Hill sachs remplissage, an arthroscopic solution for the engaging hill sachs lesion. Concomitant reverse hillsachs lesion and posterior. The hill sachs hs lesion is very common and can be observed in almost 100% of patients with recurrent anterior shoulder dislocation. Postoperative status showing the subscapularis tendon scarred to the former hill sachs lesion. Horst and his colleagues also found that a larger hill sachs lesion leads to greater.
We then position 2 spinal needles to determine the angle of approach for the transtendon placement of the suture anchors. We evaluated the ability of sonography to identify engaging hill sachs lesions by using a transaxillary approach and dynamic scanning. The lesion is a bipolar injury, and identification of concomitant glenoid bone loss is essential to optimize clinical outcome. Marys medical center, san francisco, ca, usa bsportsmed orthopaedic group, inc, san francisco, ca, usa background. The humeral head is well centred in the glenoid knee surg sports traumatol arthrosc 20 21. On mr a hill sachs defect is seen at or above the level of the coracoid.
Glenohumeral dislocation with engaging hillsachs lesion. Mri evaluation of bipolar bone loss using the ontrack off. The incidence of these lesions in the setting of glenohumeral. Hillsachs lesion classification under arthroscopic findings. Hillsachs lesions are best treated with a surface replacement. With the arm moving along the posterior endrange of movement, or with the arm in various degrees of abduction, maximum external rotation and maximum horizontal extension, the glenoid moves along the posterior. The hill sachs lesion is a compression fracture caused by impact on the trabe culae of the humeral head during anterior glenohumeral dislocation. Since then, studies have shown such lesions to exist.
We present a new technique to address these lesions arthroscopicassisted with the use of a bone substitute. This injury occurs when you dislocate your shoulder. Jbjs noted 2% recurrance rate 2 subluxatons if you want to hedge the bet consider scope remplissasge with open bankart repair vs scope bankart age. The shoulder was secured in an immobilizing sling for. Doctors would be at a loss without this term, but it is commonly wrongly regarded by lay people as implying some specific condition such as an adhesion. Hillsachs lesion on mr arthrography of the shoulder koreamed. Avoid placing the joint capsule under stress by stretching into abduction or er during the early phases of rehabilitation, until dynamic joint stability is restored. A hillsachs lesion is a compression fracture of the humeral head in occurrence with anterior glenohumeral instability. One of the treatment principles consists of the subscapular tendon transfer to the injury area or mclaughlin procedure. There was a trend for a larger biceps angle in the engaging group. This paper presents the results of arthroscopic remplissage in the treatment of traumatic. Oct 05, 2015 the hill sachs lesion that extended medially over the glenoid track was observed in 7% of 100 shoulders with recurrent anterior instability. Arthroscopic doublepulley remplissage technique for engaging hillsachs lesions in anterior shoulder instability repairs.
A bone loss of the humeral head, known as a hill sachs lesion hsl, is a compression fracture of the humeral head caused by the anterior rim of the glenoid when the humeral head is dislocated anteriorly in front of the glenoid. We present an arthroscopic technique used to treat traumatic shoulder instability in patients with glenoid bone loss and a large hillsachs lesion. Under abduction and external rotation, this lesion may engage the anterior glenoid border, thus favoring instability. Hill sachs lesion is a defect of the posterosuperior aspect of the humeral head that occurs during an episode of instability. Four out of five patients with anterior instability have both hill sachs and glenoid bone lesions, which is called a bipolar lesion. It results from forceful impaction of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly. Eleven patients had evidence of an engaging hill sachs lesion on physical ex amination and 22 did not. Rowe and colleagues with subsequent work by burkhart specifiedthe pathologic nature of the hill sachs lesion as large and engaging humeral head defects on the anterior glenoid that often. The analysis revealed that neither radiography nor arthroscopy displayed the lesion with sufficient accuracy to represent a true standard of reference for the evaluation of mr imaging in the diagnosis of the hillsachs lesion.
Remplisssage is the open or arthroscopic transposition of the infraspinatus tendon into the humeral head defect. The management of hill sachs lesions is complex and involves numerous interventions. Arthroscopic remplissage with bankart repair for the. The patient had an uneventful postoperative course and was discharged the next day. The hill sachs lesion hsl is a humeral head impres sion fracture that occurs after anterior shoulder dislocation. Regarding the severity of hill sachs lesion, the largest surface length of hill sachs lesion measured on contiguous axial mr images ranged from 9. This lesion is important because it may contribute to recurrent.
When this happens, a pocket at the front of the glenoid forms that allows the humeral head to dislocate into it. The shoulder remplissage procedure for hill sachs lesions. Both are produced during the anterior dislocation of the. In terms of glenoid bone loss, several studies have. A case of a man with a reverse hill sachs defect treated with a modification of mclaughlins original technique is presented. Hillsachs lesions are felt to become clinically important if they engage around the anterior rim of the glenoid at a position of function. Hillsachs lesion measurement with tridimensional models. Arthroscopicassisted treatment of a reversed hillsachs. Arthroscopic panlabral repair with remplissage of hill. Intraoperative photographs showing the defect of the posterolateral aspect of the humeral head a.
