The incidence of Hill-Sachs lesions in initial anterior shoulder dislocations

doi:10.1016/0749-8063(89)90138-2

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 5, Issue 4, December 1989, Pages 254-257

https://doi.org/10.1016/0749-8063(89)90138-2 Get rights and content

Abstract

We undertook a prospective study using arthroscopy to determine the intraarticular derangement caused by initial anterior shoulder dislocations. Of our 32 patients, 15 (47%) had a grade I, grade II, or grade III Hill-Sachs lesion. The patients were 29 men and 3 women whose ages ranged from 15 to 28 years (mean 22 years). All of the patients studied were United States military personnel or members of their families. None of the patients had had prior injuries of the affected shoulder, and all underwent arthroscopy within 72 h of injury. Few reports describe a Hill-Sachs lesion in a patient following a single anterior dislocation. Early reports of this lesion were based on indirect (radiographic) evidence. Our arthroscopic findings indicate that the incidence of this lesion after one anterior dislocation is higher than previously thought.

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Cited by (259)

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As capsule elongation is assumed to weaken the static stability of the shoulder joint, the purpose of this biomechanical study was to demonstrate that capsule elongation occurs immediately after a first-time shoulder dislocation and not just after recurrent dislocation events. We hypothesize an increment in joint clearance due to joint capsule elongation after a first-time dislocation.
An experimental in-vitro study was conducted on 6 paired fresh frozen human shoulders (4 females; 2 males; 12 specimen) with a mean age of 80 (Range 67–89) years. The shoulder joint with the articular capsule was exposed and an inferior static tension force of 2.5 N was applied to the humerus prior to dislocation. Next, the humeral head was dislocated and was then immediately reduced back into the start position. The joint gap as well as joint capsule deformation was assessed using optical techniques.
The radiographic joint gap increased from 13.7 ± 6.9 mm (prior to dislocation) to 18.1 ± 6.5 mm (post dislocation) (p < .001). The increase in joint clearance was 4.4 mm. The joint capsule elongated from 5.9 ± 0.005 % (prior to dislocation) to 9.4 ± 0.007 % (post dislocation) (p < .001). The mean increase in joint capsule elongation was 3.5 %.
Capsule elongation was observed immediately after a simulated first-time shoulder dislocation in an in-vitro model of elderly human cadavers. It might therefore not only be a phenomenon of recurrent dislocation events.
Infraspinatus function impairment after arthroscopic Bankart repair with Hill Sachs remplissage. Isokinetic, functional, and radiographic analysis
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Arthroscopic Bankart repair with Hill Sachs remplissage (BHSR) is an option for anterior shoulder instability with humeral defect. Our hypothesis was that infraspinatus capsulo-tenodesis is an effective solution, with good clinical results and no consequences on shoulder strength and ranges of motion.
We performed a retrospective case-control study involving 22 patients operated with arthroscopic BHSR. We compared isokinetic evaluation of both shoulders using a dynanometer in concentric, eccentric force and endurance. Ranges of motion were measured using a goniometer and compared to the contralateral unaffected side. Functional assessment included Constant, Rowe, Walch and Duplay and WOSI scores. Healing and fatty degeneration were analyzed with magnetic resonance imaging.
At mean 37.2 months follow-up, 21 patients (95.4%) were satisfied or very satisfied with the intervention. Range of motion in external rotation of the affected side decreased by 10.8° in adduction and 6° at 90° of abduction (p < 0.05). Deficit in external rotation strength of the affected side greater than 15% was found in all isokinetic tests (p < 0.05). Walch and Duplay, Rowe, WOSI and adjusted Constant average scores were respectively 71.05 ± 14.1 (40–90), 67.63 ± 19.7 (15–100), 34.6% ± 19.9 (8.43–76.23) and 69.8 ± 13.57 (36.7–101). Postoperative MRI showed good capsulo-tenodesis healing without infraspinatus muscle fatty degeneration.
Arthroscopic BHSR provides satisfactory functional outcomes but significant infraspinatus functional impairments in both strength and ranges of motion in external rotation.
III; case-control study.
Review of Burkhart and DeBeer's (2000) article on traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repair: Where have we taken the concept of glenoid bone loss in 2023?
2023, Journal of ISAKOS
This classic discusses the original publication by Burkhart and DeBeer “Traumatic Glenohumeral Bone Defects and Their Relationship to Failure of Arthroscopic Bankart Repair” published in 2000 in Arthroscopy. At that time, the authors sought to understand the reasons behind the failure of arthroscopic soft tissue repair. Based on their findings, the authors introduced the concept of the inverted pear glenoid and engaging Hill-Sachs lesion which is now part of the orthopedic lexicon. The importance of bony pathologic changes in anterior glenohumeral instability has become so apparent, that it now forms the basis of clinical understanding and underpins treatment algorithms. Since this publication over 20 years ago, the idea of glenohumeral bone loss has been extensively explored and refined. There is no doubt of the importance of structural bone loss yet there is still uncertainty as to the best management of those with subcritical bone loss. The purpose of revisiting this classic article is to look at where we are in understanding recurrent instability and bony deficiency while appreciating how far we have come.
This review begins with a detailed summary of the classic article along with a historic perspective. Next, we look at the current evidence as it pertains to the classic article and how modern technology and innovation has advanced our ability to assess and quantify glenohumeral bone loss. We finish with expert commentary on the topic from two current surgeons with a research interest in shoulder instability to offer an insight into how modern surgeons view and address this issue. One of the original authors also reflects on the topic. The findings of this classic study changed the way we think about shoulder instability and opened the doors to an exciting body of research that is still growing today. Future research offers an opportunity for high quality evidence to guide management in the group of patients with subcritical bone loss and we eagerly await the results.
The Arthroscopic Trillat Procedure Is a Valuable Treatment Option for Recurrent Anterior Instability in Young Athletes With Shoulder Hyperlaxity
2023, Arthroscopy - Journal of Arthroscopic and Related Surgery
The purpose of this study is to report the outcomes of the all-arthroscopic Trillat procedure, combined with capsular plication, for the treatment of recurrent anterior instability in young athletes with shoulder hyperlaxity (external rotation >90°).
We performed a retrospective evaluation of patients with recurrent anterior instability and shoulder hyperlaxity who underwent an arthroscopic Trillat between 2009 and 2019. Patients with concomitant rotator cuff lesions or voluntary or multidirectional instability were excluded. The osteotomized coracoid was fixed above the subscapularis with a cannulated screw or a suture button; a capsular plication was systematically associated. We followed patients with x-rays, computed tomography scans, and Subjective Shoulder Value, visual analog scale, Walch, Constant, and Rowe scores. Mean follow-up was 56 months (24-145).
Twenty-eight consecutive patients (30 shoulders) with a mean age of 25 years were identified, and all met criteria. The main finding under arthroscopy was a “loose shoulder” with anteroinferior capsular redundancy and no or few (10%) labrum tears, glenoid erosion (13%), or Hill-Sachs lesions (10%). At last follow-up, 90% of the shoulders (27/30) were stable, and 79% (19/24) of the patients practicing sports returned to their preinjury activity level. The Walch-Duplay and Rowe scores improved from 54 (38-68) to 81 (4-100) and 55 (30-71) to 84 (45-100), respectively, P < .001.
The arthroscopic Trillat is an effective procedure for the treatment of recurrent anterior instability in young athletes with shoulder hyperlaxity but no substantial humeral or glenoid bone loss, allowing return to overhead/contact sports.
Level IV, retrospective study.
Arthroscopic Hill-Sachs Filling Technique Using an Absorbable Interference Screw
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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.
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The incidence of Hill-Sachs lesions in initial anterior shoulder dislocations

