Purpose
We sought to qualitatively and quantitatively describe characteristics of Hill-Sachs
lesions (HSL) in a cohort of anterior shoulder instability patients using advanced
3-dimensional (3-D) modeling software and assess the impact of various HSL parameters
on the HSL volume, location, and orientation in patients with anterior shoulder instability.
Methods
A total of 100 recurrent anterior instability patients with evidence of HSL with a
mean age of 27.2 years (range = 18 to 43 years) were evaluated. Three-dimensional
models of unilateral proximal humeri were reconstructed from CT scans, and the volume,
surface area (SA), width, and depth of identified HSLs were quantified along with
their location (medial, superior, and inferior extent). Multiple angular orientation
measures of HSLs were recorded, including Hill-Sachs rim (HSLr) angle in order to
classify the level and location of potential humeral head engagement. Mann-Whitney
U test assessed the relationship between measured parameters.
Results
By volume, larger HSL had greater humeral head surface area (HH SA) loss (P = .001), HSL width (P = .001), were more medial (P = .015), and more inferior (P = .001). Additionally, more medial lesions had greater HSLr angles (P = 0.001). The mean depth, width, and volume of HSLs were 3.3 mm (range = 1.2–7.1
mm), 16.0 mm (range = 6.2–30.4 mm) and 449.2 mm3 (range = 62.0–1365.6 mm3), respectively. The medial border of the HSL extended to 17.2 ± 4.4 (range = 9.3-28.3
mm) off the most medial edge of the HH cartilage margin (medialization). The mean
HSLr was 29.3 ± 10.5°.
Conclusion
There was a statistically significant association between HSL medialization and HSL
volume, position, and orientation. More medialized HSL have larger volume, greater
width, more SA loss and higher lesion angles and are more inferior in the humeral
head. As it has been established that more medialized lesions have poorer clinical
outcomes, this study highlights that HS lesions have varying angles and medialization,
which may portend eventual treatment and outcomes.
Level of Evidence
IV, case series.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 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
- Classification and analysis of attritional glenoid bone loss in recurrent anterior shoulder instability.Am J Sports Med. 2017; 45: 767-774
- Utility of the instability severity index score in predicting failure after arthroscopic anterior stabilization of the shoulder.Am J Sports Med. 2015; 43: 1983-1988
- Remplissage versus modified latarjet for off-track Hill-Sachs lesions with subcritical glenoid bone loss.Am J Sports Med. 2018; 46: 1885-1891
- Long-term restoration of anterior shoulder stability: A retrospective analysis of arthroscopic Bankart repair versus open latarjet procedure.J Bone Joint Surg. 2016; 98: 1954-1961
- Peripheral-track and central-track Hill-Sachs lesions: A new concept of assessing an on-track lesion.Am J Sports Med. 2020; 48: 33-38
- 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
- The effect of a combined glenoid and Hill-Sachs defect on glenohumeral stability: a biomechanical cadaveric study using 3-dimensional modeling of 142 patients.Am J Sports Med. 2015; 43: 1422-1429
- Location of the Hill-Sachs lesion in shoulders with recurrent anterior dislocation.Arch Orthop Trauma Surg. 2009; 129: 1327-1334
- The bony apprehension test for instability of the shoulder: a prospective pilot analysis.Arthroscopy. 2008; 24: 974-982
- CT imaging and three-dimensional reconstructions of shoulders with anterior glenohumeral instability.Clin Anat. 1999; 12: 326-336
- 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?.Arthroscopy. 2021; 37: 450-456
- Arthroscopic findings and clinical outcomes in patients 40 years of age and older with recurrent shoulder dislocation.Arthroscopy. 2019; 35: 314-322
- Understanding the Hill-Sachs lesion in its role in patients with recurrent anterior shoulder instability.Curr Rev Musculoskelet Med. 2017; 10: 469-479
- The instability severity index score. A simple pre-operative score to select patients for arthroscopic or open shoulder stabilisation.J Bone Joint Surg Br. 2007; 89: 1470-1477
- 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
- Glenoid track instability management score: Radiographic modification of the Instability Severity Index score.Arthroscopy. 2020; 36: 56-67
- Recurrent shoulder instability: current concepts for evaluation and management of glenoid bone loss.J Bone Joint Surg Am. 2010; 92: 133-151
- Anatomic osteochondral glenoid reconstruction for recurrent glenohumeral instability with glenoid deficiency using a distal tibia allograft.Arthroscopy. 2009; 25: 446-452
- Glenoid bone deficiency in recurrent anterior shoulder instability: Diagnosis and management.J Am Acad Orthop Surg. 2009; 17: 482-493
- Quantifying glenoid bone loss in anterior shoulder instability: reliability and accuracy of 2-dimensional and 3-dimensional computed tomography measurement techniques.Am J Sports Med. 2012; 40: 2569-2577
- 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
- Radiographic analysis of the Hill-Sachs lesion in anteroinferior shoulder instability after first-time dislocations.Arthroscopy. 2016; 32: 1509-1514
Article info
Publication history
Published online: May 27, 2021
Accepted:
May 11,
2021
Received:
August 19,
2020
Footnotes
See commentary on page 3262
The authors report the following potential conflicts of interest or sources of funding: M. T. Provencher reports personal fees from Arthrex, Joint Surface Foundation, SLACK, Inc., and Arthosurface, during the conduct of the study. He is an editorial or governing board member for Arthroscopy, Knee, Orthopedics, and SLACK, Inc., and he is a board or committee member of AANA, AAOS, AOSSM, ASES, ISAKOS, the San Diego Shoulder Institute, and the Society of Military Orthopaedic Surgeons. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2021 Published by Elsevier on behalf of the Arthroscopy Association of North America
