- Review Paper
- Open Access
Management of off-track Hill-Sachs lesions in anterior glenohumeral instability
Journal of Experimental Orthopaedics volume 10, Article number: 30 (2023)
Bone loss has been identified as a risk factor for recurrent shoulder dislocations or failure after soft tissue repair. Although the range for “critical” bone loss is yet to be determined, glenoid and humeral bone defects should not be regarded as independent problems, but the interaction between them during shoulder motion should be evaluated as suggested by the glenoid track concept. The glenoid track concept is now widely accepted and considered essential for making decisions about surgery. Soft-tissue procedures usually work well in patients with on-track Hill-Sachs lesions but in off-track lesions do not. In this situation additional procedures should be performed.
Different surgical options have been described to address off-track Hill-Sachs lesions, most commonly remplissage, Latarjet or free bone block procedures. Coracoid graft and free bone grafts convert the off-track Hill-Sachs lesion into on-track by lengthening the glenoid-track, whereas remplissage fill-in the humeral lesion so that it does not engage. In the setting of a Hill-Sachs lesion with little or no glenoid bone loss, remplissage has demonstrated satisfactory outcomes with a low complications and recurrence rate. Favorable results have been reported with glenoid bone grafting when managing isolated Hill-Sachs or bipolar lesions. Studies analyzing Latarjet and Eden-Hybinette procedures show that both procedures are safe and effective in the management of anterior glenohumeral instability. Attention should be paid to those patients with large bone defects not amenable to be restored with an isolated Latarjet that may be better addressed with an Eden-Hybinnete or adding a remplissage to the Latarjet procedure.
Glenohumeral instability is a common condition frequently affecting young and active population. Recurrent instability after a first-time anterior shoulder dislocation ranges between 7 to 80% . Age below 20 years, practice of overhead or contact sports and hyperlaxity have been found to be risk factors for recurrence [10, 44]. Bone defects have also been identified as the most important predictors of recurrent instability .
Many techniques have been developed to treat the engaging Hill-Sachs lesion . Some techniques focus in addressing the humeral defect itself including a humeral head bone grafting, humeral rotation osteotomy or filling the defect with infraspinatus tendon (remplissage procedure) . Since the introduction of glenoid track concept, bone-grafting procedures such as the Latarjet or Eden-Hybinette procedures have been suggested as an alternative for managing engaging Hill-Sachs lesions. By bone grafting the glenoid track is restored keeping the Hill-Sachs lesion from engaging. In this manuscript the relevance of bone loss, the glenoid track concept and the different alternatives to address off-track Hill-Sachs lesions are reviewed.
Bone loss and glenoid track
Glenoid bone loss has been reported in up to 22% after the initial dislocation and 86% of cases in recurrent instability whereas humeral bone defects (Hill-Sachs lesion) have been identified in up to 32% of patients following the first episode of dislocation and in up to 100% of patients in recurrent instability . Combined glenoid and humeral bone defects (i.e. bipolar lesion) have been observed in 81% of patients with anterior glenohumeral instability .
In 2000, Burkhart and DeBeer  first recognized significant glenoid bone defects as risk factors for redislocation after a Bankart repair. They defined significant bone loss as one in which the normal morphology of the glenoid turns into an inverted pear-shaped glenoid, wider in its upper region than in the inferior one. This was observed when glenoid bone loss was superior to 25% of the articular surface. Yamamoto et al.  in a biomechanical cadaveric study also noted 25% as the “critical” glenoid bone loss. However, clinical studies challenge this threshold and suggest it may be lower. Calvo et al.  found that bone defects involving more than 15% of the glenoid diameter considerably increase the risk of recurrence after Bankart repair. This lower critical size was later supported by Shaha et al. , who introduced the concept of “subcritical bone loss”. They observed that, bone loss of greater than 13.5% does not result in a recurrence of dislocation, but results in poorer score at WOSI index. Regarding the humeral side, there is no consensus on the critical value of the Hill-Sachs lesion.
