Table 6 Studies Assessing Hill-Sachs Bone Loss with Radiography, CT and MRI
| 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 | |||
| Reliability | ||||
| 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 | ||||
| Outcome: | ||||
| Size of Hill-Sachs lesion correlation with recurrent instability |