Evaluation of a treatment algorithm for acute traumatic. We would like to report the 2 year clinical outcomes of bioabsorbable suture anchors used in traumatic anterior dislocations of the shoulder. Remplissagewhen and how to fill in the defect idowu. The relationship between hillsachs lesion and recurrent. Full active and passive range of motion rom for shoulder flexion, abduction. Accordingly, we simply evaluated bony hillsachs lesions. Sports medicine physical therapy rehabilitation protocols. Is clinical evaluation alone sufficient for the diagnosis. The hillsachs lesion defect was measured and showed an average bone loss of 17. An animated description of two conditions that can occur with a shoulder dislocation and contribute to further shoulder instability. Shoulder xrays, including outlet, axillary lateral, and anteroposterior views,3 may reveal a bony bankart lesion.
It should be emphasized that the prevalence of true engaging hillsachs lesions using dynamic arthroscopic assessment after bankart. Pdf arthroscopic remplissage with bankart repair for the. Method to determine whether a hillsachs lesion is on track or off track. The purpose of this study is to analyze the results after applying our treatment algorithm for acute glenoid rim fractures caused by first time traumatic anterior shoulder dislocations.
The purpose of the study was to access the diagnostic performance of the computed tomography ct in the assessment of. We use a combined allarthroscopic remplissage, latarjet, and bankart repair for patients with. The distal two centimeters of the coracoid process, with the entire conjoined tendon, was transferred through the incised subscapularis and attached to the glenoid fossa with a lag screw. All the cases underwent arthroscopic repair of the bankart lesion, together with filling of the hillsachs lesion. Hillsachs 990% arciero 1997 9100% kirkley 1999 956% larrain 2001 defect on humeral head glenoid recurrent dislocations. Open latarjet procedure for failed arthroscopic bankart. Anterior shoulder reconstruction with arthroscopic bankart repair. Imaging modalities such as magnetic resonance arthrogram mra offer great utility in diagnosing bankart lesions but they are associated with a high degree of intra and interobserver variability. Assessment of coincidence and defect sizes in bankart and hill. Pseudo hill sachs lesion is seen as flattening in posterolateral head of humerus below the level of the coracoid it is a normal variant in anatomy. Recent studies have shown effective clinical results after arthroscopic bankart repair abr but have shown several risk factors for redislocation after surgery. Open latarjet surgery is a good option for failed arthroscopic bankart repair. No attempt was made to grade the severity of bony pathology. Pdf assessment of coincidence and defect sizes in bankart and.
When this happens, a pocket at the front of the glenoid forms that allows the humeral head to dislocate into it. 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. Imaging of shoulder instability santiago quantitative. Find pdfs of our most common rehabilitation protocols. The rate of hillsachs lesions in recurrent anterior shoulder instability has been reported to be as high as 93% and increased attention has been given to the size and location of humeral bone loss. The relationship between hillsachs lesion and recurrent anterior shoulder dislocation.
This implies that intrinsic stability can be shared between the bankart repair and bone support. Evaluation of postoperative results from videoarthroscopic. Seven patients in whom closed reduction was possible were excluded from the study and the remaining eight patients were treated by open reduction and bankart lesion repair. We provide our patients with comprehensive, coordinated care from experts who understand the unique needs of women in sports. 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 hill sachs lesion without significant glenoid bone loss, were retrospectively evaluated. Arthroscopic bankart repair versus nonoperative treatment for acute, initial anterior shoulder dislocations. However, nakagawa et al 18 have reported that the size of the hillsachs lesion does not influence postoperative recurrence of instability, as there were no significant differences among the 3 groups with regard to all parameters of hillsachs lesion size length, width, and depth. Evolving concept of bipolar bone loss and the hillsachs. Is clinical evaluation alone sufficient for the diagnosis of a bankart lesion without the use of magnetic resonance imaging. Contact athletes with bone defects bankart or hillsachs have a 90% recurrence rate with soft tissue only procedures and require open surgery with bony augmentation. Accuracy of measurement of hillsachs lesions with computed tomography. Itoi e, hatakeyama y, urayama m, pradhan rl, kido t, sato k. From engaging nonengaging to ontrack offtrack epos. Links 12 kodali p, jones mh, polster j, miniaci a, fening sd.
