Posterior shoulder dislocation with associated reverse Hill-Sachs lesion: treatment options and functional outcome after a 5-year follow up

Abstract

BackgroundThe current study describes several surgical techniques for the treatment of the reverse Hill - Sachs lesion after posterior shoulder dislocation; we also aimed to present long term results followed for a minimum of five years.MethodsThis study is a prospective case series of 17 patients who were treated in our clinic between 2008 and 2011. Patients with a defect size smaller than 25% of the articular surface were treated conservatively. An endoprosthesis of the glenohumeral joint was implanted in patients with a defect size bigger than 40%. All remaining patients were treated by a variety of operative techniques, depending on the quality of the bone and size of the defect.ResultsTwelve of seventeen patients had a defect size of the humeral articular surface between 25% and 40% with a mean age of 39 years. Depending on the defect size these patients were treated with retrograde chondral elevation, antegrade cylindrical graft or a graft of the iliac bone crest with an open approach. All the procedures showed fair results, e.g. the open approach with a graft of the iliac bone crest (2010: Dash 3.89, Constant 90.33, Rowe 86.67; 2015: Dash 2.22, Constant 92.00, Rowe 93.33).ConclusionThe open approach is not a disadvantage for the functional outcome. The treatment algorithm should involve the superficial size of the defect as well as the depth of the defect and the time interval between the dislocation and the surgical treatment.Trial registration 223/2012BO2, 02 August 2010.

An exceptional case of posterior shoulder fracture dislocation in patient with recurrent anterior dislocation forming “Mirror Hill‐Sachs lesion”

“…2,6 In contrast, PSD are relatively rare and occasionally present with anterio-medial defect of humeral head "Reverse Hill-Sachs." 7,8 An unusual presentation in this patient was a double lesion. We termed it "Mirror Hill-Sachs" and discussed it further.…”

“…Majority of shoulder dislocations are anterior displacements with postero‐lateral humeral defect known as “Hill‐Sachs lesion.” 2,6 In contrast, PSD are relatively rare and occasionally present with anterio‐medial defect of humeral head “Reverse Hill‐Sachs.” 7,8 An unusual presentation in this patient was a double lesion. We termed it “Mirror Hill‐Sachs” and discussed it further.…”

Biomechanics of posterior shoulder instability - current knowledge and literature review

“…In athletes, authors tend to be a bit more aggressive in terms of surgical procedures. Guehring et al[ 69 ] additionally considers the time interval between trauma and surgery. Conservative therapy is a reasonable initial treatment, as one study demonstrated a subjective improvement after 6 mo in 70%-89% of patients.…”

Multidirectional Shoulder Instability With Circumferential Labral Tear and Bony Reverse Hill Sachs: Treatment with 270° Labral Repair and Fresh Talus Osteochondral Allograft to the Humeral Head

“…Also, an rHSL has significant cartilage involvement and can compromise up to 45° of the articular surface of the humeral head. 7 , 10 In isolation, outcomes of both reconstruction of rHSLs and arthroscopic repairs of circumferential lesions of the glenoid labrum have demonstrated improvement in objective and subjective measures 9 , 11 and no difference in shoulder stability and function when compared to anterior labral repair alone. 12 To date, no outcomes have been reported on the simultaneous treatment of rHSLs and circumferential labral lesions.…”