From the Guidelines
Treatment for a Hill-Sachs deformity should be individualized based on the size of the lesion and associated injuries, with conservative management being sufficient for small, asymptomatic lesions, and surgical intervention being necessary for larger lesions or those associated with recurrent instability. When considering treatment options for Hill-Sachs deformity, it is essential to evaluate the size of the lesion and the presence of associated injuries, such as glenoid bone loss or rotator cuff tears 1. For small, asymptomatic Hill-Sachs lesions (less than 20% of the humeral head), conservative management is typically sufficient, including physical therapy focused on strengthening the rotator cuff and scapular stabilizers. Exercises should include internal and external rotation strengthening, scapular retraction, and proprioceptive training for 6-12 weeks. However, for larger lesions or those associated with recurrent instability, surgical intervention may be necessary, with options including remplissage (capsulotenodesis of the infraspinatus tendon into the Hill-Sachs defect), bone grafting procedures, or the Latarjet procedure (transfer of the coracoid process to the anterior glenoid) 1. The choice of treatment is guided by the size of the defect, presence of glenoid bone loss (Bankart lesions), patient activity level, and history of recurrent dislocations. Some key points to consider when treating Hill-Sachs deformity include:
- The size of the lesion: Lesions larger than 20% of the humeral head may require surgical intervention.
- Associated injuries: The presence of glenoid bone loss or rotator cuff tears may affect treatment options.
- Patient activity level: Patients with high activity levels may require more aggressive treatment to prevent recurrent instability.
- History of recurrent dislocations: Patients with a history of recurrent dislocations may require surgical intervention to prevent further instability. Early treatment is important as untreated significant lesions can lead to chronic instability and degenerative joint changes over time, highlighting the need for prompt evaluation and management of Hill-Sachs deformity 1.
From the Research
Hill-Sachs Deformity Treatment Options
- Nonsurgical management, including focused rehabilitation, is acceptable in cases of small bony defects and nonengaging lesions in which the glenohumeral joint remains stable during desired activities 2
- Surgical options include arthroscopic and open techniques, such as arthroscopic remplissage with Bankart repair, which has been shown to result in better outcomes and lower recurrence rates than nonoperative management 3
Arthroscopic Remplissage Technique
- Arthroscopic remplissage is a novel procedure that involves filling the Hill-Sachs defect with tendon tissue, which can help to reduce the risk of recurrent instability 4
- The technique has been shown to be effective in treating large Hill-Sachs lesions with recurrent anterior glenohumeral instability, with minimal loss of external rotation and high patient satisfaction 4
- Indications for arthroscopic remplissage include the presence of an engaging Hill-Sachs defect in patients with little or no glenoid bone loss 5
Modified Dynamic Anterior Stabilization (DAS) Technique
- A modified all-arthroscopic DAS technique with added infraspinatus and posterior capsule remplissage has been described for the treatment of recurrent anterior shoulder dislocation with severe bone defects 6
- This technique aims to correct the extra-articular Hill-Sachs defect and provide an alternative treatment option to reconstructive bony procedures and soft tissue stabilization 6
Outcomes and Complications
- Arthroscopic remplissage with Bankart repair has been shown to result in high rates of stable shoulders and low rates of recurrence, with minimal adverse effects on postoperative shoulder range of motion 3
- The technique has been associated with a slight restriction in external rotation, but this does not significantly affect the quality of life and return to sports activities 3