However, over the last 10 years it has been stated that isolated assessment of the size of the humeral and glenoid bone defects is inaccurate, and that the key is defining the interaction of these defects, specifically whether the Hill-Sachs lesion engages the anterior glenoid rim or not. This “engagement” concept was introduced by Burkhart and DeBeer  and divide Hill-Sachs lesions into engaging, i.e. those that when the arm is brought up into 90° of abduction and external rotation engages with the anterior glenoid rim, and non-engaging Hill-Sachs lesions. They observed that patients with engaging Hill-Sachs lesions had higher risk of recurrence and failure of soft-tissue repairs. On the latter, Yamamoto et al.  analyzed the dynamic interaction between the Hill-Sachs lesion and the glenoid bone defect during external rotation and abduction of the shoulder. The authors defined the contact area between the glenoid and the humerus during functional range of motion as the “glenoid track” and found that Hill-Sachs lesions that extended medially over the glenoid track area during shoulder motion were at risk of engagement. These lesions were defined as off-track Hill-Sachs lesions and are associated with a higher degree of instability. Interestingly, it has been speculated that the glenoid track width may change depending on the shoulder’s range of motion . As the horizontal extension angle increases, the glenoid track depth decreases, thus, increasing the risk of engagement. Clinical evidence supports the use of glenoid track in predicting postoperative stability. Shaha et al.  found that the glenoid track concept was a better predictor of risk of recurrence than isolated measurement of the glenoid defect. Similarly, Locher et al.  reported an 8.3-fold higher risk of failure of an arthroscopic Bankart repair in patients with off-track lesions than those with on-track Hill-Sachs lesions.
Humeral head procedures
Procedures that directly address the humeral defect are usually indicated in patients with large and off-track Hill-Sachs lesions without or with a non-significant glenoid bone loss .
Bone humeral head augmentation can be performed with either bone grafts, synthetic materials or soft tissue (i.e. remplissage). The purpose of these procedures is to fill de humeral defect, thereby preventing the engagement of the lesion with the glenoid. Bone grafts include autograft iliac crest, or allografts, most commonly fresh humeral or femoral head allografts. Although usually performed in an open fashion, it has also been described as an arthroscopic technique. According to literature, less anterior translation with anterior load is achieved following this procedure . However, concern exist about the high complication rate including graft resorption, graft failure, cyst formation and restriction of mobility . Rotational humeral osteotomy has also been used for large humeral defects. In this technique the proximal humerus is transversely transected and derotated so that the lesion does not engage anymore . However, high rates of complications including nonunion, over-rotation or fracture have been reported .
Conversely, soft tissue augmentation with the infraspinatus (remplissage) has shown good results and less morbidity than bone grafting procedures, so it is now a very common technique in the management of Hill-Sachs lesions . As described in 2008 by Eugene Wolf, remplissage consists of filling the humeral bone defect by insertion of the lateral posterior shoulder capsule and infraspinatus tendon into de Hill-Sachs lesion  (Fig. 1). According to biomechanical studies, the remplissage procedure prevents off-track Hill-Sachs lesions engagement on the anterior glenoid rim. Elkinson et al.  found in their cadaveric study that shoulders with a 30% Hill-Sachs lesion engaged if a Bankart repair without remplissage was performed. However, engagement was prevented in all shoulders when Bankart repair was performed with remplissage. These findings were confirmed some years after by Hartzler et al. . In their 8-cadaveric study, engagement occurred in all off-track lesions after an isolated Bankart repair but did not occur when adding remplissage.
Clinical results support these biomechanical findings. Postoperative recurrence rate was reduced from 18 to 4% in patients who underwent Bankart repair with remplissage compared with those who underwent isolated Bankart repair in MacDonald et al. series . Low recurrence rates in were further supported by the systematic review performed by Camus et al. analyzing both patients with on-track and off-track Hill-Sachs lesions . The authors noted a 4.5-fold higher risk of recurrence after isolated Bankart repair when compared with Bankart plus remplissage, with recurrent instability of 14.8% in the isolated Bankart repair group vs 1.4% in the remplissage group. Additionally, long-term follow-up series demonstrated that stability is maintained over time, with redislocation rates ranging between 0 and 11.8% after a minimum 5-year follow-up .
In terms of return to sports, Garcia et al.  reported a return to sports rate of 95.5% at an average of 7 months postoperatively, but only in 41.4% of those involved in overhead throwing sports. Similar rates were reported by Lazarides  with a 90.7% return-to sport rate and 70.4% of patients practicing sport at the same or higher level by 24 months postop.
