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Does an “Off-Track” Hill-Sachs Lesion That Is Misclassified as “Non-Engaging” Affect Outcomes From Bankart Repair Alone Compared With Bankart Repair Combined With Remplissage?

Published:September 28, 2020DOI:https://doi.org/10.1016/j.arthro.2020.09.037

      Purpose

      To determine how intraoperative assessment (engagement test) may affect recurrent dislocation rate and to compare the clinical outcomes, recurrence rates, and presence of on-/off-track conditions between cases that received arthroscopic Bankart repair alone (nonengaged Hill-Sachs lesion) and Bankart repair with remplissage (engaged Hill-Sachs lesion).

      Methods

      We retrospectively reviewed 213 patients who underwent arthroscopic Bankart repair alone (186 patients with nonengaging lesions, group A) or with remplissage (27 patients with engaging lesion, group B) for recurrent anterior shoulder instability with <25% glenoid bone defect. The presence of an engaging Hill-Sachs lesion was determined during arthroscopic evaluation. On-track or off-track lesions were assessed retrospectively from preoperative 3-dimensional (3D) computed tomography (CT).

      Results

      Mean glenoid bone defect was 13.7% in group A and 20.7% in group B (P < .001). Off-track lesions were identified in 8.1% (15/186) and 100% (27/27) in group B. At the final follow-up (minimum 2 years; mean follow-up periods after surgery of 50.1 months in group A and 47.7 months in group B), there were no significant differences in shoulder functional scores and recurrence rates between groups, despite improvement after surgery. In the off-track lesion (group A-1: nonengaging but off-track lesion), recurrence instability occurred in 9 patients (60%, 9/15). Also, comparing group A-1 and group B, we noted significant differences in shoulder functional scores and recurrence rates (P < .001).

      Conclusion

      Of 186 patients, 8.1% with nonengaging Hill-Sachs lesions during direct arthroscopic examination under anesthesia actually demonstrated off-track lesions on preoperative 3D CT scans retrospectively, with 60% experiencing recurrent instability. Intraoperative manual assessment for Hill-Sachs engagement was inferior to 3D CT scan in establishing the presence of off-track defects.

      Level of evidence

      III, retrospective comparative study
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      References

