Peripheral-Track and Central-Track Hill-Sachs Lesions: A New Concept of Assessing an On-Track Lesion

Abstract

Background:

It has been demonstrated biomechanically that 25% is a critical size defect of the glenoid. However, a recent clinical study reported that a bone loss between 13.5% and 20% (subcritical bone loss) led to impairment of quality of life but not a recurrence of instability.

Purpose:

To clarify whether a subcritical bone loss exists in assessing a Hill-Sachs lesion via a disease-specific quality of life questionnaire.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Fifty patients (mean age, 27 years) with <25% glenoid defect who were treated with arthroscopic Bankart repair for recurrent anterior dislocation were assessed at a mean follow-up of 28 months. All had an on-track Hill-Sachs lesion. The Western Ontario Shoulder Instability Index (WOSI) and Rowe scores were used for the clinical evaluation. The Hill-Sachs interval was measured on 3-dimensional computed tomography images and divided by the glenoid track width, defined as the Hill-Sachs occupancy (in percentages). The glenoid track was divided into 4 zones based on the percentage of the Hill-Sachs occupancy: zone 1, <25%; zone 2, 25% to <50%; zone 3, 50% to <75%; and zone 4, ≥75%.

Results:

The recurrence rate was 6% (3 of 50 shoulders). The Rowe score significantly improved from 45.2 ± 4.7 (mean ± SD) preoperatively to 92.3 ± 6.5 at the final follow-up (P < .05). The WOSI score also significantly increased from 46.6% ± 19.3% preoperatively to 72.3% ± 21.0% at the final follow-up (P < .001). The WOSI score of patients in zone 4 (peripheral-track lesion) (n = 10) was significantly lower than those in the other zones (central-track lesion) (P = .0379). Of the 10 patients with the peripheral-track lesion, 5 had a <40% WOSI score, similar to the preoperative WOSI score (46.6%).

Conclusion:

Patients with on-track lesions can be divided into 2 subgroups: those with the Hill-Sachs occupancy ≥75% (peripheral-track lesion) showed significantly worse WOSI score without recurrent instability events than those with the Hill-Sacks occupancy <75% (central-track lesion).

Keywords

shoulder dislocation Hill-Sachs lesion glenoid track peripheral-track lesion central-track lesion

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References

Ahmed

Ashton

Robinson

. Arthroscopic Bankart repair and capsular shift for recurrent anterior shoulder instability: functional outcomes and identification of risk factors for recurrence. J Bone Joint Surg Am. 2012;94(14):1308-1315.

Blomquist

Solheim

Liavaag

Schroder

Espehaug

Havelin

. Shoulder instability surgery in Norway: the first report from a multicenter register, with 1-year follow-up. Acta Orthop. 2012;83(2):165-170.

Boileau

Villalba

Héry

Balg

Ahrens

Neyton

. Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Joint Surg Am. 2006;88(8):1755-1763.

Burkhart

De Beer

. 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. Arthroscopy. 2000;16(7):677-694.

Di Giacomo

Itoi

Burkhart

. Evolving concept of bipolar bone loss and the Hill-Sachs lesion: from “engaging/non-engaging” lesion to “on-track/off-track” lesion. Arthroscopy. 2014;30(1):90-98.

Gervaise

Teixeira

Villani

Lecocq

Louis

Blum

. CT dose optimisation and reduction in osteoarticular disease. Diagn Interv Imaging. 2013;94(4):371-388.

Ide

Maeda

Takagi

. Arthroscopic Bankart repair using suture anchors in athletes: patient selection and postoperative sports activity. Am J Sports Med. 2004;32(8):1899-1905.

Itoi

. “On-track” and “off-track” shoulder lesions. EFORT Open Reviews. 2017;2(8):343-351.

Itoi

Lee

Berglund

Berge

. The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: a cadaveric study. J Bone Joint Surg Am. 2000;82(1):35-46.

10.

Kim

Shin

Cha

Kim

. Arthroscopic double-loadedsingle-row repair in chronic traumatic anterior shoulder dislocation. Arch Orthop Trauma Surg. 2012;132(10):1515-1520.

11.

Kirkley

Griffin

McLintock

. The development and evaluation of a disease-specific quality of life measurement tool for shoulder instability: the Western Ontario Shoulder Instability Index (WOSI). Am J Sports Med. 1998;26(6):764-772.

12.

Kurokawa

Yamamoto

Nagamoto

, et al. The prevalence of a large Hill-Sachs lesion that needs to be treated. J Shoulder Elbow Surg. 2013;22(9):1285-1289.

13.

Lazarus

Sidles

Harryman

Matsen

. Effect of achondral-labral defect on glenoid concavity and glenohumeral stability: a cadaveric model. J Bone Joint Surg Am. 1996;78(1):94-102.

14.

Parten

Burkhart

. The inverted pear glenoid: an indicator of significant glenoid bone loss. Arthroscopy. 2004;20(2):169-174.

15.

Mazzocca

Brown

Carreira

Hayden

Romeo

. Arthroscopic anterior shoulder stabilization of collision and contact athletes. Am J Sports Med. 2005;33(1):52-60.

16.

Omori

Yamamoto

Koishi

, et al. Measurement of the glenoid track in vivo as investigated by 3-dimensional motion analysis using open MRI. Am J Sports Med. 2014;42(6):1290-1295.

17.

Shaha

Cook

Song

, et al. Redefining “critical” bone loss in shoulder instability: functional outcomes worsen with “subcritical” bone loss. Am J Sports Med. 2015;43(7):1719-1725.

18.

Shin

Kim

Jeon

Kwon

. Critical value of anterior glenoid bone loss that leads to recurrent glenohumeral instability after arthroscopic Bankart repair. Am J Sports Med. 2017;45(9):1975-1981.

19.

Yamamoto

Itoi

Abe

, et al. Contact between the glenoid and the humeral head in abduction, external rotation, and horizontal extension: a new concept of glenoid track. J Shoulder Elbow Surg. 2007;16(5):649-656.

20.

Yamamoto

Itoi

Abe

, et al. Effect of an anterior glenoid defect on anterior shoulder stability: a cadaveric study. Am J Sports Med. 2009;37(5):949-954.

21.

Yamamoto

Muraki

Sperling

, et al. Stabilizing mechanism in bone-grafting of a large glenoid defect. J Bone Joint Surg Am. 2010;92(11):2059-2066.

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