The complication rate of this procedure is very low . However, there is concern regarding the loss of range of motion, particularly in external rotation. Biomechanical studies on cadavers have reported a decrease on external rotation after Bankart with remplissage compared with the non-injured side. However, joint stiffness after remplissage was comparable to Bankart repair alone . Moreover, clinical studies have found that this loss did not negatively affect shoulder function. Macdonald et al. reported a 10° decrease on external rotation after a remplissage procedure at 12 months . However, this loss of range of motion did not significantly affect patient-reported outcomes or even return to sports. Furthermore, by 24 months, patients with and without remplissage had equal range of motion.
Glenoid bone augmentation procedures
Glenoid bone augmentation is the primary method of managing significant glenoid bone defects . According to the algorithm proposed by DiGiacomo , a remplissage procedure should be indicated to address those Hill-Sachs lesions without or little glenoid bone loss. However, this paradigm has been questioned and the Latarjet is now also indicated like remplissage in patients with large Hill-Sachs defects in the setting of recurrent glenohumeral instability [4, 13]. Although these procedures do not address the humeral head directly, they increase the articular glenoid surface, thus preventing engagement of the Hill-Sachs lesion. Glenoid augmentation could be either performed transferring the coracoid (Latarjet) or with free bone grafts, including iliac crest, distal tibia allograft, distal clavicle or scapular spine autograft.
First described by Michel Latarjet in 1954, in this technique the coracoid process is transferred to the anteroinferior glenoid rim with the attached conjoined tendon. The stabilizing mechanism of this procedure is a combination of a “bone-block effect” obtained by the extension of the glenoid articular arc, and a “sling effect” produced by the tensioning of the transferred conjoined tendon in the subscapularis, particularly in abduction and external rotation .
Since its description, different modifications have been proposed. In 2007, Lafosse et al. described the technique of an arthroscopic Latarjet procedure  which combines the benefits of the Latarjet procedure with the advantages of arthroscopic surgery (Fig. 2). Also, modifications in graft position and fixation have been described. Fixation was initially carried out by one screw and is now commonly performed with two screws. More recently, cortical buttons fixation devices have been introduced with satisfactory clinical and radiological results . Regarding graft position, the congruent arch technique consisting of orientation of the coracoid with its inferior aspect congruent with the face of the glenoid has been suggested. The aim was to reproduce the curved anatomy of the glenoid articular surface. Normalization of glenohumeral contact pressures has been reported using this modification .
Overall, studies that examine the outcomes of the Latarjet procedure have reported good to excellent outcomes in both the open and arthroscopic approaches. Re-dislocation rate ranges between 0–8% after the open Latarjet technique according to Bhatia’s et al. systematic review . Very low re-dislocation rates, noted at 2% have also been reported after an arthroscopic Latarjet procedure . Functional outcomes and return to sport rates are also excellent .
Accurate position of the graft is obtained with both the open and arthroscopic techniques. Comparative studies between two techniques report satisfactory results and no differences between the two approaches . Regarding graft union, the healing rate ranges between 66–89%  following an open technique and 73–95% [3, 40] in the arthroscopic group.
Despite the good clinical and radiological results reviewed above, several complications have been reported. Systematic reviews performed by Butt et al.  and Griesser et al.  reported a rate of complications up to 30%, including minor and major complications. A lower complication rate, noted at 7%, has recently been reported in the systematic review performed by Hurley et al. . Similarly, a recent multicenter study of 1555 patients that had undergone an arthroscopic Latarjet procedure reported a 2.2% rate of major complications , including fracture of the coracoid graft , neurologic injury, especially injury to the axillary, musculocutaneous or suprascapular nerve , complications related to the fixation devices  and restriction of range of motion, especially external and internal rotation. On the other hand, both open and arthroscopic Latarjet require a split of the subscapularis muscle, which may lead to damage and disfunction of the muscle, although recent studies have found no differences in subscapularis function between injured and healthy side were observed at 2-year follow-up . In addition, since it is a non-anatomic procedure, high risk of osteoarthritis exists, noted at 20% after a minimum follow-up of 20 years . Finally, it is important to note that the arthroscopic approach is a complex and challenging surgical technique and caution should be paid to its learning curve .
