Hill-Sachs Injury Research Articles

Mid-term effectiveness of LU-tarjet procedure for recurrent anterior shoulder dislocation

To evaluate the mid-term effectiveness of limited unique coracoid osteotomy suture button fixation Latarjet (LU-tarjet) procedure in treatment of recurrent anterior shoulder dislocation. Between March 2017 and February 2019, 56 patients with recurrent shoulder dislocation were treated with arthroscopic LU-tarjet procedure. There were 44 males and 12 females with an average age of 26.3 years (range, 18-41 years). Shoulder joint dislocation occurred 2-16 times, with an average of 7.5 times. The time from the initial dislocation to operation ranged from 6 months to 13 years, with a median of 4.6 years. Preoperative shoulder joint fear test and re-reduction test were positive in all patients. The Beighton score of joint relaxation ranged from 1 to 7, with an average of 4.1. The shoulder Instability Severity Index Score (ISIS) ranged from 5 to 10, with an average of 7.8. The size of glenoid defects on the affected side ranged from 15% to 32% (mean, 22.4%). All patients had Hill-Sachs injuries of varying degrees. Six patients had re-dislocation after Bankart surgery. The operation time, incision healing, and postoperative complications were recorded. The range of motion (shoulder flexion, extension, abduction, external rotation, 90° external rotation, and internal rotation) and muscle strength in shoulder flexion, abduction, external rotation, and internal rotation) of shoulder joint were compared between pre- and post-operation. The improvement of shoulder function was evaluated using the American Association for Shoulder and Elbow Surgery (ASES) score, Walch-Duplay score, and Rowe score. X-ray films and three-dimensional CT were used to analyze the location, healing, and remolding of bone graft, the repair of glenoid defect, and degenerative changes of the shoulder joint. All operations were successfully completed. The operation time ranged from 42 to 98 minutes, with an average of 63 minutes. All incisions healed by first intention. All patients were followed up 5-7 years (mean, 6.3 years). During follow-up, 2 patients experienced shoulder subluxation within 1 year after operation and 1 patient experienced recurrent shoulder joint pain. The remaining patients had no related complications. At last follow-up, there was no significant difference between the two groups ( P>0.05) in range of motion (shoulder flexion, extension, abduction, external rotation, 90° external rotation, and internal rotation) and muscle strength in shoulder flexion, abduction, external rotation, and internal rotation). The ASES score, Rowe score, and Walch-Duplay score of shoulder significantly improved when compared with those before operation ( P<0.05). Postoperative CT showed that 53 cases (94.64%) of coracoid bone masses were centered placed vertically, 2 cases (3.57%) were superior, and 1 case (1.79%) was inferior; 49 cases (87.50%) of the coracoid bone grafts were flush with the glenoid, 2 cases (3.57%) and 5 cases (8.93%) were medially and laterally positioned. The volume of coracoid bone graft decreased first and then increased, and the shape of the bone graft was continuously remodeling and gradually matched with the track of the humerus head (the optimal circle of the glenoid), all coracoid bone grafts healed. At last follow-up, the coverage rate of optimal glenoid circle was 89.6%-100%, with an average of 97.4%. The area of glenoid defect was 2.6%±1.3%, which significantly decreased when compared with preoperative (22.4%±5.4%) ( P<0.05). At last follow-up, no obvious degenerative changes of shoulder joint was observed. LU-tarjet procedure for recurrent anterior shoulder dislocation has good mid-term effectiveness with short operation time and few complications.

Bilateral posterior shoulder dislocation with associated reverse Hill-Sachs lesions after electrical injury

After workers suffer electric shock, the ankylosis and contraction of muscle groups around the shoulder joint are more likely to lead to posterior dislocation and fracture, of which 80% are complicated with reverse Hill-Sachs injury of humeral head. This paper reports a case of bilateral posterior dislocation of shoulder joint combined with Hill-Sachs injury caused by electric shock in the Department of Orthopedics, Affiliated Huzhou Hospital, Zhejiang University School of Medicine in August 2020. The diagnosis of left posterior shoulder dislocation was clear, and the diagnosis of right posterior shoulder dislocation was missed. The patient successfully reconstructed the stability of the shoulder joint by actively performing shoulder arthroscopic surgery to repair the joint capsule. After 6 months of follow-up, there was no further dislocation and the function was good.

