Relationship Between Glenoid Defects and Hill-Sachs Lesions in Shoulders With Traumatic Anterior Instability

Nakagawa, Shigeto; Ozaki, Ritsuro; Take, Yasuhiro; Iuchi, Ryo; Mae, Tatsuo

doi:10.1177/0363546515597668

Cited by 64 publications

(62 citation statements)

References 28 publications

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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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Section: Managementmentioning

confidence: 99%

Anterior Shoulder Instability in the Military Athlete

2016

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“…Evidence has emerged that this is in actual fact a bipolar phenomenon that affects up to 56% of cases. 46 The epileptic population is prone to such defects because of multiple, vigorous seizures resulting in dislocations or subluxations that occur with considerable force. 10,67 Understanding of this relatively new concept is essential in deciding on the precise operative strategy to employ because such lesions further potentiate instability owing to their combined effect on glenohumeral translation.…”

Section: Bipolar (Glenoid and Humeral) Bone Lossmentioning

confidence: 99%

“…In a retrospective radiographic analysis of 153 shoulders before Bankart repair, Nakagawa et al 46 found bipolar bone loss in 56% of the cohort. As the glenoid defect became larger, the Hill-Sachs lesion also increased in size, although there was little correlation between the two.…”

Section: Bipolar (Glenoid and Humeral) Bone Lossmentioning

confidence: 99%

Management of recurrent shoulder instability in patients with epilepsy

Thangarajah

Lambert

2016

Journal of Shoulder and Elbow Surgery

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“…Although postoperative instability recurrence was noted as 0% in patients with no bony lesion, a 29.4% recurrent rate was seen in patients with bipolar lesions. 3 Furthermore, in 33 patients with primary instability and 111 patients with recurrent instability, a significant difference was shown in the prevalence of Hill-Sachs lesions and inverted pearshaped glenoid lesions. 4 This reaffirms the findings of Arciero et al 5 showing an additive and negative effect on glenohumeral stability as a result of combined glenoid and humeral head defects.…”

mentioning

confidence: 97%

“…In 103 shoulders, Nakagawa et al 3 showed an incidence rate of bipolar lesions (bony lesion at both the glenoid and humeral head) in 33.3% of all shoulders with primary instability and 61.8% of all shoulders with recurrent instability. Although postoperative instability recurrence was noted as 0% in patients with no bony lesion, a 29.4% recurrent rate was seen in patients with bipolar lesions.…”

mentioning

confidence: 99%

Bipolar Bone Loss of the Shoulder Joint due to Recurrent Instability: Use of Fresh Osteochondral Distal Tibia and Humeral Head Allografts

Haber

Sanchez

Sánchez

et al. 2017

Arthroscopy Techniques

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With increasing shoulder instability events, the likelihood of a bony lesion of the glenoid and/or humeral head rises. Although bone loss of either the glenoid or humeral head may result in recurrent instability, bipolar lesions have been shown, in particular, to result in a negative and additive effect on glenohumeral stability. In the case of a bipolar lesion comprising severe glenoid bone loss and an engaging, "off-track" Hill-Sachs lesion, the bony foundation of the glenohumeral joint is compromised and bony augmentation is necessary. We present our preferred technique, made up of the application of a distal tibia allograft to address the glenoid bone loss and humeral head allograft to address the HillSachs lesion, for the treatment of a severe bipolar lesion in the setting of recurrent anterior shoulder instability after a failed Latarjet procedure.

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Relationship Between Glenoid Defects and Hill-Sachs Lesions in Shoulders With Traumatic Anterior Instability

Cited by 64 publications

References 28 publications

Anterior Shoulder Instability in the Military Athlete

Anterior Shoulder Instability in the Military Athlete

Management of recurrent shoulder instability in patients with epilepsy

Bipolar Bone Loss of the Shoulder Joint due to Recurrent Instability: Use of Fresh Osteochondral Distal Tibia and Humeral Head Allografts

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