Besides these complications, there are concerns on whether the Latarjet procedure can convert all off-track HS lesions into on-track lesions, especially in patients with bipolar glenohumeral bone loss or large bone defects (Fig. 3). Moon et al.  and Paladini et al.  both assessed whether the Latarjet procedure can fully restore the surface area of the glenoid in patients with large glenoid rim defects. 44 patients with a mean glenoid defect of 25.3% ± 6% and 143 patients, mean bone loss 26 ± 3.9% were respectively analyzed. Glenoid surface area was successfully restored in all patients. However, in a cadaveric study, Patel et al.  found that Hill-Sachs lesions greater than 31% were not sufficiently stabilized by the Latarjet procedure. The clinical study performed by Calvo et al.  supports this finding. In their study, 6 out of 51 (11.8%) Hill-Sachs lesions remained off-track despite the Latarjet procedure. The authors identified a Hill-Sachs interval wider than the glenoid track in a value greater than 7.45 mm as a risk factor for a persistent postoperative off-track lesion. Furthermore, the authors noted that persistent postoperative off-track lesions show a higher recurrence rate at a 24-months follow-up and recommend preoperative measurement of the glenoid track and the size of the coracoid process to confirm that the coracoid process is able to convert the off-track Hill-Sachs lesion into on-track. In these specific population of patients with large or very medial Hill-Sachs off-track defects another procedure should be added to the coracoid transfer, either concomitant bone grafting of the Hill-Sachs defect or remplissage [28, 50]. Larger free bone block procedures able to restore the glenoid track can also be recommended in this setting.
Free bone graft procedures
The first reports detailing an open free bone-grafting procedure to address glenoid bone defects were described by Eden in 1918 and Hybinette in 1932 [17, 27]. Arthroscopic bone-block procedure was developed by Scheibel  in 2007 (Fig. 4). The arthroscopic Eden-Hybinette procedure provides an anatomical reconstruction, preserves the integrity of the subscapularis tendon, and theoretically decreases the risk of damaging to neurovascular structures associated to the Latarjet procedure . From a biomechanical standpoint, the theoretical limitation of free bone graft procedures when compared to Latarjet is the lack of the sling stabilizing effect provided by the conjoint tendon. Yamamoto et al. demonstrated in a biomechanical cadaveric study that the main stabilizing mechanism of the Latarjet procedure was the sling effect at both the end-range and the mid-range arm positions .
The Eden-Hybinette procedure has been suggested as a salvage procedure after a failed Latarjet procedure , but also as a primary surgery in patients with subcritical bone loss and reparable soft-tissues  or those with large bone defects not amenable to be reconstructed with the coracoid process bone graft .
Since its initial description the technique has suffered many modifications: the changeover from open surgery to arthroscopy, use of special instruments and glenoid guides to improve graft positioning  and development of different fixations devices besides screws, such us round-buttons  or sutures . Also, different grafts have been proposed. Since Hybinette first harvested the iliac crest graft for this procedure, this area has remained the main autograft donor site. However, complications have been reported in up to 25% of the cases, including injury to the lateral femoral cutaneous nerve, hematoma, infection or persistent pain at the donor area . The use of allografts may reduce these complications. Several sources of allografts have been used to address glenohumeral instability, including iliac crest  distal tibia  femoral head, and humeral head allografts . However, allografts could have adverse effects, mostly risk of disease transmission or graft resorption . Scapular spine and distal aspect of the clavicle have recently emerged as possible alternatives for reconstruction of the anterior glenoid rim [57, 61]. These grafts have the advantages of autologous grafts with less donor-site morbidity.
This technique provides excellent clinical results according to literature. A 2020 systematic review including 9 studies, 261 patients who underwent and Eden-Hybinette procedure (78% using iliac crest autograft and 22% iliac crest allograft), showed a recurrence rate of 4.8% . Taverna et al.  reported a clinical series of 26 patients who underwent an arthroscopic bone-block procedure using iliac crest allograft. At two-year follow-up the Rowe mean score was noted at 94.6 and no redislocations were reported. However, it is important to note that not only patients with off-track Hill-Sachs lesion were included, but also those with on-track lesions and additional risk factors.