        • Kim S.J.
        • Kim S.H.
        • Park B.K.
        • Chun Y.M.
        Arthroscopic stabilization for recurrent shoulder instability with moderate glenoid bone defect in patients with moderate to low functional demand.
        Arthroscopy. 2014; 30: 921-927
        • Park I.
        • Kang J.S.
        • Jo Y.G.
        • Shin S.J.
        Factors related to patient dissatisfaction versus objective failure after arthroscopic shoulder stabilization for instability.
        J Bone Joint Surg Am. 2019; 101: 1070-1076
        • Itoi E.
        • Lee S.-B.
        • Berglund L.J.
        • Berge L.L.
        • An K.-N.
        The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: A cadaveric study.
        J Bone Joint Surg Am. 2000; 82: 35-46
        • Saito H.
        • Itoi E.
        • Minagawa H.
        • Yamamoto N.
        • Tuoheti Y.
        • Seki N.
        Location of the Hill-Sachs lesion in shoulders with recurrent anterior dislocation.
        Arch Orthop Trauma Surg. 2009; 129: 1327-1334
        • Burkhart S.S.
        • De Beer J.F.
        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. 2000; 16: 677-694
        • Lazarides A.L.
        • Duchman K.R.
        • Ledbetter L.
        • Riboh J.C.
        • Garrigues G.E.
        Arthroscopic remplissage for anterior shoulder instability: A systematic review of clinical and biomechanical studies.
        Arthroscopy. 2019; 35: 617-628
        • Buza III, J.A.
        • Iyengar J.J.
        • Anakwenze O.A.
        • Ahmad C.S.
        • Levine W.N.
        Arthroscopic Hill-Sachs remplissage: A systematic review.
        J Bone Joint Surg Am. 2014; 96: 549-555
        • Camus D.
        • Domos P.
        • Berard E.
        • Toulemonde J.
        • Mansat P.
        • Bonnevialle N.
        Isolated arthroscopic Bankart repair vs. Bankart repair with “remplissage” for anterior shoulder instability with engaging Hill-Sachs lesion: A meta-analysis.
        Orthop Traumatol Surg Res. 2018; 104: 803-809
        • Park I.
        • Kang J.S.
        • Jo Y.G.
        • Kim S.W.
        • Shin S.J.
        Off-track Hill-Sachs lesions do not increase postoperative recurrent instability after arthroscopic Bankart repair with selective Remplissage procedure.
        Knee Surg Sports Traumatol Arthrosc. 2019; 27: 3864-3870
        • Di Giacomo G.
        • Itoi E.
        • Burkhart S.S.
        Evolving concept of bipolar bone loss and the Hill-Sachs lesion: From “engaging/non-engaging” lesion to “on-track/off-track” lesion.
        Arthroscopy. 2014; 30: 90-98
        • Yamamoto N.
        • Itoi E.
        • Abe H.
        • et al.
        Contact between the glenoid and the humeral head in abduction, external rotation, and horizontal extension: A new concept of glenoid track.
        J Shoulder Elbow Surg. 2007; 16: 649-656
        • Wolf E.M.
        • Pollack M.
        • Smalley C.
        • Hill-Sachs “Remplissage”
        An arthroscopic solution for the engaging Hill-Sachs lesion.
        Arthroscopy. 2007; 23: e1-e2
        • Omori Y.
        • Yamamoto N.
        • Koishi H.
        • et al.
        Measurement of the glenoid track in vivo as investigated by 3-dimensional motion analysis using open MRI.
        Am J Sports Med. 2014; 42: 1290-1295
        • Gyftopoulos S.
        • Beltran L.S.
        • Bookman J.
        • Rokito A.
        MRI evaluation of bipolar bone loss using the on-track off-track method: A feasibility study.
        Am J Roentgenol. 2015; 205: 848-852
        • Gerber C.
        • Fuchs B.
        • Hodler J.
        The results of repair of massive tears of the rotator cuff.
        J Bone Joint Surg Am. 2000; 82: 505-515
        • Bartl C.
        • Scheibel M.
        • Magosch P.
        • Lichtenberg S.
        • Habermeyer P.
        Open repair of isolated traumatic subscapularis tendon tears.
        Am J Sports Med. 2011; 39: 490-496
        • Park I.
        • Lee J.H.
        • Hyun H.S.
        • Lee T.K.
        • Shin S.J.
        Minimal clinically important differences in Rowe and Western Ontario Shoulder Instability Index scores after arthroscopic repair of anterior shoulder instability.
        J Shoulder Elbow Surg. 2018; 27: 579-584
        • Sugaya H.
        Techniques to evaluate glenoid bone loss.
        Curr Rev Musculoskelet Med. 2014; 7: 1-5
        • Boileau P.
        • O’Shea K.
        • Vargas P.
        • Pinedo M.
        • Old J.
        • Zumstein M.
        Anatomical and functional results after arthroscopic Hill-Sachs remplissage.
        J Bone Joint Surg Am. 2012; 94: 618-626
        • Kurokawa D.
        • Yamamoto N.
        • Nagamoto H.
        • et al.
        The prevalence of a large Hill-Sachs lesion that needs to be treated.
        J Shoulder Elbow Surg. 2013; 22: 1285-1289
        • Cho S.H.
        • Cho N.S.
        • Rhee Y.G.
        Preoperative analysis of the Hill-Sachs lesion in anterior shoulder instability: How to predict engagement of the lesion.
        Am J Sports Med. 2011; 39: 2389-2395
        • Locher J.
        • Wilken F.
        • Beitzel K.
        • et al.
        Hill-Sachs off-track lesions as risk factor for recurrence of instability after arthroscopic Bankart repair.
        Arthroscopy. 2016; 32: 1993-1999
        • Shaha J.S.
        • Cook J.B.
        • Rowles D.J.
        • Bottoni C.R.
        • Shaha S.H.
        • Tokish J.M.
        Clinical validation of the glenoid track concept in anterior glenohumeral instability.
        J Bone Joint Surg Am. 2016; 98: 1918-1923