Hill Sachs Lesion : Wheeless' Textbook of Orthopaedics

- Discussion:
- posterolateral humeral head indentation fracture is created occuring from anterior shoulder dislocation, as soft base of humeral
head impacts against relatively hard anterior glenoid;
- occurs in 35-40% of anterior dislocations & upto 80 % of recurrent dislocations;
- during shoulder arthroscopy this lesion is sometimes confused w/ the normal bare area of postero-inferior aspect of humeral head;
- it is noteworthy that the Hill sachs lesion occurs thru the cartilagenous surface of the humeral head and that often there will remain a
small island of cartilage located between the bare area and the Hill Sachs lesion;
- Hill Sachs Lesion may destabilizes glenohumeral joint & may predispose to further dislocation;
- ref: Traumatic Shoulder Dislocation Among Adolescents: Hill-Sachs Lesion Volume and Recurrent Instability

- Radiographs:

- combination of AP view in int rotation & Stryker Notch view allow evaluation of Hill Sachs Lesions in posterolateral aspect of humeral head;
- AP View:
- this defect is visualized on AP x-ray w/ arm in internal rotation & may be missed on routine AP views;
- ref: Radiographic views in recurrent anterior shoulder dislocation. Comparison of 6 methods for identification of typical lesions.

- Treatment:
      - Treatment of osseous defects associated with anterior shoulder instability.
      - Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion
      - Open capsular repair w/o bone block for recurrent anterior shoulder instability in patients with and without bony defects of the glenoid and/or humeral head.
      - Arthroscopic Bankart repair: results and risk factors of recurrence of instability

      - remplissage
                   - The Effect of the Remplissage Procedure on Shoulder Stability and Range of Motion: An in Vitro Biomechanical Assessment
                   - Arthroscopic Bankart repair combined with remplissage technique for the treatment of anterior shoulder instability with engaging Hill-Sachs lesion: a report of 49 cases with a minimum 2-year follow-up.
                   - Anatomical and functional results after arthroscopic Hill-Sachs remplissage
                   - A prospective, comparative, radiological, and clinical study of the influence of the "remplissage" procedure on shoulder range of motion after stabilization by arthroscopic Bankart repair
                   - Arthroscopic remplissage with Bankart repair for the treatment of glenohumeral instability with Hill-Sachs defects
                   - Outcomes of arthroscopic "remplissage": capsulotenodesis of the engaging large Hill-Sachs lesion.