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KMID : 1037920140010020082
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Arthroscopy and Orthopedic Sports Medicine
2014 Volume.1 No. 2 p.82 ~ p.90
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Humeral head bone defects in anterior shoulder instability: preoperative assessment and surgical management for Hill-Sachs lesion
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Cho Nam-Su
Hwang Sang-Phil
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Abstract
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As engaging Hill-Sachs lesions continue to be implicated in the failure of arthroscopic Bankart repair, various procedures have been introduced to overcome them. In this regard, precise judgment of the Hill-Sachs lesion and prediction of its engagement before operation may be useful in planning additional procedures to treat a significant bone defect on the humeral head. The most difficult aspect of Hill-Sachs lesions is determining which Hill-Sachs lesions are clinically significant and need to be addressed surgically. Further, lesion size, orientation, location, and concomitant loss of glenoid bone must be evaluated in light of the patient’s symptoms. Recent literature suggests that Hill-Sachs lesions are best approached as bipolar problems in which a glenoid defect is magnified in the setting of glenoid bone loss. Nonsurgical management, including focused rehabilitation, is acceptable in cases of small bony defects and nonengaging lesions in which the glenohumeral joint remains stable during desired activities. Surgical management may be adressed solely on the glenoid side of small lesions to increase the articular arc and prevent the engagement of the lesions. However, large Hill-Sachs defects may require a combined procedure that addresses the humeral defect directly, such as arthroplasty, humeral head allograft, remplissage, and resurfacing.
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KEYWORD
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Shoulder, Anterior instability, Hill-Sachs lesion, Engagement, Surgical management
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FullTexts / Linksout information
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Listed journal information
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