Hill-Sachs lesion classification under arthroscopic findings

Arthroscopic Hill-Sachs Filling Technique Using an Absorbable Interference Screw

We present an arthroscopic technique used to treat traumatic shoulder instability in the patient with a Hill-Sachs lesion, especially an off-track lesion. The incidence of this bony defect is approximately 40% to 90% of all anterior shoulder instability cases-and up to 100% in patients with recurrent anterior instability. Incorrect management of this humeral bone defect can lead to treatment failure, and it is essential to define characteristics such as the lesion's location, depth, width, and orientation. Many arthroscopic and open procedures have been described for the surgical management of the Hill-Sachs lesion. Using arthroscopy for the surgical treatment of shoulder instability offers numerous advantages. We describe an arthroscopic technique that consists of filling the Hill-Sachs lesion with absorbable interference screws made out of an advanced biocomposite material. After repair of the Hill-Sachs lesion, the Bankart lesion is repaired. As these screws are resorbed by bone tissue over several months, the bony anatomy is restored.

Normal Humeral Head Ossification in Pediatric and Adolescent Shoulders Can Mimic Hill-Sachs Lesions: A Magnetic Resonance Imaging-based Study

BACKGROUND

The sequential maturation of the humeral head (HH) as viewed on magnetic resonance imaging (MRI) has not been described to date. Proper assessment may be complicated by the presence of physeal tissue in pediatric patients. Past studies suggest that skeletally immature patients may also have a higher risk of a false-positive diagnosis of Hill-Sachs lesion on MRI. The purpose of this study was to define pediatric HH developmental patterns using MRI and to investigate for any associations with findings of known false-positive Hill-Sachs.

METHODS

Picture Archiving and Communication System (PACS) records at an urban academic tertiary care musculoskeletal facility from 2014 to 2020 were queried for shoulder MRI in patients aged 0 to 15 years. Patients were excluded if they had a history of glenohumeral instability, fracture, growth arrest, brachial plexus injury, surgery, or infection. All images were independently evaluated by a musculoskeletal fellowship-trained radiologist. Each HH was staged based on skeletal maturity.

RESULTS

For both sexes, HHs matured in a predictable manner with increasing chronological age associated with a higher ossification stage. False Hill-Sachs lesions were observed in girls aged 4 to 7 and boys aged 5 to 14, exclusively during stage I to II ossification.

CONCLUSIONS

False Hill-Sachs lesions were visualized on MRI in stage I to II proximal humerus ossification. Due to differential timing of skeletal maturation, males present with false Hill-Sachs lesions at a later age than females on average. When interpreting shoulder MRI for glenohumeral instability, clinicians should be cautious of false Hill-Sachs lesions, especially in younger patients with distinct greater tuberosity and HH ossification centers (stage I to II ossification).

LEVEL OF EVIDENCE

Level III.

Do Techniques for Hill-Sachs Remplissage Matter in Terms of Functional and Radiological Outcomes?

Background:

Different techniques are used for the remplissage procedure, including the double-pulley and mattress suture techniques. Both techniques have shown good results; however, it is unclear if one technique is superior.

Hypothesis:

The remplissage procedure using the double-pulley technique with 2 anchors would have superior functional and radiological outcomes compared with the mattress suture technique with a single anchor.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

This study included patients with anterior shoulder instability who were treated using arthroscopic Bankart repair combined with remplissage between 2012 and 2017. A structured questionnaire was used to gather information on the following metrics: Instability Severity Index Score, hyperlaxity, Sugaya index, presence of a Hill-Sachs defect, number of dislocations before surgery, sports participation, radiological measurement of the Hill-Sachs lesion, postoperative range of motion in both shoulders, Rowe score, Walch-Duplay score, American Shoulder and Elbow Surgeons score, and Filling Index Score of Remplissage grade according to magnetic resonance imaging scans at the last follow-up.

