Risk factors for shoulder redislocation after arthroscopic. With increased followup length, a slight tendency to higher redislocation rates was observed in presence of a hill sachs lesion. Findings a metaanalysis on instability recurrence risk after arthroscopic bankart repair and recurrence rate stratification for time from intervention were not possible for lack of data. In an engaging lesion, the long axis of the humeral head defect. Preoperative analysis of the hillsachs lesion in anterior. A glenohumeral joint that has remained dislocated for several days is called a chronic dislocation. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic bankart repairs. Biomechanics of the hill sachs lesion and hill sachs remplissage. The hill sachs lesion is an osseous defect of the humeral head that is typically associated with anterior. A large hill sachs lesion compromises shoulder stability and should be addressed with bone augmentation when it is too deep.
Hillsachs defects 40% are clinically significant, and this is recognized as the critical value requiring bone graft, while 20% is the threshold for remplissage procedure, even if the lesion is not engaged 4951. There was no statistically significant difference between any of the dimensions or overall area of the hillsachs lesion when comparing the group with an engaging hillsachs lesion and the group with a nonengaging lesion surface area, 3. There is a relationship between recurrent dislocations and failure of arthroscopic bankart repair with increasing size of the hillsachs lesion, although an accepted threshold value for hillsachs bone loss has not yet been determined 9, 27, 28. Clinical and image outcomes of the hillsachs injury approach. Arthroscopic bone grafting of the humeral head for treatment. The hillsachs lesion is a compression fracture caused by impact on the trabe culae of the. Imaging of the unstable shoulder the open orthopaedics.
Mri has also been shown to be highly reliable for the diagnosis of hillsachs and bankart lesions. Jiangarthroscopic bankart repair combined with remplissage technique for the treatment of anterior shoulder instability with engaging hillsachs lesion. A type x lesion is either a tear of the superior labrum with extension into the rotator cuff interval, resulting in an injury to the superior glenohumeral ligament, coracohumeral ligament, capsule, or synovium figs 21, e3, or it is a slap lesion associated with a reverse bankart lesion. Here, we introduce a method of arthroscopic bone grafting of the humeral head for the treatment of a deep hillsachs lesion in patients with anterior shoulder instability. Hillsachs bone loss occurs simultaneously with glenoid bone loss in up to 62 % of ghi patients. Recurrent anterior shoulder dislocation often leads to the presence of a hillsachs lesion. The incidence of anterior glenoid rim fractures has been reported to be up to 22% after first time anterior shoulder dislocation and up to 73% after recurrent dislocations 27.
A hill sachs lesion occurs when the lesion to the labrum presents simultaneously with a. Amaryl lids to download pdf you need some things, like my website and the name of the file. Osteochondral allograft transplantation for large hillsachs. It has been reported that engagement of the hillsachs lesion affects postoperative recurrence of anterior shoulder instability. Is clinical evaluation alone sufficient for the diagnosis of. On mr a hill sachs defect is seen at or above the level of the coracoid. The aim of this study was to evaluate midterm outcomes of bankart repair with hillsachs remplissage bhsr and to highlight prognostic factors of failure. Patients who underwent osteochondral allograft transplantation for large hill sachs lesions were identified. A large hillsachs lesion compromises shoulder stability and should be addressed with bone augmentation when it is too deep.
The goal of the procedure is to reattach and tighten the torn labrum and ligaments of. Outcomes of arthroscopic hillsachs remplissage and anterior. Evaluation of a treatment algorithm for acute traumatic. Imaging methods for quantifying glenoid and hillsachs bone. It is an indication for surgery and often accompanied by a hillsachs lesion, damage to the posterior humeral head the bankart lesion is named after english. Long term results of arthroscopic bankart repair for. It results from forceful impaction of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly. Hillsachs lesion this is a defect in the posterolateral aspect of the humeral head. However, no method has been recognized as an effective preoperative means to predict engagement of the hillsachs lesion. When the damage only involves the labrum it is called a bankart lesion. These old dislocations most often are traumatic but frequently have been produced by a trivial injury as a result of the patients increasing age and weakness and degeneration of the soft tissue about the shoulder joint such as the subscapularis and other rotator cuff tendons 1, 2. Imaging in anterior glenohumeral instability radiology.
