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Author Reply to “Accurate Assessment of the Hill-Sachs Lesion: There Is No Information About the Accuracy of Quantification of These Lesions”

      We appreciate the comments from Verweij el al. regarding our manuscript, “Accuracy and Reliability of Imaging Modalities for the Diagnosis and Quantification of Hill–Sachs Lesions: A Systematic Review.” The goal of this study was to assess the current literature on the diagnosis and identification of Hill–Sachs lesions. As our systematic review illustrates, there are only a few high-level studies that directly compare different imaging modalities in quantifying Hill–Sachs lesions. As such, we were limited to performing a systematic review in lieu of a meta-analysis. However, Verweij et al. are correct that Cusick et al.’s findings reported diagnosis and did not quantify Hill–Sachs lesions.
      • Cicak N.
      • Bilić R.
      • Delimar D.
      Hill-Sachs lesion in recurrent shoulder dislocation: Sonographic detection.
      They are therefore accurate in stating that there is currently no study in the literature that establishes Hill–Sachs lesion assessment by ultrasound.
      Verweij et al.
      • Verweij L.P.E.
      • Schuit A.A.
      • Kerkhoffs G.
      • Blankevoort L.
      • van den Bekerom M.P.J.
      • van Deurzen D.F.P.
      Accuracy of currently available methods in quantifying anterior glenoid bone loss: Controversy regarding gold standard—a systematic review.
      stated that 3-dimensional (3D) computed tomography has been shown to be the most accurate in evaluating bone loss. However, they concluded, analogous with our findings, that existing evidence on a superior imaging modality to assess its lesions is still lacking.
      • Verweij L.P.E.
      • Schuit A.A.
      • Kerkhoffs G.
      • Blankevoort L.
      • van den Bekerom M.P.J.
      • van Deurzen D.F.P.
      Accuracy of currently available methods in quantifying anterior glenoid bone loss: Controversy regarding gold standard—a systematic review.
      However, we have recently shown that 3D imaging is superior to 2-dimensional imaging.
      • Provencher M.T.
      • Frank R.M.
      • Leclere L.E.
      • et al.
      The Hill–Sachs lesion: Diagnosis, classification, and management.
      ,
      • Arciero R.A.
      • Parrino A.
      • Bernhardson A.S.
      • et al.
      The effect of a combined glenoid and Hill–Sachs defect on glenohumeral stability: A biomechanical cadaveric study using 3-dimensional modeling of 142 patients.
      Thus, we agree with Verweij et al. that 3D imaging is likely the “gold standard” in diagnosing, quantifying, and determining whether a Hill–Sachs lesion is truly “on” or “off” track.
      • Verweij L.P.E.
      • Schuit A.A.
      • Kerkhoffs G.
      • Blankevoort L.
      • van den Bekerom M.P.J.
      • van Deurzen D.F.P.
      Accuracy of currently available methods in quantifying anterior glenoid bone loss: Controversy regarding gold standard—a systematic review.
      Lastly, although we believe that 3D computed tomography is the most reliable way to quantify these lesions, 3D magnetic resonance imaging has the potential to provide similar accurate information while decreasing cost and radiation exposure to the patient.
      • Vopat B.G.
      • Cai W.
      • Torriani M.
      • et al.
      Measurement of glenoid bone loss with 3-dimensional magnetic resonance imaging: A matched computed tomography analysis.
      ,
      • Vopat M.L.
      • Peebles L.A.
      • McBride T.
      • Cirone I.
      • Rider D.
      • Provencher M.T.
      Provencher MT. Accuracy and reliability of imaging modalities for the diagnosis and quantification of Hill–Sachs lesions: A systematic review.
      Future studies are still necessary to fully establish 3D magnetic resonance imaging as a viable assessment tool.
      In summary, we agree with Verweij et al. and appreciate their comments as we all strive to find efficient, reliable, and safe methods to accurately quantify Hill–Sachs lesions.

      Supplementary Data

      References

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        Accuracy of currently available methods in quantifying anterior glenoid bone loss: Controversy regarding gold standard—a systematic review.
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