Traumatic anterior shoulder instability: Part III. Hill-Sachs lesions

The Hill-Sachs lesion is one of the common findings seen in patients with recurrent anterior dislocation of the shoulder. Seven percent of these lesions are a large Hill-Sachs lesion that needs to be treated, which may engage with the glenoid rim even after arthroscopic Bankart repair. We have proposed to use a concept of glenoid track to evaluate the risk of engagement with the glenoid. If a Hill-Sachs lesion is located more medially over the medial margin of the glenoid track or off the glenoid track (off-track lesion), such lesion needs to be treated and arthroscopic Bankart repair alone is not enough. There are several surgical treatment options such as the Latarjet procedure or arthroscopic remplissage procedure for such a large Hill-Sachs lesion. If a large glenoid defect exists in addition to an off-track Hill-Sachs lesion, the Latarjet procedure would be the best option. If the glenoid defect is small, it may be the best indication for arthroscopic remplissage procedure.