Imaging of the unstable shoulder open orthopaedics journal. The arthroscopic method offers a less invasive technique of bankart repair for traumatic anterior shoulder instability. It has been reported that the incidence of hillsachs lesions in acute cases is significantly, less than that in chronic cases. The hillsachs lesion, may be limited to the articular cartilage or may extend to the subchondral bone. A bankart lesion is an injury of the anterior glenoid labrum of the shoulder due to anterior shoulder dislocation. Research article open access risk factors for shoulder re. Arthroscopic hillsachs remplissage with bankart repair. This study compared the clinical outcomes of arthroscopic remplissage with bankart repair and latarjet operation in patients with a large engaging hillsachs lesion. The hillsachs lesion, a posttraumatic impaction injury along. The influence of arthroscopic remplissage for engaging hillsachs lesions combined with bankart repair on redislocation and shoulder function compared with bankart repair alone. The reported incidence of bankart and hillsachs lesions varies. In terms of glenoid bone loss, several studies have discussed the different types, its role in recurrent dislocation, and the importance of accurate quantification for treatment 36. Clinical outcome of arthroscopic remplissage as augmentation. Hillsachs lesions can be seen in 6580% of initial glenohumeral dislocations, and up to 100% of recurrent instability episodes 10,11.
The two most common osseous injuries in the setting of anterior shoulder dislocation are anterior glenoid bone loss and hillsachs lesions 1, 2. Arthroscopic bone grafting of the humeral head for. A hill sachs lesion is a compression fracture or dent of the posterosuperolateral humeral head that occurs in association with anterior instability or dislocation of the glenohumeral joint. Bankart lesion labral tear at anterior half of glenoid rim 26. The osseous bankart lesion is an avulsion of the humeral labral complex with an anterior rim fracture. Patients who underwent osteochondral allograft transplantation for large hillsachs lesions were identified. There is a relationship between recurrent dislocations and failure of arthroscopic bankart repair with increasing size of the hill sachs lesion, although an accepted threshold value for hill sachs bone loss has not yet been determined 9, 27, 28. Hillsachs lesion is not a significant prognostic factor for. From engaging nonengaging to ontrack offtrack epos.
Pdf the influence of arthroscopic remplissage for engaging. Arthroscopic stabilization with hillsachs remplissage and. There was no statistically significant difference between any of the dimensions or overall area of the hill sachs lesion when comparing the group with an engaging hill sachs lesion and the group with a nonengaging lesion surface area, 3. A hill sachs lesion occurs when the lesion to the labrum presents simultaneously.
The hillsachs lesion is a compression fracture of the posterosuperolateral aspect of the humeral head that occurs when it comes into contact with the dense cortical bone of the anterior glenoid. Dynamic arthroscopic examination was made to confirm engagement of the hill sachs lesion. We would like to report the 2 year clinical outcomes of bioabsorbable suture anchors used in traumatic anterior dislocations of the shoulder. Contrast magnetic resonance imaging of the affected shoulder was. Ducha no retirar tiras esteriles durante 6 semanas inmov. Following placement of two transtendon suture anchors in the hill sachs lesion, the bankart repair sutures are tied. Any information contained in this pdf file is automatically generated from. Results of arthroscopic bankart repair with hillsachs. To investigate the clinical outcomes after osteochondral allograft transplantation for large hill sachs lesions. Arthroscopic findings in anterior shoulder instability. Throughout midranges of shoulder motion, stability is conferred primarily by the compressioncavity effect of the rotator cuff as muscular contractions maintain the humeral head centred in the glenoid cavity. Jun 16, 2010 a glenohumeral joint that has remained dislocated for several days is called a chronic dislocation. Here, we introduce a method of arthroscopic bone grafting of the humeral head for the treatment of a deep hill sachs lesion in patients with anterior shoulder instability.
