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Hill-Sachs lesion

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Hill-Sachs lesion and Bankart lesion (1):

  • common sequelae to recurrent anterior dislocation of the shoulder joint
  • Hill-Sachs lesion
    • is a compression fracture of the posterolateral humeral head due to its compression against the anteroinferior part of the glenoid when the humerus is anteriorly dislocated
    • the anatomical apposition gives a characteristic position of the lesion; the comparable injury caused by posterior dislocation is a reverse Hill-Sachs lesion
  • Bankart lesion
    • commonly seen in patients with an anterior shoulder dislocation
    • defined as a detachment of the anetroinferior labrum associated with a glenoid rim fracture
    • may occur as an isolated injury to the labrum, or it can extend to the bony glenoid margin, where it is called a "bony Bankart"
  • in most cases, both findings are associated together
  • first anatomic description of the traumatic notch on the humeral head was made in 1855 by Malgaigne
    • in 1940 two radiologists, Harold Arthur Hill and Maurice David Sachs, published a paper, in which they made the radiographic description of lesion, naming it Hill–Sachs lesion (HSL)
    • later on the glenoid rim lesions were reported (2)
    • HSL is often linked with recurrent anterior shoulder instability
      • demonstrated in 67–93% of anterior dislocations and can reach an incidence rate of 100% in patients with recurrent anterior shoulder instability (3)
      • typically occurs with an anteroinferior glenohumeral dislocation event
      • young age and hyperlaxity of the ligaments surrounding the glenohumeral joint lead to a predisposition for recurrence of dislocation
      • most common method of determining the HSL is the Calandra classification, which uses arthroscopy to measure the depth of the lesion

Grade

Description

I

Defect in articular surface that does not affect subchondral bone

II

Defect includes subchondral bone

II

  • Large defect in the subchondral bone
  • quantifying bone loss is of utmost importance to decide the best treatment for recurrent anterior glenohumeral instability patients (3)
    • this is the determinant factor influencing the choice of the surgical technique: soft tissue procedure or bone block procedure
    • 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 bestfit circle on the inferior surface of the glenoid
  • 3DCT 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 (4)

Reference:

(accessed 10/6/2020)

  • Charousset C, Beauthier V, Bellaïche L, et al. Can we improve radiological analysis of osseous lesions in chronic anterior shoulder instability? Orthop Traumatol Surg Res 2010;96:S88–S93.
  • Maio M et al. How to measure a Hill–Sachs lesion: a systematic review. EFORT Open Rev 2019;4:151-157.
  • Fox JK et al. Understanding the Hill-Sachs Lesion in Its Role in Patients with Recurrent Anterior Shoulder Instability. Curr Rev Musculoskelet Med (2017) 10:469–479
  • Shibayama K, Iwaso H. Hill-Sachs lesion classification under arthroscopic findings. J Shoulder Elb Surg. 2017;26(5):888–94

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