Results:

There were 41 patients included with a mean age of 30 ± 7 years who underwent the Hill-Sachs remplissage procedure using the double-pulley technique with 2 anchors (n = 21; group DA) or the mattress suture technique with a single anchor (n = 20; group SA). At the final follow-up, there were no significant differences between the groups regarding the Instability Severity Index Score (P = .134), the Sugaya index (P = .538), sports participation (P = .41), the radiological measurement of the Hill-Sachs lesion (P = .803), or the Rowe score (P = .182). However, there were significant differences between the groups in the Walch-Duplay score (P = .012), American Shoulder and Elbow Surgeons score (P = .005), and Filling Index Score of Remplissage grade (P = .015), favoring group DA, as well as differences in external rotation in a neutral position (external rotation loss: 9° ± 3° [group SA] vs 12° ± 3° [group DA]; P = .003) and at 90° of abduction (external rotation loss: 8° ± 3° [group SA] vs 11° ± 3° [group DA]; P = .006), favoring group SA.

Conclusion:

In the remplissage procedure, the double-pulley technique provided better filling of the lesion and improvement in functional scores, but external rotation was limited compared with the mattress suture technique.

Microfracture in Linear, Isolated, Narrow, Engaging Hill-Sachs Lesion

Treatment of Hill-Sachs lesions is still controversial despite the frequent incidence in patients with recurrent shoulder dislocation. We report the use of arthroscopic microfracture for the treatment of recurrent shoulder dislocation with a linear, isolated, narrow, engaging Hill-Sachs lesion. Arthroscopic microfracture can be an alternative treatment option to obtain healing of defects and avoid external rotation limitation in young, active patients with recurrent dislocation with linear, isolated, narrow, engaging lesions.

Bone Loss and Glenohumeral Instability

Glenohumeral instability secondary to glenohumeral bone loss presents a complex problem to the treating surgeon because of the complex biomechanics of the glenohumeral joint and its reliance on numerous dynamic and static stabilizers. The role of glenoid bone loss, specifically inferior-anterior glenoid bone loss, has been well characterized in the setting of recurrent unidirectional instability with greatly improved clinical results when following an algorithmic reconstructive approach to the location and percentage of overall bone loss. Furthermore, as the role of bipolar bone loss in the setting of glenohumeral engagement becomes more apparent, surgeons can more effectively address those lesions contributing to the recurrent instability. As such, surgeons should carefully and critically asses patients with recurrent anterior instability to optimize patient clinical outcomes.

Understanding the Hill-Sachs Lesion in Its Role in Patients with Recurrent Anterior Shoulder Instability

PURPOSE OF REVIEW

The purpose of this study is to provide an update to the orthopedic field in regard to treatment of the Hill-Sachs lesion and anterior shoulder instability. The review highlights the most current knowledge of epidemiology, clinical evaluation, and surgical methods used to treat Hill-Sachs lesions. It also details the relevant clinical and surgical findings that have been made throughout the literature in the past couple of years.

RECENT FINDINGS

The most recent literature covering the Hill-Sachs lesion has focused on the relatively new and unexplored topic of the importance of concomitant injuries while treating a humeral head defect. The glenoid track concept has been clinically validated as a method to predict engagement. 3D-CT has become the "gold standard" for Hill-Sachs imaging; however, it has been noted that 3D-MRI produces results that are not significantly different from CT. Also, it has been found that when the arm is in a position of abduction during the primary injury, there is a higher risk of engagement and subsequent dislocation. Recent studies have demonstrated successful results stemming from purely arthroscopic procedures in treating Hill-Sachs lesions. Anterior shoulder instability, specifically the Hill-Sachs lesion, is an area of orthopedic study that is highly active and constantly producing new studies in an attempt of gaining the best outcomes for patients. The past few years have yielded many excellent discoveries, but there is still much more work to be done in order to fully understand the role of the Hill-Sachs lesion in anterior shoulder instability.