Posterior shoulder dislocation with associated reverse Hill–Sachs lesion: clinical outcome 10 years after joint-preserving surgery

Abstract

Introduction Posterior shoulder dislocation in association with reverse Hill–Sachs lesion is a rather rare injury. Few studies reporting results after joint-preserving surgery in these cases are available. This current study presents the clinical outcomes 10 years postoperatively. Materials and methods In a prospective case series, we operatively treated 12 consecutive patients (all males) after posterior shoulder dislocation with associated reverse Hill–Sachs lesion using joint-preserving techniques. Patients received surgery in a single center between January 2008 and December 2011. The joint-preserving surgical procedure was chosen depending on the defect size and bone quality. The following outcome-measures were analyzed: Constant-Score, DASH-Score, ROWE-Score, and SF-12. Results 1, 5, and 10 years postoperatively were compared. Results Out of 12 patients, ten patients (83.3%) were followed-up with a mean follow-up interval of 10.7 years (range 9.3–12.8). The mean patient age at the time of the last follow-up was 51 years (32–66). The outcome scores at the final follow-up were: Constant 92.5 (range 70.0–100), DASH 3.2 (0.0–10.8), ROWE 91.0 (85.0–100), and SF-12 87.8 (77.5–98.3). Clinical results had improved from 1 to 5 years postoperatively and showed a tendency for even further improvement after 10 years. Conclusions Joint-preserving surgical therapy of posterior shoulder dislocation provides excellent results when the morphology of the reverse Hill–Sachs lesion is respected in surgical decision-making. Trial registration 223/2012BO2, 02 August 2010.

From Diagnosis to Decision-Making: A Systematic Review of the Management of Reverse Hill-Sachs Lesions after Posterior Shoulder Dislocations

“…Pre-operative UCLA score was reported in four studies and its weighted average was 15.7 (7.8-25.8) [21,26,31,32]. The post-operative weighted average UCLA was found to be 27.4 ± 5.2 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31) and was reported in five studies [21,26,29,31,32].…”

“…Only three studies reported the pre-operative CMS with a mean value of 29 points [5,26,33]. The weighted average CMS found at the post-operative clinical evaluation was 79.4 (59-94) and was reported in 9 studies [5,8,[22][23][24][26][27][28]33]. Joint replacement procedures [28] and rotational osteotomy associated with ML procedure [24] reported the lowest post-operative scores, respectively, 59.5 and 59.…”

“…All studies reported the pre-operative imaging used: pre-operative X-rays were performed in all studies, 13 studies also used CT scans, while MRI was used in 2 studies only. Romano et al and Konrads et al also performed a diagnostic arthroscopy in the surgical setting [5,23]. Measurements of the defect were performed, adopting different techniques: one author used the Chen method, 4 used the Gerber method, 2 used the Moroder method, and 1 used the Hawkins method.…”

“…The clinical and radiological results were reported with a weighted mean follow-up of 62.1 months. The shortest follow-up period (18 months) was reported by Abdel-Hameed et al [21], whereas Gerber et al [22] and Konrads et al [23] reported the longest one with a mean value of 128.4 months. Schliemann et al [24] reported the results of 35 patients with a posterior shoulder dislocation who were treated with different approaches and methods; the demographical data reported refer to the entire population regardless of the treatment method used.…”

“…All of the studies included-except for two [5,8]-used both X-rays and a CT scan. Konrads et al [23] performed a diagnostic arthroscopy as the first part of their surgical procedure in order to assess the cartilage damage: if the patient was treated within 14 days and a cartilage lesion of less than grade 2 (ICRS classification) was detected, the joint surface was restored using a retrograde elevation of the McLaughlin lesion. If worse cartilage damage was found (Grade 3 or 4 ICRS), an open surgical procedure was performed.…”