Arthroscopic Bankart repair combined with Reimplissage for the treatment of recurrent anterior dislocation of shoulder in adults with Hill-Sachs defect

To investigate the method and clinical effects of the treatment of recurrent anterior dislocation of shoulder with Hill-Sachs injury by arthroscopic Bankart repair and Remplissage. From March 2016 to March 2019, 106 patients with recurrent anterior dislocation of shoulder with glenoid bone defect less than 20% underwent arthroscopic Bankart repair, including 76 males and 30 females, aged from 18 to 45 (27.3±8.6) years, 59 cases of left shoulder and 47 cases of right shoulder. Range of motion (ROM), American Shoulder and Elbow Surgeons(ASES) score, Constant-Murley score and Rowe score were used to evaluate shoulder functionand stability before and after operation. All patients were followed up, and the duration ranged from 21 to 60 months, with a mean of (41.5± 8.5) months. One patient developed infection after operation, and the infection was controlled after arthroscopic debridement again. The remaining patients did not have clinical complications such as infection, intra articular hematocele and redislocation. Shoulder flexion and lifting increased from (158.33±15.72) ° preoperatively to (169.43±10.04) ° at the latest follow up, and internal rotation changed from T7 (T4 to T10) preoperatively to T8 (T5 to T10) at the latest follow up;the average lateral external rotation and abduction 90 ° external rotation decreased from (58.46±15.51) ° preoperatively and (99.37±14.09) ° to (53.18±14.90) ° and (92.52±13.10) ° at the latest follow up, respectively. The ASES score, Constant -Murley score and Rowe score were significantly improved. The clinical effect of rehabilitation of Bankart repair combined with Remplissageunder arthroscopy in the treatment of recurrent dislocation of shoulder joint in adults with Hill-Sachs defect is satisfactory. Although the external rotation function is weaker than that before operation, it can effectively reconstruct the shoulder function and avoid the occurrence ofdislocation after operation.

Evaluation and Management of Glenohumeral Instability With Associated Bone Loss: An Expert Consensus Statement Using the Modified Delphi Technique

To establish an international expert consensus, using the modified Delphi technique, on the evaluation and management of glenohumeral instability with associated bone loss. A working group of 6 individuals generated a list of statements related to history and physical examination, imaging and specialized diagnostic tests, bone loss quantification and classification, treatment outcomes and complications, and rehabilitation for the management of glenohumeral instability associated with bone loss to form the basis of an initial survey for rating by a group of experts. The expert group (composed of 22 high-volume glenohumeral instability experts) was surveyed on 3 occasions to establish a consensus on the statements. Items with over 70% agreement and less than 10% disagreement achieved consensus. After a total of 3 rounds, 31 statements achieved consensus. Eighty-six percent of the experts agreed that a history of multiple dislocations and failed soft-tissue surgery should raise suspicion about the possibility of an associated bone deficit. Ninety-five percent of the experts agreed that 3-dimensional (3D) computed tomography (CT) is the most accurate diagnostic method to evaluate and quantify bone loss. Eighty-six percent of the experts agreed that any of the available methods to measure glenoid bone deficiency is adequate; however, 91% of the experts thought that an en face view of the glenoid using 3D CT provides the most accurate method. Ninety-five percent of the experts agreed that Hill-Sachs lesions are poorly quantified and classified by current imaging systems. Ninety percent of the experts agreed that in cases with a glenoid bone deficit greater than 20%, glenoid bone graft reconstruction should be performed and any of the available options is valid. There was no consensus among experts on how Hill-Sachs injuries should be managed or on how postoperative rehabilitation should be carried out. The essential statements on which the experts reached consensus included the following: A history of multiple dislocations and failed soft-tissue surgery should make surgeons consider the possibility of an associated bone deficit. Three-dimensional CT is the most accurate diagnostic method to evaluate and quantify bone loss. Although any of the available methods to measure glenoid bone deficiency is adequate, an en face view of the glenoid using 3D CT provides the most accurate method. Hill-Sachs lesions are poorly quantified and classified by current imaging systems. Finally, in cases with a glenoid bone deficit greater than 20%, glenoid bone graft reconstruction should be performed. Level V, consensus statement.

Traitement arthroscopique par autogreffe iliaque de l’instabilité postérieure de l’épaule avec lésion inversée de Hill–Sachs

Posterior dislocation of the shoulder is often accompanied by an impression fracture in the anterior surface of the humeral head, called a reverse Hill–Sachs injury. This bone defect can engage on the posterior glenoid rim, which can lead to recurrent instability and progressive joint destruction. We describe a new arthroscopic procedure that fills the reverse Hill–Sachs lesion with an iliac bone-block autograft and repairs the posterior articular capsule arthroscopically, which can stabilize the posterior shoulder. It avoids the need to detach the subscapularis tendon and can reduce the risks associated with open procedures. Level of evidenceV, technical note.