Abstract

Orthop Clin North Am

Recurrent dislocation of the shoulder

Prognosis in dislocations of the shoulder

J Bone Joint Surg

On the pathological changes produced in the shoulder-joint by traumatic dislocation, as derived from an examination of all the specimens illustrating this injury in the museums of London

Trans Pathol Soc London

A case of sub-coracoid dislocation of the humerus, with the formation of an indentation on the posterior surface of the head, the joint being unopened; with remarks on the mode of production of fracture of the anatomical neck, with dislocation

Medico-Chirurg Trans

The grooved defect of the humeral head. A frequently unrecognized complication of dislocations of the shoulder joint

Radiology

Fractures and dislocations of the shoulder

Zur Rontgenuntersuchung der habituellen Schulterverrenkung

Arch Klin Chir

Rontgenologische studien uber die traumatischen und habituellen schultergelenkverrenkungen nach vorn und nach unten

Acta Radiol Supp

The Hill-Sachs lesion. An experimental study

Am J Sports Med

The roentgenographic evaluation of anterior shoulder instability

Clin Orthop

Modified axillary roentgenogram. A useful adjunct in the diagnosis of recurrent instability of the shoulder

Clin Orthop

Radiographic views in recurrent anterior shoulder dislocation

Acta Orthop Scand

Evaluation of unstable shoulders by computed tomography. A preliminary study

Am J Sports Med