Sachs lesions
had on the stability of the shoulder, and the impact treating these lesions with osteochondral allograft implantation had on restoring a stable glenohumeral joint.
Bencardino and colleagues (24) found that SLAP lesions were associated with partial rotator cuff tears in 42% of patients, frayed or lax inferior glenohumeral ligaments in 26%, Bankart lesions in 16%, Hill-Sachs lesions
in 16%, chondral lesions in 16%, loose bodies in 10%, complete rotator cuff tears in 5%, and posterior labral tears in 5%.
They reported a high variability in pathologic lesions associated with glenohumeral instability, including anterior glenoid labral tears (87%), anterior capsule deficiency (79%), Hill-Sachs lesions
(68%), glenohumeral ligament disruptions (55%), rotator cuff tears (14%), posterior labral tears (12%), and SLAP (superior labrum, anterior to posterior) lesions (7%).