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. 2014 Mar;7(1):6-11.
doi: 10.1007/s12178-013-9194-7.

Management of humeral head deficiencies and glenoid track

Giovanni Di Giacomo  1 , Andrea De Vita, Alberto Costantini, Nicola de Gasperis, Paolo Scarso
Affiliations

Management of humeral head deficiencies and glenoid track

Giovanni Di Giacomo et al. Curr Rev Musculoskelet Med. 2014 Mar.

Abstract

When considering the management of shoulder anterior instability with glenoid bone loss ≥25 % of the inferior glenoid diameter (inverted-pear glenoid), the consensus among recent authors is that glenoid bone grafting should be done. Although the engaging Hill-Sachs lesion has been recognized as a risk factor for recurrent anterior instability, there has been no generally accepted methodology for quantifying the Hill-Sachs lesion taking into account the geometric interplay of various sizes and various orientations of bipolar (humeral-sided plus glenoid-sided) bone loss. Keeping the glenoid track concept in mind, if a Hill-Sachs lesion engages the anterior glenoid rim, with or without concomitant anterior glenoid bone loss, it is possible to manage this pathology, reducing the risk of recurrent shoulder instability after surgery. If the Hill-Sachs engages, "Remplissage" or "Latarjet" surgical procedures are indicated depending of glenoid bone loss.

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Figures

Fig. 1
Fig. 1
a, Glenohumeral joint in abduction and external rotation. If the Hill-Sachs lesion is within the medial margin of the glenoid track there is still glenoid track support for bone stability (non-engaging Hill-Sachs lesion).This implies that intrinsic stability can be shared between Bankart repair and bone support. b, Glenohumeral joint in abduction and external rotation in shoulder with a glenoid bone loss and a Hill-Sachs lesion (bipolar bone loss). The Hill-Sachs lesion extends medial to the medial margin of the glenoid track, with loss of bone support at the anterior glenoid rim (engaging Hill-Sachs lesion). (GT glenoid track, HS Hill-Sachs)
See this image and copyright information in PMC

References

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