HillSachslesjon

Hill-Sachs lesion is a cortical impaction fracture of the posterolateral aspect of the humeral head that occurs after an anterior shoulder dislocation. The injury results when the humeral head strikes the glenoid rim during dislocation, producing a dent that can engage with the glenoid rim during arm movements and contribute to recurrent instability.

The lesion often occurs with other injuries to the shoulder, most notably a Bankart lesion (detachment of the anterior glenoid labrum) and sometimes glenoid bone loss. Engagement of the Hill-Sachs defect with the glenoid during the range of motion defines its clinical significance; engaging lesions are more likely to cause recurrent instability, especially in younger, active patients.

Imaging typically starts with radiographs, but computed tomography (CT) is preferred for accurately defining the size and pattern of the bony defect, while magnetic resonance imaging (MRI) better delineates associated soft tissue injuries such as Bankart lesions and rotator cuff or capsule involvement. Advanced concepts classify Hill-Sachs lesions as engaging versus non-engaging and on-track versus off-track relative to the glenoid track, which helps guide treatment decisions.

Management is tailored to lesion size, engagement, patient age and activity, and glenoid bone loss. Small, non-engaging defects may be managed nonoperatively or with soft tissue stabilization if instability persists. Engaging or recurrent lesions frequently require surgical intervention, such as remplissage (arthroscopic posterior capsule and infraspinatus tenodesis to fill the defect), osteochondral grafting or bone grafting, and procedures to address glenoid bone loss (for example, the Latarjet procedure) in conjunction with Bankart repair when indicated.

The Hill-Sachs lesion is a well-known consequence of anterior shoulder dislocations and a key factor in assessing and treating shoulder instability. It was described by Hill and Sachs in the mid-20th century.