Arthroscopic Bankart repair is an established option for patients with isolated soft tissue Bankart lesions, yet Burkhart and coworkers reported a near 70% instability recurrence rate following soft tissue stabilization with underlying bony Bankart or Hill-Sachs lesions
If a Hill-Sachs lesion remains within the glenoid track, then there is no chance of engagement (Fig.
In diagnosing a patient with recurrent instability from a Hill-Sachs lesion, obtaining a thorough history is important.
The Hill-Sachs angle is defined as the angle between the axis of the deepest groove of the Hill-Sachs lesion and the longitudinal axis of the humeral shaft (Fig.
Hill-Sachs "Remplissage": An arthroscopic solution for the engaging Hill-Sachs lesion.
Two other commonly found pathologies in previously failed stabilization are bone defects on the glenoid and Hill-Sachs lesions of the humeral head.
Hill-Sachs lesions have classically been best viewed with a combination of internal rotation and a Stryker-Notch view.
Gerber and Lambert (30) reported their experience using osteochondral allografts in the treatment of reverse Hill-Sachs lesions
for four patients who presented with chronic locked posterior shoulder dislocations.
In all cases, an engaging Hill-Sachs lesion was noted on preoperative exam under anesthesia; preoperative and intraoperative direct observation demonstrated that the Hill-Sachs lesions were large (approximately 40% of the articular surface).
A few papers outline treatment strategies for large reverse Hill-Sachs lesions acquired from locked posterior dislocations.
Specialized views include the Stryker notch view, (30) which aids in the evaluation of a Hill-Sachs lesion; the West Point Axillary view, (31) which is used to evaluate anteroinferior glenoid rim fractures; and the apical oblique view of Garth, (32) which is useful for the identification of anteroinferior glenoid fractures, labral calcifications, and for the evaluation of Hill-Sachs lesions.
13,36) An estimation of the degree of humeral head involvement of a Hill-Sachs lesion may be made from axial images, thus obviating the need for an additional CT scan.