Arthroscopic treatment of posterior instability of the shoulder with an associated reverse Hill–Sachs lesion using an iliac bone-block autograft

Posterior dislocation of the shoulder is often accompanied by an impression fracture in the anterior surface of the humeral head, called a reverse Hill–Sachs injury. This bone defect can engage on the posterior glenoid rim, which can lead to recurrent instability and progressive joint destruction. We describe a new arthroscopic procedure that fills the reverse Hill–Sachs lesion with an iliac bone-block autograft and repairs the posterior articular capsule arthroscopically, which can stabilize the posterior shoulder. It avoids the need to detach the subscapularis tendon and can reduce the risks associated with open procedures. Level of evidenceV, technical note.

Clinical forms of shoulder instability in pediatric patients

Background. The recurrence rate of adolescent chronic shoulder instability is approximately 56%–68%. However, this pathology is often missed in childhood and adolescence.Aim. To identify the clinical forms of shoulder joint instability in pediatric patients.Materials and methods. The authors present the data from 57 pediatric patients aged 3−17 years with a total of 61 unstable shoulder joints. All patients were divided into groups according to the form of instability. Traumatic chronic shoulder instability was identified in 40 patients (Bankart and Hill–Sachs injuries). Of these, non-traumatic shoulder instability was diagnose in 17, including five with recurrent dislocation, and spontaneous shoulder dislocation due to dysplasia of glenoid and labrum was diagnosed in 12. Of the 57 patients in the study cohort, 53 underwent surgery. Postoperatively, two patients developed recurrent shoulder dislocation (Andreev–Boichev technique) due type III shoulder dysplasia in the first patient and multidirectional injury in the second.Conclusions. Shoulder joint instability should be considered as the traumatic or non-traumatic form. Treatment decisions should be based on anatomical characteristics that predispose to recurrent dislocation.

The Evaluation of Hill-Sachs Injuries and the Use of Humeral Head Allograft for Repair of Hill-Sachs and Reverse Hill-Sachs Injuries

The human shoulder is an inherently stable joint. Changes within the anatomical structure of the shoulder, both static and dynamic, allow for significant movement in multiple planes, making the shoulder one of the most commonly dislocated joints in the body. Anterior glenohumeral dislocation can result in glenoid bone loss because of fracture abrasion or the compression of the anterior inferior glenoid against the posterior lateral aspect of the humeral head known as a lesion. Posterior shoulder instability is a much more rare injury, which may result in significant bone defects of the anterior humeral head. Often, small defects are addressed by soft tissue repair, whereas larger defects may require a bony procedure, such as the use of humeral head allograft for the repair of Hill-Sachs and reverse Hill-Sachs lesions.

Glenohumeral instability in patients over 40 years-old: injuries, treatment and complications

IntroductionRecurrent shoulder dislocation is infrequent after forty years and presents different injuries than younger patients. ObjectiveTo compare injuries and complications after surgery between one group older than forty years of age and another younger group. Material and methodsA review was made on all patients who had undergone arthroscopic surgery due to glenohumeral instability from 1999 until 2011. The mean follow-up was 64 months.The case group consisted of all patients older than 40 years at the time of the surgery (n=21), which was compared with a similar sized control group of randomly selected younger patients (n=27). ResultsThe mean age in the older group was 54 years (SD 11.86), while it was 26 years (SD 5.80) in the younger group.No differences were founded between both groups in labrum injury, Hill–Sachs injury, and bone Bankart lesion (P>.05). Rotator cuff tears were 7.3 times (95% CI; 2.5–21.6) more frequent in the older group (81%) compared to the younger group (P<.05). However, neurological injuries after dislocation were not more frequent in this group.There was no significant difference between the complications after surgery and the age according to the design (P>.05). ConclusionsAnterior recurrent dislocation after forty years of age is usually associated with rotator cuff tears. Arthroscopic treatment of instability was effective with no more postoperative complications.

