Hill-Sachs Lesions in Shoulders With Traumatic Anterior Instability

Ozaki, Ritsuro; Nakagawa, Shigeto; Mizuno, Naoko; Mae, Tatsuo; Yoneda, Minoru

doi:10.1177/0363546514549543

Cited by 63 publications

(44 citation statements)

References 19 publications

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“…While Hill-Sachs lesions were classified according to arthroscopic findings in the present study, a more precise and simple CT classification has been established recently. 18 , 19 Moreover, not only the size but also the location of Hill-Sachs lesion was recently reported to be important according to the concept of the glenoid track. 8 , 26 Although we understood the importance of precise investigation regarding the influence of Hill-Sachs lesions on postoperative recurrence after arthroscopic Bankart repair, detailed investigation based on the size and location of Hill-Sachs lesions by CT might have caused our study to become more complicated.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for the Postoperative Recurrence of Instability After Arthroscopic Bankart Repair in Athletes

Nakagawa

Mae

Sato

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Several risk factors for the postoperative recurrence of instability after arthroscopic Bankart repair have been reported, but there have been few detailed investigations of the specific risk factors in relation to the type of sport.Purpose:This study investigated the postoperative recurrence of instability after arthroscopic Bankart repair without additional reinforcement procedures in competitive athletes, including athletes with a large glenoid defect. The purpose of this study was to investigate risk factors related to the postoperative recurrence of instability in athletes.Study Design:Case-control study; Level of evidence, 3.Methods:A total of 115 athletes (123 shoulders) were classified into 5 groups according to type of sport: rugby (41 shoulders), American football (32 shoulders), other collision sports (18 shoulders), contact sports (15 shoulders), and overhead sports (17 shoulders). First, the recurrence rate in each sporting category was investigated, with 113 shoulders followed up for a minimum of 2 years. Then, factors related to postoperative recurrence were investigated in relation to the type of sport.Results:Postoperative recurrence of instability was noted in 23 of 113 shoulders (20.4%). The recurrence rate was 33.3% in rugby, 17.2% in American football, 11.1% in other collision sports, 14.3% in contact sports, and 12.5% in overhead sports. The most frequent cause of recurrence was tackling, and recurrence occurred with tackling in 12 of 16 athletes playing rugby or American football. Reoperation was completed in 11 shoulders. By univariate analysis, significant risk factors for postoperative recurrence of instability included playing rugby, age between 10 and 19 years at surgery, preoperative glenoid defect, small bone fragment of bony Bankart lesion, and capsular tear. However, by multivariate analysis, the most significant factor was not the type of sport but younger age at operation and a preoperative glenoid defect with small or no bone fragment. Compared with the other sports, there was a significantly greater recurrence rate among rugby players without the aforementioned significant risk factors (small glenoid defect, ≤10%; medium or large bone fragment, >5%; and no capsular tear).Conclusion:Younger age at operation and preoperative glenoid defect with small or no bone fragment significantly influenced recurrent instability among competitive athletes.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for the Postoperative Recurrence of Instability After Arthroscopic Bankart Repair in Athletes

Nakagawa

Mae

Sato

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…16,40,49 More complex osseous lesions must be critically evaluated to ensure comprehensive management. While the glenoid has traditionally been the area of focus, characteristics of the Hill-Sachs lesion have recently received increased attention.…”

Section: Managementmentioning

confidence: 99%

Anterior Shoulder Instability in the Military Athlete

2016

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Context:Given its young, predominately male demographics and intense physical demands, the US military remains an ideal cohort for the study of anterior shoulder instability.Evidence Acquisition:A literature search of PubMed, MEDLINE, and the Cochrane Database was performed to identify all peer-reviewed publications from 1950 to 2016 from US military orthopaedic surgeons focusing on the management of anterior shoulder instability.Study Design:Clinical review.Level of Evidence:Level 4.Results:The incidence of anterior shoulder instability events in the military occurs at an order of magnitude greater than in civilian populations, with rates as high as 3% per year among high-risk groups. With more than 90% risk of a Bankart lesion and high risk for instability recurrence, the military has advocated for early intervention of first-time shoulder instability while documenting up to 76% relative risk reduction versus nonoperative treatment. Preoperative evaluation with advanced radiographic imaging should be used to evaluate for attritional bone loss or “off-track” engaging defects to guide comprehensive surgical management. With complex recurrent shoulder instability and/or cases of clinically significant osseous lesions, potential options such as remplissage, anterior open capsular procedures, or bone augmentation procedures may be preferentially considered.Conclusion:Careful risk stratification, clinical evaluation, and selective surgical management for at-risk military patients with anterior shoulder instability can optimize the recurrence risk and functional outcome in this population.

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“…In a radiographic study, Osaki et al [45] detected only 90 of 118 lesions using CT imaging. Assessment of width and depth of such lesions using 2D CT has had good results, but further studies need to be done to improve these measurements [46].…”

Section: Discussionmentioning

confidence: 99%

Evaluation and treatment of failed shoulder instability procedures

Gowda

Wiater

2016

J Orthopaed Traumatol

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Management of the unstable shoulder after a failed stabilization procedure can be difficult and challenging. Detailed understanding of the native shoulder anatomy, including its static and dynamic restraints, is necessary for determining the patient’s primary pathology. In addition, evaluation of the patient’s history, physical exam, and imaging is important for identifying the cause for failure after the initial procedure. Common mistakes include under-appreciation of bony defects, failure to recognize capsular laxity, technical errors, and missed associated pathology. Many potential treatment options exist for revision surgery, including open or arthroscopic Bankart repair, bony augmentation procedures, and management of Hill Sachs defects. The aim of this narrative review is to discuss in-depth the common risk factors for post-surgical failure, components for appropriate evaluation, and the different surgical options available for revision stabilization.Level of evidence Level V.

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Hill-Sachs Lesions in Shoulders With Traumatic Anterior Instability

Cited by 63 publications

References 19 publications

Risk Factors for the Postoperative Recurrence of Instability After Arthroscopic Bankart Repair in Athletes

Risk Factors for the Postoperative Recurrence of Instability After Arthroscopic Bankart Repair in Athletes

Anterior Shoulder Instability in the Military Athlete

Evaluation and treatment of failed shoulder instability procedures

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