Arthroscopic Treatment of Hill-Sachs Lesions – A Chapetr of “Shoulder Arthroscopy” June 2023
The Hill-Sachs lesion is a compression fracture of the posterosuperolateral aspect of the humeral head that occurs in association with anteroinferior instability of the glenohumeral joint and might lead to recurrence.
The glenoid track refers to the area of contact between the humeral head and glenoid and is defined as 83% of glenoid width.
An Hill-Sachs lesion is considered “On-track” or “Off-track” respectively when is inside or outside the glenoid track. With a method based on CT scan the physician might assess whether a lesion is On-track or Off-track.
The treatment algorithm frequently used which aims at reducing the risk of anteroinferior shoulder instability takes into consideration either the percentage of glenoid bone loss (greater or not than 25%) and the width and position of the Hills-Sachs lesion (Glenoid track).
Those two cut-off values are useful in determining whether the glenoid, humeral or both sides has to be corrected.
The remplissage is a safe procedure with a low postoperative recurrence rate, and it allows the surgeon to address large humeral defects. It seems to be safer than Latarjet procedure, due to the fewer overall postoperative complications.