Tomographic evaluation of Hill–Sachs lesions: is there a correlation between different methods of measurement?

The treatment of recurrent glenohumeral instability, especially with a concomitant bony lesion, remains challenging. This is especially true in the case of posterior instability given its less common incidence. Moreover, the presence of an engaging reverse Hill-Sachs lesion in combination with posterior instability will result in the need for a more aggressive treatment option. In comparison with a Hill-Sachs lesion, a reverse Hill-Sachs lesion features greater chondral deficiency that must be addressed during treatment. We propose the talus allograft as a potential allograft for treatment of an engaging reverse Hill-Sachs lesion. The superior articular surface of the talus may be used to reconstruct the articular surface of the humeral head. In this technical note, we describe our preferred primary technique for treatment of an engaging reverse Hill-Sachs lesion with recurrent glenohumeral instability through use of a fresh osteochondral talus allograft, as well as discuss the advantages and disadvantages of this allograft option.

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“…Ultimately, this potential for interaction dictates the risk of engagement and recurrence of instability. 13 …”

Section: Diagnosis Of Posterior Shoulder Instabilitymentioning

confidence: 99%

Anatomic Humeral Head Reconstruction With Fresh Osteochondral Talus Allograft for Recurrent Glenohumeral Instability With Reverse Hill-Sachs Lesion

Provencher

Sánchez

Schantz

et al. 2017

Arthroscopy Techniques

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“…Assunção et al 2 assessed CT or arthro-CT scans from patients with recurrent anterior glenohumeral dislocation, independently evaluated by two examiners. These authors brought attention to the description of a new method, being the residual articular arc and percentage of articular arc bone loss.…”

Section: Resultsmentioning

confidence: 99%

“…Assunção et al conclude that the best bone loss predictors are HSL width on axial plane and percentage of articular arc loss. 2…”

Section: Resultsmentioning

confidence: 99%

“…This is the determinant factor influencing the choice of the surgical technique: soft tissue procedure or bone block procedure. 2 It has been extensively reported in the literature that the limit of glenoid bone loss above which an arthroscopic Bankart repair may fail is ⩾ 25% of the glenoid width. This percentage is equivalent to ⩾ 20% of the surface area created by a best-fit circle on the inferior surface of the glenoid.…”

Section: Introductionmentioning

confidence: 99%

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How to measure a Hill–Sachs lesion: a systematic review

et al. 2019

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Quantifying bone loss is important to decide the best treatment for patients with recurrent anterior glenohumeral instability. Currently, there is no standard method available to make a precise evaluation of the Hill–Sachs lesion and predict its engagement before the surgical procedure. This literature review was performed in order to identify existing published imaging methods quantifying humeral head bone loss in Hill–Sachs lesions. Searches were undertaken in Scopus and PubMed databases from January 2008 until February 2018. The search terms were “Hill-Sachs” and “measurement” for the initial search and “Hill–Sachs bone loss” for the second, to be present in the keywords, abstracts and title. All articles that presented a method for quantifying measurement of Hill–Sachs lesions were analysed. Several methods are currently available to evaluate Hill–Sachs lesions. The length, width and depth measurements on CT scans show strong inter and intra-observer correlation coefficients. Three-dimensional CT is helpful for evaluation of bony injuries; however, there were no significant differences between 3D CT and 3D MRI measurements. The on-track off-track method using MRI allows a simultaneous evaluation of the Hill–Sachs and glenoid bone loss and also predicts the engaging lesions with good accuracy. Cite this article: EFORT Open Rev 2019;4:151-157. DOI: 10.1302/2058-5241.4.180031

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“…These include humeral residual articular arc and percentage of articular arc loss, with and depth of the lesion on the axial and coronal planes (24) ( Figure 6). Of them, the articular arc loss, Hill Sachs lesion width and depth on the axial plane showed greater reliability and are recommended (25). Measurements in the coronal plane showed lower inter-examiner reliability and are less advisable (26).…”

Section: Multidetector Computed Tomography (Mdct)mentioning

confidence: 99%

Imaging of shoulder instability

Santiago¹,

Martínez²,

Muñóz³

et al. 2017

Quant. Imaging Med. Surg.

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This extended review tries to cover the imaging findings of the wide range of shoulder injuries secondary to shoulder joint instability. Usefulness of the different imaging methods is stressed, including radiography, computed tomography (CT) and magnetic resonance. The main topics to be covered include traumatic, atraumatic and minor instability syndromes. Radiography may show bone abnormalities associated to instability, including developmental and post-traumatic changes. CT is the best technique depicting and quantifying skeletal changes. MR-arthrography is the main tool in diagnosing the shoulder instability injuries.

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Tomographic evaluation of Hill–Sachs lesions: is there a correlation between different methods of measurement?

Abstract: The measurements of articular arc loss and HS lesion width on the axial plane exhibited strong correlation. The inter-examiner reliability relative to articular arc loss, HS lesion width and depth on the axial plane, and glenoid bone loss was good.

Cited by 14 publications

References 28 publications

Anatomic Humeral Head Reconstruction With Fresh Osteochondral Talus Allograft for Recurrent Glenohumeral Instability With Reverse Hill-Sachs Lesion

Anatomic Humeral Head Reconstruction With Fresh Osteochondral Talus Allograft for Recurrent Glenohumeral Instability With Reverse Hill-Sachs Lesion

How to measure a Hill–Sachs lesion: a systematic review

Imaging of shoulder instability

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