Evolving concept of bipolar bone loss and the Hill-Sachs lesion: from "engaging/non-engaging" lesion to "on-track/off-track" lesion

Arthroscopy. 2014 Jan;30(1):90-8. doi: 10.1016/j.arthro.2013.10.004.


For anterior instability with glenoid bone loss comprising 25% or more of the inferior glenoid diameter (inverted-pear glenoid), the consensus of recent authors is that glenoid bone grafting should be performed. Although the engaging Hill-Sachs lesion has been recognized as a risk factor for recurrent anterior instability, there has been no generally accepted method for quantifying the Hill-Sachs lesion and then integrating that quantification into treatment recommendations, taking into account the geometric interplay of various sizes and various orientations of bipolar (humeral-sided plus glenoid-sided) bone loss. We have developed a method (both radiographic and arthroscopic) that uses the concept of the glenoid track to determine whether a Hill-Sachs lesion will engage the anterior glenoid rim, whether or not there is concomitant anterior glenoid bone loss. If the Hill-Sachs lesion engages, it is called an "off-track" Hill-Sachs lesion; if it does not engage, it is an "on-track" lesion. On the basis of our quantitative method, we have developed a treatment paradigm with specific surgical criteria for all patients with anterior instability, both with and without bipolar bone loss.

MeSH terms

  • Arthroscopy / methods
  • Bone Resorption / complications*
  • Bone Resorption / diagnostic imaging
  • Bone Resorption / pathology
  • Bone Resorption / surgery*
  • Bone Transplantation*
  • Evidence-Based Medicine
  • Humans
  • Imaging, Three-Dimensional
  • Joint Instability / diagnostic imaging
  • Joint Instability / etiology*
  • Joint Instability / pathology
  • Joint Instability / surgery*
  • Recurrence
  • Shoulder Joint / diagnostic imaging
  • Shoulder Joint / pathology
  • Shoulder Joint / surgery*
  • Tomography, X-Ray Computed