A hillsachs lesion, or hillsachs fracture, is a cortical depression in the posterolateral head of the humerus. Horst and his colleagues also found that a larger hill sachs lesion leads to greater. The sports physical therapy service is an integral part of the sports medicine center and the department of. Each group was followed up for a mean more than 2year period. Any information contained in this pdf file is automatically generated from digital material. Glenohumeral joint in abduction and external rotation in shoulder with glenoid defect and hillsachs lesion hs bipolar bone loss. It results from forceful impaction of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly. The hill sachs lesion may be old, since the patient had previous shoulder dislocations. A correlation between a bankart lesion and the grade of a hillsachs lesion was found. Pdf on mar 31, 2019, mohsen a mashour and others published arthroscopic remplissage.
The relationship between hill sachs and recurrent anterior. The contribution of the hillsachs lesion to glenohumeral instability depends on the. A practical guide to shoulder injuries in the throwing athlete. The physiologic groove in the humerus or cysts and erosions at the attachment site of the infraspinatus tendon can simulate a hill sachs, but usually this is not.
Contact between the glenoid and the humeral head in abduction, external rotation, and horizontal extension. We evaluated whether patients are at a risk for redislocation during the first year after abr, examined the recurrence rate after abr, and sought to identify new risk factors. Long term results of arthroscopic bankart repair for. Bankart and hillsachs lesions are often associated with anterior shoulder dislocation. Habituele anterieure schouderinstabiliteit als gevolg van een.
We performed abr using bioabsorbable suture anchors in. Bankart lesion 9antinf labrum torn hillsachs lesion 9impaction of humeral. Combined allarthroscopic hillsachs remplissage, latarjet, and. Reverse hill sachs lesion is seen as a depression in anteromedial head of humerus. Evolving concept of bipolar bone loss and the hillsachs lesion. External rotation was significantly increased after creation of the bankart and hillsachs lesion. Recurrence rates now seem comparable to those reported for open bankart procedures although higher than for boneblock procedures, especially in case of bone defect of the humeral head humeral notch or hillsachs lesion or anteroinferior glenoid cavity edge.
A bankart lesion is an injury of the anterior glenoid labrum of the shoulder due to anterior shoulder dislocation. Physical examinations may reveal the instability of a glenohumeral joint but cannot diagnose the bony bankart lesions. Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic bankart repairs. Treatment of chronic anterior shoulder dislocation by open. Data from 79 shoulders in 74 patients were collected over 4 years 2004 2008. Magnetic resonance images have high cost and availability issues. Fifty patients had a hillsachs lesion in ap or axillary radiographs, and two had no signs of a hillsachs lesion. Revision open bankart surgery after arthroscopic repair for traumatic anterior shoulder.
Between november 2004 and september 2007, 15 patients with unilateral chronic anterior shoulder dislocation were referred to our clinic. Eighteen patients had normal contour of the anterior glenoid, 28 had signs of glenoid erosion, and four patients had a visible bone fragment bony bankart lesion. Use inferior capsular flap to repair bankart lesion. Following placement of two transtendon suture anchors in. Hillsachs lesion measurement with tridimensional models. A report of 49 cases with a minimum 2year followup. The hillsachs 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. A hill sachs lesion occurs when the lesion to the labrum presents simultaneously with a. Perthes lesion a perthes lesion is a labroligamentous avulsion like a bankart, but with a medially stripped intact periosteum. Perthes lesion is variant of bankart lesion, presenting as an anterior glenohumeral injury that occurs when the scapular periosteum remains intact but is stripped. Evaluation of the diagnostic performance of the simple. Location of the hillsachs lesion in shoulders with recurrent anterior dislocation. Open latarjet procedure for failed arthroscopic bankart repair. It is due to recurrent posterior dislocation of shoulder joint.
Combined large hillsachs and bony bankart lesions treated by. The relationship between hill sachs and recurrent anterior shoulder dislocation article in acta orthopaedica belgica 732. Fifty patients had a hillsachs lesion and 32 patients had glenoid bone lesions on plain radiographs. Assessment of bone loss in anterior shoulder instability.
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