Hill-Sachs Off-track Lesions as Risk Factor for Recurrence of Instability After Arthroscopic Bankart Repair

Locher, Joel; Wilken, Frauke; Beitzel, Knut; Buchmann, Stefan; Longo, Umile Giuseppe; Denaro, Vincenzo; Imhoff, Andreas B.

doi:10.1016/j.arthro.2016.03.005

Cited by 108 publications

(90 citation statements)

References 25 publications

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“…Owens et al proposed an algorithm for the management of instability in the in-season athlete [22]. Athletes with GBL greater than 13.5 to 17.3%, a large (engaging) HS lesion, or recurrent instability events are recommended to have immediate season ending surgery [23][24][25]. Patients with an initial instability event at the beginning of the season may attempt return to play following 2-3 weeks of immobilization and physical therapy, if they are able to perform sport specific activities without pain and instability.…”

Section: Indications/contraindicationsmentioning

confidence: 99%

Arthroscopic Bankart Repair for the Management of Anterior Shoulder Instability: Indications and Outcomes

DeFroda

Bokshan

Stern

et al. 2017

Curr Rev Musculoskelet Med

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Purpose of Review Arthroscopic Bankart repair is commonly utilized for shoulder stabilization in patients with anterior shoulder instability with minimum glenoid bone loss. The purpose of this review is to provide the indications, surgical technique, complications, and recent outcomes in arthroscopic Bankart repair for shoulder instability. Recent Findings Improvements in arthroscopic techniques have led to better patient outcomes, as well as an improved understanding of the pathoanatomy of instability. More recent studies have shown that one of the potential failures of primary arthroscopic repair may be due to unaddressed bone loss. This underscores the importance of evaluating glenoid bone loss and proper patient selection for this procedure to ensure successful outcome. Summary When indicated, arthroscopic stabilization is the treatment of choice for many surgeons due to its lower morbidity and low overall complication rate. Future work must focus on longer-term outcomes in patients undergoing arthroscopic Bankart repair, as well as the clinical outcomes of new fixation techniques, augmentation techniques, and the effect of glenoid bone loss in outcome.

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Section: Indications/contraindicationsmentioning

confidence: 99%

Arthroscopic Bankart Repair for the Management of Anterior Shoulder Instability: Indications and Outcomes

DeFroda

Bokshan

Stern

et al. 2017

Curr Rev Musculoskelet Med

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“…Of the 100 patients, 88 were found to have ‘on-track’ HS lesions and 12 had ‘off-track’ HS lesions. Five patients (6%) with ‘on-track’ HS lesions required revision surgery, while four patients (33%) with ‘off-track’ HS lesions (OR, 8.3, p=0.006) 67. Reporting on outcomes of 38 patients treated with the Latarjet procedure for recurrent instability in the setting of bipolar bone loss, Mook et al demonstrated that 50% (4 of 8) of failures occurred in the setting of ‘off-track’ HS lesions versus 16% (4 of 25) failures with ‘on-track’ lesions (p=0.33).…”

Section: Clinical Results Supporting the Glenoid Track Paradigmmentioning

confidence: 99%

Shoulder instability: State of the Art

et al. 2016

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“…4,5 Furthermore, increasing humeral head and glenoid defect sizes were found to be associated with increasing shoulder instability in a finite-element model. 10 The authors suggested that with increasing defect size, bony reconstruction procedures may be necessary to obtain a stable shoulder.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 In such cases with BBL, it is an important factor to define whether the humeral head is on-track or off-track. [3][4][5] This calculation takes into account the combined bone defects and their locations. In addition, the amount of anterior glenoid bone loss is an essential determinant for the choice of treatment for BBL in AGI.…”

mentioning

confidence: 99%

Arthroscopic Remplissage and Open Latarjet Procedure for the Treatment of Anterior Glenohumeral Instability With Severe Bipolar Bone Loss

Katthagen

Anavian

Tahal

et al. 2016

Arthroscopy Techniques

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Bipolar bone loss in patients with anterior glenohumeral instability is challenging to treat. The goal of the treatment is to restore stability by ensuring that the humeral head remains within the glenoid vault. This can be achieved either with the combination of an arthroscopic Bankart procedure and remplissage (glenoid bone loss <25%), or with a Latarjet procedure (glenoid bone loss >25%). In cases with more severe bipolar bone loss of both the glenoid and the humeral head, the conventional approach has been to lengthen the articular arc of the glenoid and to ignore the Hill-Sachs lesion. However, it has recently been shown that this can still lead to an "off-track" situation with persistent shoulder instability from engagement of the Hill-Sachs on the anterior glenoid. In these cases, the combination of a Hill-Sachs remplissage and the Latarjet procedure can be effective in preventing persistent instability. In this technical note, the surgical technique of an arthroscopic Hill-Sachs remplissage in combination with an open Latarjet procedure is presented.

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Hill-Sachs Off-track Lesions as Risk Factor for Recurrence of Instability After Arthroscopic Bankart Repair

Cited by 108 publications

References 25 publications

Arthroscopic Bankart Repair for the Management of Anterior Shoulder Instability: Indications and Outcomes

Arthroscopic Bankart Repair for the Management of Anterior Shoulder Instability: Indications and Outcomes

Shoulder instability: State of the Art

Arthroscopic Remplissage and Open Latarjet Procedure for the Treatment of Anterior Glenohumeral Instability With Severe Bipolar Bone Loss

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