Arthroscopic treatment of a reverse hillsachs lesion. Assessment of coincidence and defect sizes in bankart and. A hillsachs lesion, or hill sachs fracture, is a cortical depression in the posterolateral head of the humerus. Avoid activities in extreme roms early in the rehabilitation process factors affecting recovery time. Anterior shoulder instability is often accompanied by a hillsachs defect on the humeral head.
We report the case of a 45yearold male with a reversed hill sachs lesion after posterior shoulder dislocation. A report of 49 cases with a minimum 2year followup. The hill sachs lesion is a compression fracture of the posterosuperolateral aspect of the humeral head that occurs when it comes into contact with the dense cortical bone of the anterior glenoid. This lesion is caused by an anterior shoulder dislocation which causes a humeral head. Radiographic analysis of the hillsachs lesion in anteroinferior shoulder instability after firsttime.
Thepatientwastreated with combined arthroscopic posterior labral repair, capsulorrhaphy, and fracture disimpaction of the reverse hill sachs defect, leading to an excellent outcome. Hillsachs remplissage, an arthroscopic solution for the. We found it useful to divide our patients into 2 groups. Four out of five patients with anterior instability have both hill sachs and glenoid bone lesions, which is called a. A hill sachs lesion extending beyond the medial margin of the track, meaning that the hill sachs width is greater than the width of the glenoid track, would lead to decreased contact between the apposing bone surfaces and increased risk of engagement and instability fig. We evaluated the ability of sonography to identify engaging hill sachs lesions by using a transaxillary approach and dynam. Anterior shoulder instability with engaging hill sachs lesion. Hill sachs lesions were measured with rhinocerus 5. There was no statistically significant difference between any of the dimensions or overall area of the hill sachs lesion when comparing the group with an engag ing hill sachs lesion and the group with a nonengaging lesion surface area, 3.
Several open techniques have been developed to address large hill sachs lesions, including an open transfer of the infraspinatus tendon and capsule into the defect. Osteoarticular allograft reconstruction for hillsachs. Sonography as a tool for identifying engaging hillsachs. It was first described by two radiologists by the name ha hill and md sachs in 1940. Aug 17, 2019 a hill sachs lesion is a bony defect of the humeral head that is often linked with recurrent anterior shoulder instability. Anatomical reconstruction of reverse hillsachs lesions. A hillsachs defect is the terminology of preference over other terms, such as hillsachs lesions, and hillsachs fractures 14. Bony defects of the glenoid are reported in 8% 90% of cases of traumatic anterior shoulder instability.
The prevalence of a large hill sachs lesion that needs to be treated. Searches were undertaken in scopus and pubmed data. Hill sachs lesion is a defect of the posterosuperior aspect of the humeral head that. The hill sachs lesion that extended medially over the glenoid track was observed in 7% of 100 shoulders with recurrent anterior instability. The prevalence of hill sachs lesions was found to be 84.
They range from the skin sores associated with eczema to the changes in lung tissue that occur in tuberculosis. A hillsachs lesion, or hill sachs impaction fracture, is an injury to the back portion of the rounded top of your upper arm bone humerus. The incidence of these lesions in the setting of glenohumeral instability is relatively high and approaches 100% in persons with recurrent anterior shoulder instability. Engaging hill sachs lesions can be a factor predictive of recurrent anterior shoulder instability, yet no method has been recognized as an effective means to predict engagement.
A hillsachs lesion is a compression fracture or dent of the posterosuperolateral humeral head that occurs in association with anterior instability or dislocation of the glenohumeral joint. Sachs lesion was found in 54 88% shoulders of the 61 surgically treated patients. Biomechanical studies suggest that humeral head lesions as small as 12. The measurement was made on the axial images at the point with the largest medial extent of the hill sachs lesion. Introduction posterosuperolateral compression fractures of the humeral head, eponymously described by hill and sachs in 1940, occur in 4090% of anterior shoulder dislocations and typically occur in conjunction with anterior capsulolabral tears bankart and variant lesions. Fresh osteochondral allograft to the humeral head for. Arthroscopic remplissage using a doublepulley system for. The extent of bankart lesion according to the arthroscopic reports in 78 patients showing hill sachs lesions on mr arthrograms, ranged from one to six. Association of bankart and hill sachs lesions the occurrence of both hill sachs and bankart lesions is associated with anterior shoulder dislocation. May 01, 2012 in 1940, hill and sachs 1 described an impaction fracture of the posterolateral humeral head following traumatic anterior shoulder dislocation. Concomitant reverse hillsachs lesion and posterior humeral. A bankart lesion is an injury of the anterior glenoid labrum of the shoulder due to anterior shoulder dislocation. A hillsachs defect is the terminology of preference over other terms, such as hillsachs lesions, and hillsachs fractures 14 repeat dislocations lead to larger defects, which can result in an engaging hillsachs defect, which engages the anterior glenoid when the shoulder is abducted and externally rotated 4 see article.
