Recurrence in traumatic anterior shoulder dislocations increases the prevalence of Hill–Sachs and Bankart lesions: a systematic review and meta-analysis

Abstract

Purpose The extent of shoulder instability and the indication for surgery may be determined by the prevalence or size of associated lesions. However, a varying prevalence is reported and the actual values are therefore unclear. In addition, it is unclear whether these lesions are present after the first dislocation and whether or not these lesions increase in size after recurrence. The aim of this systematic review was (1) to determine the prevalence of lesions associated with traumatic anterior shoulder dislocations, (2) to determine if the prevalence is higher following recurrent dislocations compared to first-time dislocations and (3) to determine if the prevalence is higher following complete dislocations compared to subluxations. Methods PubMed, EMBASE, Cochrane and Web of Science were searched. Studies examining shoulders after traumatic anterior dislocations during arthroscopy or with MRI/MRA or CT published after 1999 were included. A total of 22 studies (1920 shoulders) were included. Results The proportion of Hill–Sachs and Bankart lesions was higher in recurrent dislocations (85%; 66%) compared to first-time dislocations (71%; 59%) and this was statistically significant (P < 0.01; P = 0.05). No significant difference between recurrent and first-time dislocations was observed for SLAP lesions, rotator-cuff tears, bony Bankart lesions, HAGL lesions and ALPSA lesions. The proportion of Hill–Sachs lesions was significantly higher in complete dislocations (82%) compared to subluxations (54%; P < 0.01). Conclusion Higher proportions of Hill–Sachs and Bankart were observed in recurrent dislocations compared to first-time dislocations. No difference was observed for bony Bankart, HAGL, SLAP, rotator-cuff tear and ALPSA. Especially when a Hill–Sachs or Bankart is present after first-time dislocation, early surgical stabilization may need to be considered as other lesions may not be expected after recurrence and to limit lesion growth. However, results should be interpreted with caution due to substantial heterogeneity and large variance. Level of evidence IV.

High resorption rates following glenoid augmentation procedures do not seem to lead to higher recurrence rates or worse clinical outcomes: a systematic review and meta-analysis

“…Evaluating glenoid morphology may be valuable to determine shoulder instability and the need for surgery. Glenoid depth, version, inclination, the critical shoulder angle and smoking may be reliable predictors for instability [23,[29][30][31]. The alignment between the graft and glenoid curve may also predict outcomes.…”

“…Bony lesions are common following anterior glenohumeral dislocation and may be present in up to 96% of patients [19,25,31]. Anterior glenoid bone loss can cause the shoulder 1 3 to be unstable in the mid-range of motion and Hill-Sachs lesions in the end range [2,9,14].…”

Correlation between glenoid bone structure and recurrent anterior dislocation of the shoulder joint

“…Glenohumeral joint dislocation accounts for more than 40% of joint dislocations in the whole body 3 , resulting in shoulder pain or dysfunction. It often occurs in young patients, with an average age of 20 years old, and more often in male patients than in female patients, the vast majority of which experience anterior dislocations (85%-95%) [4][5][6][7] . Unfortunately, this injury is associated with a very high rate of recurrence (85%) in younger athletes after the initial injury 3 .…”

Atypical Shoulder Instability Patterns in Adolescents Following Traumatic Anterior Shoulder Dislocation

“…Previous studies, primarily in the adult population, reported the prevalence of bony Bankart lesion to be between 0% and 43%, soft tissue Bankart between 20% and 100%, and Hill-Sachs lesion in 13% to 100% of shoulders with a traumatic anterior dislocation. 13…”

“…Previous studies, primarily in the adult population, reported the prevalence of bony Bankart lesion to be between 0% and 43%, soft tissue Bankart between 20% and 100%, and Hill-Sachs lesion in 13% to 100% of shoulders with a traumatic anterior dislocation. 13 Lesions that occur less frequently than Bankart or Hill-Sachs injuries may still be present and result in recurrent instability. Identification of these lesions may require focused anticipatory examination of imaging studies, and recognition during surgical assessment is crucial to ensure adequate treatment and glenohumeral stabilization.…”