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. 2021 Jul;29(7):2289-2296.
doi: 10.1007/s00167-020-06176-1. Epub 2020 Aug 1.

Off-track Hill-Sachs lesions predispose to recurrence after nonoperative management of first-time anterior shoulder dislocations

Felix G E Dyrna  1 , Marius Ludwig  2 , Andreas B Imhoff  2 , Frank Martetschläger  3   4
Affiliations

Off-track Hill-Sachs lesions predispose to recurrence after nonoperative management of first-time anterior shoulder dislocations

Felix G E Dyrna et al. Knee Surg Sports Traumatol Arthrosc. 2021 Jul.

Abstract

Purpose: The purpose of this study was to evaluate whether the presence of an off-track Hill-Sachs lesion has an impact on the recurrence rate after nonoperative management of first-time anterior shoulder dislocations.

Methods: A retrospective cohort study was planned with a follow-up via questionnaire after a minimum of 24 months. Fifty four patients were included in the study (mean age: 29.5 years; 16 female, 38 male). All of these patients opted for primary nonoperative management after first-time traumatic anterior shoulder dislocation, in some cases even against the clinician's advice. The glenoid track and the Hill-Sachs interval were evaluated in the MRI scans. The clinical outcome was evaluated via a shoulder-specific questionnaire, ASES-Score and Constant Score. Further, patients were asked to report on recurrent dislocation (yes/no), time to recurrent dislocation, pain, feeling of instability and satisfaction with nonoperative management.

Results: In 7 (13%) patients, an off-track Hill-Sachs lesion was present, while in 36 (67%) the lesion was on-track and 11 (20%) did not have a structural Hill-Sachs lesion at all. In total, 31 (57%) patients suffered recurrent dislocations. In the off-track group, all shoulders dislocated again (100%), while 21 (58%) in the on-track group and 3 (27%) in the no structural Hill--Sachs lesion group had a recurrent dislocation, p = 0.008. The mean age in the group with a recurrence was 23.7 ± 10.1 years, while those patients without recurrent dislocation were 37.4 ± 13.1 years old, p < 0.01. The risk for recurrence in patients under 30 years of age was higher than in those older than 30 years (OR = 12.66, p < 0.001). There were no significant differences between patients with on- and off-track lesions regarding patients' sex, height, weight and time to reduction and glenoid diameter. Off-track patients were younger than on-track patients (24.9 ± 7.3 years vs. 29.6 ± 13.6 years). However, this difference was not statistically significant.

Conclusion: The presence of an off-track Hill-Sachs lesion leads to significantly higher recurrence rates compared to on-track or no structural Hill--Sachs lesions in patients with nonoperative management and should be considered when choosing the right treatment option. Therefore, surgical intervention should be considered in patients with off-track Hill-Sachs lesions.

Level of evidence: IV.

Keywords: Anterior shoulder dislocation; Glenoid track; Nonoperative management; Off-track Hill–Sachs lesion; Shoulder instability.

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References

    1. Arciero RA, Parrino A, Bernhardson AS, Diaz-Doran V, Obopilwe E, Cote MP et al (2015) The effect of a combined glenoid and Hill–Sachs defect on glenohumeral stability: a biomechanical cadaveric study using 3-dimensional modeling of 142 patients. Am J Sports Med 43:1422–1429 - DOI
    1. Boehm D, Wollmerstedt N, Doesch M, Handwerker M, Mehling E, Gohlke F (2004) Entwicklung eines fragebogens basierend auf dem Constant-Murely-Score zur selbstevaluation der schulterfunktion durch den patienten. Der Unfallchirurg 107:397–402 - DOI
    1. Boileau P, Villalba M, Hery JY, Balg F, Ahrens P, Neyton L (2006) Risk factors for recurrence of shoulder instability after arthroscopic Bankart repair. J Bone Jt Surg Am 88A:1755–1763 - DOI
    1. Burkhart SS, De Beer JF (2000) Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill–Sachs lesion. Arthroscopy 16:677–694 - DOI
    1. Di Giacomo G, Itoi E, Burkhart SS (2014) Evolving concept of bipolar bone loss and the Hill–Sachs lesion: from “engaging/non-engaging” lesion to “on-track/off-track” lesion. Arthroscopy 30:90–98 - DOI

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