With regard to radiological results, arthroscopic bone-block procedure using specific guides provides accurate bone-graft positioning [14, 56]. Healing rates reported in literature vary widely [20, 65]. In a systematic review performed by Gilat et al.  analyzing the results of allografts and autografts iliac crest in the bone-block procedure, no differences were observed between the two groups with a mean healing rate of 78%. Regarding osteolysis, Kraus et al.  found resorption of the extraarticular part of the iliac crest autograft in patients with glenoid bone defects. With regard to allografts, significant rates of osteolysis were observed by Boehm in patients with iliac crest allografts . Ten out of ten patients suffer a complete graft’s osteolysis 12 months after surgery. As a result, no restoration of the glenoid surface area was obtained. Distal tibia allografts to reconstruct the glenoid surface also show satisfactory results. Provencher et al.  in a case series of 27 patients, observed that 89% of the grafts were healed. Resorption occurred in 3% of the grafts. Promising results have also been obtained when using scapular spine autograft. In the study performed by Xiang et al. graft’s resorption was noted at 19.4% 1 year after surgery .
Studies comparing Latarjet and Eden-Hybinette procedure are limited. Moroder et al.  performed a randomized, controlled prospective study comparing clinical results at 24 months between an open Latarjet procedure and an arthroscopic bone-block technique in patients with recurrent anterior shoulder instability and glenoid bone loss. The authors reported no significant differences in WOSI index, patient-reported outcomes, and recurrence. However, complications were higher in the bone-block group, mostly resulting from harvesting bone graft. On the other hand, incidence of scapular dyskinesis and loss of internal rotation range of motion was higher in the Latarjet group when compared to iliac crest procedure. In 2020 Gilat et al.  published a systematic review comparing the outcomes between the Latarjet and Eden-Hybinette procedures. Seventy studies were included, and 4540 shoulders were evaluated. No differences in recurrence rate were found, noted at 5% in the Latarjet procedure and 3% in the Eden-Hybinette. This study did not find differences between the two procedures in complications rate, progression of osteoarthrosis and return to sports. Concerning Hill-Sachs off-track lesions, Eden-Hybinette has the advantage over Latarjet that the size of the bone graft can be tailored to restore glenoid track in patients with large or very medial off-track lesions . Moreover, addition of remplissage to the Eden-Hybinette enhances stability, restoring stiffness closer to the native shoulder according to Callegari et al. .
Off-track Hill-Sachs lesions can be managed with many different procedures. Remplissage has been proposed as a way of treating large and off-track Hill-Sachs lesions but little or no glenoid bone loss. Bone-grafting techniques have shown to be safe and effective in the management of bone loss and restoration of the glenoid track, thus preventing the Hill-Sachs lesion from engaging. Nevertheless, surgeons should be aware of a small subpopulation of patients with large or too medial humeral bone defects that could not fully be restored with the Latarjet procedure and may need either an Eden-Hybinette or adding additional techniques to the Latarjet such as a remplissage.
Bhatia S, Frank RM, Ghodadra NS, Hsu AR, Romeo AA, Bach BR Jr et al (2014) The outcomes and surgical techniques of the Latarjet procedure. Arthroscopy 30:227–235
Boehm E, Minkus M, Moroder P, Scheibel M (2020) Massive graft resorption after iliac crest allograft reconstruction for glenoid bone loss in recurrent anterior shoulder instability. Arch Orthop Trauma Surg 140(7):895–903
Boileau P, Saliken D, Gendre P, Seeto BL, d’Ollonne T, Gonzalez JF et al (2019) Arthroscopic Latarjet: Suture-Button Fixation Is a Safe and Reliable Alternative to Screw Fixation. Arthroscopy 35:1050–1061
Brandariz RN, Gorodischer TD, Pasqualini I, Rossi LA, Tanoira I, Ranalletta M (2021) The Latarjet Procedure Without Remplissage Is Effective to Restore Stability in Athletes With Glenoid Bone Defects Greater Than 25% and Off-Track Hill-Sachs Lesions. Arthroscopy 37:2455–2461