Inestabilidad glenohumeral en pacientes mayores de 40 años: lesiones, tratamiento y complicaciones

IntroductionRecurrent shoulder dislocation is infrequent after forty years and presents different injuries than younger patients. ObjectiveTo compare injuries and complications after surgery between one group older than forty years of age and another younger group. Material and methodsA review was made o all patients who had undergone arthroscopic surgery due to glenohumeral instability from 1999 until 2011. The mean follow-up was 64 months.The case group consisted of all patients older than 40 years at the time of the surgery (n=21), which was compared with a similar sized control group of randomly selected younger patients (n=27). ResultsThe mean age in the older group was 54 years (SD 11.86), while it was 26 years (SD 5.80) in the younger group.No differences were founded between both groups in labrum injury, Hill-Sachs injury, and bone Bankart lesion (P>.05). Rotator cuff tears were 7.3 times (95% CI; 2.5-21.6) more frequent in the older group (81%) compared to the younger group (P<.05). However, neurological injuries after dislocation were not more frequent in this group.There was no significant difference between the complications after surgery and the age according to the design (P>.05). ConclusionsAnterior recurrent dislocation after forty years of age is usually associated with rotator cuff tears. Arthroscopic treatment of instability was effective with no more postoperative complications.

Clinical Application of the "Glenoid Track" Concept for Defining Humeral Head Engagement in Anterior Shoulder Instability: A Preliminary Report.

Background:The optimal treatment of Hill-Sachs injuries is difficult to determine and is potentiated by the finding that a Hill-Sachs injury becomes more important in the setting of glenoid bone loss, making engagement of the humeral head on the glenoid inherently easier. The “glenoid track” concept was developed to biomechanically quantify the effects of a combined glenoid and humeral head bony defects on instability.Purpose:To clinically evaluate humeral head engagement on the glenoid by utilizing glenoid track measurements of both humeral head and glenoid bone loss.Study Design:Retrospective cohort.Methods:A total of 205 patients with recurrent anterior shoulder instability were evaluated, and of these, 140 patients (68%; 9 females [6%] and 131 males [94%]) with a Hill-Sachs lesion and a mean age of 27.6 years (range, 15-47 years; standard error of mean [SEM], 0.59) were included in the final magnetic resonance angiogram [MRA]) analysis. Bipolar bone loss measures of glenoid bone loss (sagittal oblique MRA) and multiple size measures of the Hill-Sachs injury (coronal, axial, and sagittal MRA) were recorded. Based on the extent of the bipolar lesion, patients were classified with glenoid track as either outside and engaging of the glenoid on the humeral head (OUT-E) or inside and nonengaging (IN-NE). The 2 groups were then compared with clinical evidence of engagement on examination under anesthesia (EUA) using video arthroscopy, number of dislocations, length of instability, and patient age.Results:The mean glenoid bone loss was 7.6% (range, 0%-29%; SEM, 1.20%), and 31 of 140 (22%) patients demonstrated clinical engagement on EUA. Radiographically, 19 (13.4%) patients were determined to be OUT-E, while 121 (86.6%) were IN-NE and not expected to engage. Of those 19 patients with suggested radiographic engagement (OUT-E), 16 (84.5%) had clinical evidence of engagement versus only 12.4% that clinically engaged (15/121) without radiographic evidence of engagement (IN-NE) (P < .001). Younger age and a greater number of recurrence events were jointly predictive of a patient being classified as OUT-E (11.8 vs 6.4 dislocations; P = .015).Conclusion:This study demonstrates that glenohumeral engagement was well predicted based on preoperative glenoid and humeral head bone loss measurements using the glenoid track method. In addition, younger age and a greater number of recurrences were predictive of engagement. The glenoid track concept may be important to fully assess the overall risk for engagement prior to surgery and may help guide surgical decision making such as bony augmentation procedures.

Arthroscopic findings in the recurrent anterior instability of the shoulder

A recurrent anterior shoulder dislocation consists of a variety of lesion types. To evaluate the pathological classification of recurrent anterior dislocation of the shoulder joint under arthroscopy. Thirty-one patients with recurrent anterior shoulder dislocation were inspected by arthroscopy, including 23 males and 8 females, with a mean age of 35.1 (18-46) years. The patients were divided into two groups: 17 with shoulder dislocation and hyper-laxity (the hyper-laxity group) and 14 with only traumatic shoulder dislocation (the trauma group). All the patients were assessed by arthroscopy for pathological changes, and the differences in the pathological changes were compared between the two groups. All these 31 patients suffered from anteroinferior labrum injury. Twenty-five had Hill-Sachs injury; 27, bone or cartilage injury of anteroinferior glenoid; 16, SLAP injury; and 5, rotator cuff injury. Bankart injury occurred more in the trauma group, and anterior labroligamentous periosteal sleeve avulsion injury and glenolabral articular disruption injury were more in the hyper-laxity group. Bone or cartilage injury of anteroinferior glenoid was more noticed in the trauma group. Significant differences are found under arthroscopy in the pathological changes of recurrent anterior shoulder dislocation between the purely traumatic group and the hyper-laxity group. The pathological changes in the trauma group were more severe than in the hyper-laxity group.