It is an indication for surgery and often accompanied by a hill sachs lesion, damage to the posterior humeral head the bankart lesion is named after english. Vote on proceedure 20 year old athlete with a hill sachs engaging 20mm 10mm 5 mm 1. Glenoid bone loss is typically associated with the hill sachs lesion in patients with recurrent anterior shoulder instability. Sachs lesion is an osseous defect of the humeral head that is typically associated with anterior shoulder instability.
With engaging hill sachs lesion the shoulder is in an abducted and externally rotated position, increasing the likelihood of recurrent glenohumeral dislocations. Impaction fractures of the anterior aspect of the humeral head, the reversed hill sachs lesion, are common in posterior shoulder dislocation. Traumatic glenohumeral bone defects and their relationship to. Using surgical findings as the gold standard, we found sonography to be 96% 52 of 54 cases sensitive, 100% specific seven of seven cases, and 97% 59 of 61 cases accurate in the diagnosis of hillsachs lesion. Lesions were considered engaging, or offtrack, if the hill sachs interval exceeded the glenoid track. The hill sachs lesion has a width equal to 3 probe tips. A hillsachs lesion represents an impression fracture of the posterolateral margin of the humeral head caused by impaction on the anteroinferior rim of the glenoid during an anterior shoulder dislocation. Pdf measurement of adult hillsachs lesions on magnetic. A hill sachs lesion occurs when the lesion to the labrum presents simultaneously with a. Posterior shoulder instability with a reverse hillsachs.
Lesion is a broad term, including wounds, sores, ulcers, tumors, cataracts, and any other tissue damage. Hillsachs lesion is not a significant prognostic factor for. The hill sachs interval was assessed in all three mri planes axial, coronal, and sagittal. A hillsachs lesion is a compression fracture or dent of the posterosuperolateral humeral head that occurs in association with anterior instability or dislocation. Sachs lesion has been described in patients with posterior shoulder instability. Management of hillsachs lesions international congress for. Midlateral distance, perpendicular to humeral shaft, cranialcaudal distance, parallel to humeral shaft, and the longitudinal distance of the lesion were measured. The posterior remplissage portal must be at the appropriate angle and centered on the hill sachs lesion. Normal bankart lesion normal hillsachs lesion total. This essentially converts the reverse hill sachs lesion. Anatomical reconstruction of reverse hillsachs lesions using. Pdf evolving concept of bipolar bone loss and the hill. We termed it mirror hill sachs and discussed it further.
Hill sachs lesion evaluated with magnetic resonance abstract background. Hill and sachs1 first described these humeral head defects in 1940. Repeat dislocations lead to larger defects, which can result in an engaging hillsachs defect, which engages the anterior glenoid when the shoulder is abducted and externally rotated 4. For defects that affect between 20% and 40% of the. This leads to laxity of posterior band of the inferior glenohumeral ligament with posterior displacement of the humeral. An animated description of two conditions that can occur with a shoulder dislocation and contribute to further shoulder instability. Reverse bankart lesion radiology reference article. It is an indication for surgery and often accompanied by a hill sachs lesion, damage to the posterior humeral head. Reverse bankart lesion is defined as the detachment of posteroinferior labrum with avulsion of posterior capsular periosteum.
Even before the description of the lesion by hill and sachs in 1940, there was debate on how to treat osseous defects of the humeral head. The hill sachs angle has been defined by cho et al. Repairing a bankart lesion without simultaneously addressing significant hill sachs lesions may result in repeated. If the posterior portal initially created is not ideally located, a spinal needle is used to accurately localize a portal well centered over the hill sachs lesion and inserted with an 8. Reverse hill sachs lesion has been described in patients with posterior shoulder instability. May 01, 2012 this led to clinical suspicion of a reverse hill sachs lesion, and ct scan with 3dimensional reconstruction revealed an anterior humeral head lesion involving 35% of the head circumference and an.
Apr 17, 2020 a hill sachs lesion occurs when the lesion to the labrum presents simultaneously with a. Connolly3 reported satisfactory results in all but 1 of 15 patients treated with this transfer of the infraspinatus tendon for large defects of the humeral head. Diagnosis, classification, and management the hill sachs lesion is an osseous defect of the humeral. This leads to laxity of posterior band of the inferior glenohumeral ligament with posterior displacement of the humeral head as is the case with a bankart lesion, the trauma may be severe enough to involve the bony glenoid, resulting in an accompanying small flake. Osteoarticular allograft reconstruction for hillsachs lesion. Management of hillsachs lesions international congress. Hillsachs and bankart lesions are commonly found when evaluating the shoulder instability 57. The patient is in the lateral position with the arm.
The hill sachs lesion is an osseous defect of the humeral head that is typically associated with anterior shoulder instability. Hillsachs lesion measurement with tridimensional models in. Despite the large range of increase in stiffness, no technique stiffened the joint significantly more than the others s. It maintains the attachment of the subscapularis tendon to the lesser tuberosity while insetting it into the bony defect with 2 suture anchors. An exceptional case of posterior shoulder fracture. Hillsachs lesion on mr arthrography of the shoulder.
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