Management of hillsachs lesions international congress for. Clinical and radiographic evaluation was performed at 1. The critical size of a hill sachs lesion that causes instability is thought to be a volume 250 mm3 1618. Thirtyseven shoulders subjected to arthroscopic remplissage with a bankart repair group a and 35 shoulders subjected to a latarjet operation group b, for a large engaging hillsachs lesion without significant glenoid bone. Thirtyfour patients operated on for anterior shoulder instability with bhsr were enrolled in a prospective nonrandomised study. Imaging methods for quantifying glenoid and hillsachs. This study was undertaken to assess the diagnostic validity of computed tomography ct with 3dimensional 3d. When this happens, a pocket at the front of the glenoid forms that allows the humeral head to dislocate into it. Hill sachs lesion this is a defect in the posterolateral aspect of the humeral head. Arthroscopic findings confirmed that all patients had bankart lesion, of which there were 7 patients 3. The bony bankart lesion is new, as evidenced by lack of cortex on the superior part of the fragment, and is presumed to be caused by glenohumeral ligaments pulling the humerus towards the glenoid as the shoulder dislocates, causing a fracture even without significant external forces. This lesion is caused by an anterior shoulder dislocation which causes a humeral head. Preoperatively, ct with 3d reconstruction was performed on all patients to evaluate the size width and depth measured on axial and coronal images, orientation hill sachs angle, and location bicipital and vertical angles of the hill sachs lesion. Imaging the glenoid labrum and labral tears radiographics.
This leads to laxity of posterior band of the inferior glenohumeral ligament with posterior displacement of the humeral. Reverse bankart lesion is defined as the detachment of posteroinferior labrum with avulsion of posterior capsular periosteum. Chronic anterior shoulder instability with significant hill. The purpose of the study was to evaluate the longterm outcomes following arthroscopic bankart repair. It was first described by two radiologists by the name ha hill and md sachs in 1940. The contribution of the hillsachs lesion to glenohumeral instability depends on the. Longterm outcomes following isolated arthroscopic bankart. May 11, 2017 the aim of this study was to evaluate midterm outcomes of bankart repair with hill sachs remplissage bhsr and to highlight prognostic factors of failure. The hill sachs lesion may be old, since the patient had previous shoulder dislocations. This leads to laxity of posterior band of the inferior glenohumeral ligament with posterior displacement of the humeral head as is the case with a bankart lesion, the trauma may be severe enough to involve the bony glenoid, resulting in an accompanying small flake.
The longterm outcomes following arthroscopic bankart repair have been rarely reported. Clinical assessment consisted of active range of motion rom, american shoulder and elbow surgeons score ases, constantmurley score, rowe score, and patient. Recurrent anterior shoulder dislocation often leads to the presence of a hill sachs lesion. Reverse bankart lesion radiology reference article. Additional stryker notch and west point views help to confirm the presence of hill sachs lesion or bankart fracture, respectively. Given the complex threedimensional nature of such lesions, failure rates as high as 67% have been reported with arthroscopic bankart repair alone. Chronic anterior shoulder instability with significant. Treatment of chronic anterior shoulder dislocation by open. Adductionexternal rotation has been advocated for postreduction immobilization as a way to displace joint fluid posteriorly and approximate the detached labrum to the anterior glenoid rim and promote healing 16.
Remplissagewhen and how to fill in the defect idowu. Arthroscopic remplissage for moderatesize hillsachs lesion. Statistical analysis the software jmp sas institute inc. Management of hillsachs lesions international congress. Hillsachs lesion is not a significant prognostic factor. Therefore, several procedures have been proposed to address these humeral head defects including humeral.
