The Hill-Sachs lesions is a dent in the posterior aspect of the humeral head, which occurs during an anterior shoulder dislocation. The humeral head impacts against the front of the glenoid cavity of the scapula. A Hill-Sachs lesion is usually associated with a Bankart lesion. A Bankart lesion is the most common lesion of anterior shoulder instability following dislocation. It involves an avulsion of the anterior inferior labrum. The Hill-Sachs lesion can range from a small to large indentation and the size of the lesion can affect the treatment given to the patient. The larger the Hill-Sachs lesion, the more likely that the shoulder will be unstable and the more likely to
dislocate again (recurrent dislocations). The larger the Hill-Sachs lesion is, the more likely that the glenoid labrum and joint capsule have a significant tear.
Treatment for a small sized Hill-Sachs lesion of less than 20% can usually be treated nonoperatively. A medium sized Hill-Sachs lesion—a defect greater than 25%– may require an arthroscopic or open remplissage procedure (may be performed in combination with Bankart repair). The defect is “filled in” with the posterior capsule and rotator cuff. Larger sized Hill-Sachs lesions are rare. Lesions greater than 40% are usually filled with bone or metal.
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