Balloon treatment of posterior shoulder dislocation with reverse Hill–Sachs injury: description of a new technique

Posterior shoulder dislocations are rare, and are usually the result of seizures. Anterior defects of the humeral head known as "reverse Hill-Sachs lesions" may increase the risk of recurrent dislocation and are difficult to treat. We developed a percutaneous technique for reduction of the dislocation or reduction of the anterior impaction fracture, using percutaneous balloon dilatation and cement fixation. From 2009 to 2012, three patients aged 33, 72 and 75 years were admitted to our institution with a posterior shoulder dislocation showing an anterior "reverse Hill-Sachs" impaction fracture. One case was bilateral (four fractures). Patients were operated upon in the sitting position; the humeral head was stabilised by external fixator pins during balloon inflation. Reduction or filling of the defect was obtained in all cases. All patients were followed up and two patients (three fractures) were examined after one year by an independent observer. The clinical results were assessed using the Constant score and the RAND-36 physical components score. A computed tomography (CT) scan was obtained in all patients before and after the operation and at the latest follow-up. At three months postoperatively, all patients had resumed work or daily life activities with no limitation. The mean Constant score was 71 and RAND-36 score was 85.5. After one year, the mean Constant score was 73 and the RAND-36 score was 86.4 for the two patients who had sufficient follow-up. On the postoperative radiograph and CT scan, sphericity of the humeral head was restored, and the reverse Hill-Sachs impaction was filled or reduced in all cases. There was no recurrent dislocation. Based on this small series, we believe that this technique should be added to our current armamentarium for posterior shoulder dislocations showing a deep impaction fracture of the humeral head that are at risk for recurrent dislocation.

Incidence of Associated Injury in Posterior Shoulder Dislocation

Posterior shoulder dislocations are rare and often missed. Classically associated with seizures, very little is known about the incidence and type of associated injuries. Unfortunately, the majority of the literature consists of incidental reports or small case series. Our goal was to increase the strength of available data by performing a systematic review. We searched EMBASE and PubMed for the terms "posterior shoulder dislocation." Our inclusion criteria were articles in either English or French with the words "posterior" and "dislocation" in the abstract or title. All reports of chronic cases or instability as well as those without patient information were excluded. Data regarding demographics, etiology, investigations, associated injuries, treatments, and outcomes were extracted. All data were analyzed by using SPSS 18.0 (IBM, Chicago, IL). A total of 766 articles were found of which 108 were retained for analysis. A total of 475 patients (543 shoulders) were compiled. Seizures were reported in 34% of cases. A majority of dislocations (65%) had associated injuries. Fracture was most common followed by reverse Hill-Sachs and cuff tears. In the absence of fracture or reverse Hill-Sachs injury, the risk of cuff tear increased nearly fivefold (odds ratio, 4.6; P = 0.016). Our results suggest the amount of associated injuries related to posterior shoulder dislocation is far greater than thought. We propose an investigation algorithm for acute posterior shoulder dislocations.

Clinical Grading of Hill-Sachs Injuries: Association with Glenoid Bone Loss and Clinical Application of the “Glenoid Track” Concept in Terms of Humeral Head Engagement (SS-13)

Clinical Grading of Hill-Sachs Injuries: Association with Glenoid Bone Loss and Clinical Application of the “Glenoid Track” Concept in Terms of Humeral Head Engagement (SS-13)

Traumatic Bilateral Posterior Fracture-Dislocation of Shoulders

Bilateral posterior fracture-dislocation of shoulders (BPFDS) is a rare injury and is most commonly sustained after epileptic seizure, extreme trauma or electrocution. A unique case of isolated BPFDS as a result of a fall from a bicycle in a healthy young man is presented. Unilateral posterior fracture-dislocation of the shoulder as a result of trauma is rare and such an injury occurring bilaterally is yet to be reported in the literature. BPFDS is associated with rotator cuff tears, reverse Hill-Sachs lesion and posterior labrum injuries. BPFDS if not treated promptly can lead to avascular necrosis of the head of humerus. Diagnosis of BPFDS is difficult and if there is any suspicion on the plain films, CT or MRI scans should be performed to confirm the diagnosis and define any associated injuries.