Outcomes of arthroscopic hillsachs remplissage and. The mobility of the glenohumeral joint in multiple anatomic planes is not without consequence as recurrent instability is common, particularly among young, active individuals. The hillsachs lesion is an osseous defect of the humeral head that is typically associated with anterior. Conclusions and relevance a hill sachs lesion could not be confirmed as a statistically significant negative prognostic factor after arthroscopic bankart repair. The critical size of a hillsachs lesion that causes instability is thought to be a volume 250 mm3 1618. Bankart lesionlabral tear at anterior half of glenoid rim 26. The hillsachs hs lesion is very common and can be observed in almost 100% of patients with recurrent anterior shoulder dislocation. The ratio between recurrence cases and total cases was 0. While hillsachs lesions were classified according to arthroscopic findings in the present study, a more precise and simple ct classification has been established recently. A report of 49 cases with a minimum 2year followup. It is an indication for surgery and often accompanied by a hill sachs lesion, damage to the posterior humeral head.
Arthroscopic bankart repair combined with remplissage technique for the treatment of anterior shoulder instability with engaging hill sachs lesion. Bankart and hillsachs lesions are often associated with anterior shoulder dislocation. Is clinical evaluation alone sufficient for the diagnosis. Perthes lesion is variant of bankart lesion, presenting as an anterior glenohumeral injury that occurs when the scapular periosteum remains intact but is stripped. It may result either from a traumatic glenohumeral dislocation or a direct trauma to the adducted arm. Clinical and image outcomes of the hillsachs injury. Arthroscopic bankart repair combined with remplissage technique for the treatment of anterior shoulder instability with engaging hillsachs lesion. When he dislocated his shoulder during a game, he wanted to treat his injury as quickly as possible and get back on the court.
Because of its relative novelty, little is known about recurrent instability, postoperative arthritis, and patient satisfaction, particularly for wellestablished modern procedures. Preoperative radiographic imaging, consisting of anteroposterior, scapular y, and axillary views, was obtained to evaluate the glenoid shape of the glenoid and the presence of any bony i. A hillsachs lesion, or hillsachs fracture, is a cortical depression in the posterolateral head of the humerus. Objective to evaluate the functional outcome of the remplissage technique, the healing of the capsulotenodesis of the infraspinatus tendon in hillsachs lesion, and the degree of fatty in. Assessment of coincidence and defect sizes in bankart and hill.
To investigate the clinical outcomes after osteochondral allograft transplantation for large hillsachs lesions. Hill sachs defects 40% are clinically significant, and this is recognized as the critical value requiring bone graft, while 20% is the threshold for remplissage procedure, even if the lesion is not engaged 4951. The hill sachs lesion is freshened with a bur placed in the posterior portal and afterwards, a posterior cannula is placed through the deltoid without penetration of the infraspinatus tendon or capsule. First of all, it applied to those patients with a single, or first time, dislocation. Bankart repairs, and 3 fullthickness rotator cuff tears. The traumatic detachment of the glenoid labrum has been called the bankart lesion. Clinical assessment consisted of active range of motion rom, american shoulder and elbow surgeons score ases, constantmurley score, rowe score, and patient satisfaction. Jun 14, 2011 the arthroscopic method offers a less invasive technique of bankart repair for traumatic anterior shoulder instability. A bankart repair is one of the minimally invasive, tissuesparing options we use to treat shoulder instability when an anterior labrum injury has occurred, this is one of the best ways to increase security and comfort of the shoulder, says dr. Osteochondral allograft transplantation for large hill. Data from 79 shoulders in 74 patients were collected over 4 years 2004 2008. Hill sachs bone loss occurs simultaneously with glenoid bone loss in up to 62 % of ghi patients. Despite some restriction of external rotation, remplissage leads to better clinical scores and no recurrence, providing a valid means of augmentation for bankart repair. Horst and his colleagues also found that a larger hill sachs lesion leads to greater.
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