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Table 6 Studies Assessing Hill-Sachs Bone Loss with Radiography, CT and MRI

From: Imaging methods for quantifying glenoid and Hill-Sachs bone loss in traumatic instability of the shoulder: a scoping review

Citation Method Details Quantification Method Findings
Charousset et al. [47]: Retrospective case series Radiography 26 patients Quantitative assessment: P/R ratio reliability:
Assessment: P/R ratio on true AP radiography in internal rotation (Fig. 10) Inter-observer ICC 0.81-0.92
3 observers measured twice Qualitative assessment: Intra-observer ICC 0.72-0.97
Outcome: True AP radiograph in external rotation (present or absent lesion) Qualitative assessment reliability:
Reliability   Inter-observer ICC 0–0.30
   Intra-observer ICC 0.06-0.92
   Note: Simple patient positioning and reliable
Ito et al. [38]: Retrospective case series Radiography 27 patients (30 shoulders) Width and depth of Hill-Sachs lesion measured: Width difference (p > 0.05) :
Assessment: Supine position; arm 135 ° flexion, 15 ° internal rotation; radiography beam perpendicular Dislocation group 13.4 mm+/−2.5 mm
Divided into 2 groups: dislocation (11) and dislocation with recurrent subluxation (19); 1 observer measured once Note: Patient positioning may be cumbersome and difficult to replicate in a clinical setting With subluxation group 13.8+/−3.5 mm
Outcome:   Depth difference (p < 0.05):
Width difference   Dislocation group 3.9+/−0.9 mm
   With subluxation group 2.1+/−1.0 mm
   Note: Deeper lesions associated with subjective joint laxity but not number of dislocations
Kralinger et al. [39]: Retrospective cohort study Radiography 166 patients Hill-Sachs Quotient: Recurrence rate associated with Hill-Sachs Quotient:
Assessment: Bernageau view and AP view at 60 ° internal rotation (Fig. 8) Grade I 23.3 %
1 observer measured once   Grade II 16.2 %
Outcome:   Grade III 66.7 %
Recurrence rate   
Sommaire et al. [46]: Retrospective cohort study Radiography 77 patients d/R ratio: Risk of recurrence (p = 0.016):
Assessment: True AP radiograph in internal rotation (similar to Charousset et al. [2010]; Fig. 9) 9.6 % in d/R ratio <20 %
Final clinical outcome after arthroscopic Bankart repair and imaging; 1 observer measured once   40 % in d/R ratio >20 %
Outcome:   Note: d/R ratio predictive of failure of arthroscopic Bankart repair
Need for revision repair
Hardy et al. [37]: Retrospective cohort study Radiography; 2DCT 59 patients Radiograph 45 ° internal rotation view: d/R ratio (p < 0.01):
Assessment: Depth of defect/radius of humerus (d/R) ratio (similar to Charousset et al. [2010]) Good/excellent group: 16.2 %
   After arthroscopic stabilization divided into 2 groups based on Duplay clinical functional score: good/excellent (38) fair/poor (21); 1 observer measured all patients once; 10 observers measured 10 patients CT: Poor/fair group: 21.3 %
Outcome: Humeral head radius (best-fit circle to circumference); defect width; defect depth (from edge of circle); defect length (amount of CT slices with the defect); lateralization angle (compared to AP line through center of head) Mean volume of lesion (p < 0.001):
Correlation of clinical score with radiographic findings; surgical failure rate Note: Radiographic technique easily obtained Good/excellent group: 640 mm3
   Poor/fair group: 2160 mm3
   Surgical failure rate:
   d/R >15 %: 56 %
   d/R < 15 %: 16 %
   Presence of lesion, depth, lateralization angle, lesion, and humeral head volume ratio all non-significant between groups
   Reliability :
   Inter-observer reliability for depth and radius measurements non-significant
Kodali et al. [72]: Laboratory study 2DCT 6 anatomic bone substitute models Circle fit to humeral head: Inter-observer reliability ICC:
Assessment: Width and depth measured on sagittal, axial, and coronal planes (similar to Saito et al. (2009) Depth - 0.879
Circular humeral head defects created; 2DCT width-depth measurements made in 3 planes and compared to the defect sizes measured by a 3D laser scanner   Width 0.721
Outcome:   Accuracy (PE):
5 observers measured once   Width: sagittal 10.9+/−8.6 %, axial 10.5+/−4.4 %, coronal 15.9+/−8.6 %;
   Depth: sagittal 12.7+/−10.0 %, axial 16.7+/−10.2 %,coronal 22.5+/−16.6 %
Saito et al. [12]: Retrospective case-controls study 2DCT 35 patients; 13 normal Circle fit to the humeral head on axial slices: Mean size of Hill-Sachs lesion:
Assessment: Depth: greatest length of distance from floor of defect to edge of circle; width: measured between edges of defect Depth 5.0+/−4.0 mm; width 22+/−6 mm
1 observer measured 3 times   Intra-observer reliability:
Outcome:   Pearson correlation coefficient: 0.954-0.998
Reliability   Coefficient of variation: 0–7.4 %.
Cho et al. [36]: Prospective cohort study 3DCT 104 patients (107 shoulders) Fit circle to articular surface of humeral head: Inter-observer reliability:
Assessment: Axial and coronal planes: width and depth measured on axial and coronal slice where lesion was largest ICC 0.629-0.992
evaluated size, orientation, & location as means to predict engagement; engagement defined arthroscopically; 1 observer measured 27 randomly selected shoulders 3 times; 2nd observer measured once   Intra-observer reliability:
Outcome:   ICC 0.845-0.998
Reliability, size of Hill-Sachs lesion relationship to engaging lesions   Size of Hill-Sachs lesion (axial):
   Engaging group width 52 % & depth 14 %
   Non-engaging group width 40 % & depth 10 % (both p <0.001)
   Size of Hill-Sachs lesion (coronal):
   Engaging group width 42 % & depth 13 %
   Non-engaging group width 31 %, & depth 11 % (p = 0.012 & 0.007 respectively).
   Note: Orientation of Hill-Sachs angle significantly higher in engaging lesions
Kawasaki et al. [73]: Modeling 3DCT Evaluated 7 CT scans of bilateral shoulders Created 3D contour; mirrored the normal shoulder and overlap contours; computer measured defect difference Proposed a method to calculate humeral head bone loss
Kirkley et al. [70]: Prospective case series MRI 16 patients Hill-Sachs lesions were categorized as small (<1 cm) or large (>1 cm); Presence vs. absence of Hill-Sachs lesion:
Assessment: Note: Did not clarify slice or dimensions measured to determine Hill-Sachs lesion size Kappa = 1
MRI followed by arthroscopic evaluation; 2 observers measured once   Distinguishing small from large lesion:
Kappa = 0.44
Outcome:   Not able to accurately quantify size
Salomonsson et al. [71]: Prospective cohort study MRI 51 patients Hill-Sachs depth: Size of Hill-Sachs lesion:
Assessment: Measured on axial slice at largest point Stable group 5 mm; unstable group 3 mm (non-significant)
MRI immediately and clinical follow-up to 105 months; divided into stable and unstable (recurrent instability); 2 observers measured once   
Size of Hill-Sachs lesion correlation with recurrent instability   
  1. List of Abbreviations: ICC: intraclass correlation coefficient; PE: percent error