Brooks-Hill AL, Forster BB, van Wyngaarden C, Hawkins R, Regan WD (2013) Weber osteotomy for large Hill-Sachs Defects: clinical and CT assessments. Clin Orthop Relat Res 471:2548–2555
Burkhart SS, De Beer JF (2000) Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: Significance of the Inverted-Pear Glenoid and the Humeral Engaging Hill-Sachs Lesion. Arthroscopy 16:677–694
Butt U, Charalambous CP (2012) Complications associated with open coracoid transfer procedures for shoulder instability. J Shoulder Elbow Surg 21:1110–1119
Callegari JJ, McGarry M, Crook L, Adamson NA, Fraipont GM, Provencher M et al (2022) The Addition of Remplissage to Free Bone Block Restores Translation and Stiffness Compared to Bone Block Alone or Latarjet in a Bipolar Bone Loss Model. Arthroscopy 38:2609–2617
Calvo C, Calvo J, Rojas D, Valencia M, Calvo E (2021) Clinical Relevance of Persistent Off-Track Hill-Sachs Lesion After Arthroscopic Latarjet Procedure. Am J Sports Med 49:2006–2012
Calvo E, Granizo JJ, Fernandez-Yruegas D (2005) Criteria for arthroscopic treatment of anterior instability of the shoulder: a prospective study. J Bone Joint Surg Br 87:677–683
Calvo E, Itoi E, Landreau P, Arce G, Yamamoto N, Ma J et al (2021) Anterior and posterior glenoid bone augmentation options for shoulder instability: state of the art. J isakos 6:308–317
Camus D, Domos P, Berard E, Toulemonde J, Mansat P, Bonnevialle N (2018) Isolated arthroscopic Bankart repair vs. Bankart repair with “remplissage” for anterior shoulder instability with engaging Hill-Sachs lesion: A meta-analysis. Orthop Traumatol Surg Res 104:803–809
Cho NS, Yoo JH, Rhee YG (2016) Management of an engaging Hill-Sachs lesion: arthroscopic remplissage with Bankart repair versus Latarjet procedure. Knee Surg Sports Traumatol Arthrosc 24:3793–3800
Delgado C, Cañete P, Diaz J, Ruiz R, Garcia Navlet M, Asenjo C et al (2021) The cortical double button fixation system with posterior guide for anterior arthroscopic bone block allows precise graft positioning. Revista Española de Artroscopia y Cirugía Articular English ed 28:227–234
Di Giacomo G, Itoi E, Burkhart SS (2014) Evolving concept of bipolar bone loss and the Hill-Sachs lesion: from “engaging/non-engaging” lesion to “on-track/off-track” lesion. Arthroscopy 30:90–98
Dimitriou R, Mataliotakis GI, Angoules AG, Kanakaris NK, Giannoudis PV (2011) Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review. Injury 42(Suppl 2):S3-15
Eden R (1918) Zur Operation der habituellen Schulterluxation unter Mitteilung eines neuen verfahrens bei Abriß am inneren Pfannenrande. Deutsche Zeitschrift für Chirurgie 144:269–280
Elkinson I, Giles JW, Faber KJ, Boons HW, Ferreira LM, Johnson JA et al (2012) The effect of the remplissage procedure on shoulder stability and range of motion: an in vitro biomechanical assessment. J Bone Joint Surg Am 94:1003–1012
Garcia GH, Wu HH, Liu JN, Huffman GR, Kelly JDt, (2016) Outcomes of the Remplissage Procedure and Its Effects on Return to Sports: Average 5-Year Follow-up. Am J Sports Med 44:1124–1130
Giannakos A, Vezeridis PS, Schwartz DG, Jany R, Lafosse L (2017) All-Arthroscopic Revision Eden-Hybinette Procedure for Failed Instability Surgery: Technique and Preliminary Results. Arthroscopy 33:39–48
Gilat R, Wong SE, Lavoie-Gagne O, Haunschild ED, Knapik DM, Fu MC et al (2021) Outcomes are comparable using free bone block autografts versus allografts for the management of anterior shoulder instability with glenoid bone loss: a systematic review and meta-analysis of “The Non-Latarjet.” Knee Surg Sports Traumatol Arthrosc 29(7):2159–2174
Griesser MJ, Harris JD, McCoy BW, Hussain WM, Jones MH, Bishop JY et al (2013) Complications and re-operations after Bristow-Latarjet shoulder stabilization: a systematic review. J Shoulder Elbow Surg 22:286–292
Gupta A, Delaney R, Petkin K, Lafosse L (2015) Complications of the Latarjet procedure. Curr Rev Musculoskelet Med 8:59–66
Hachem AI, Del Carmen M, Verdalet I, Rius J (2019) Arthroscopic Bone Block Cerclage: A Fixation Method for Glenoid Bone Loss Reconstruction Without Metal Implants. Arthrosc Tech 8:e1591-1597
Hartzler RU, Bui CN, Jeong WK, Akeda M, Peterson A, McGarry M et al (2016) Remplissage of an Off-track Hill-Sachs Lesion Is Necessary to Restore Biomechanical Glenohumeral Joint Stability in a Bipolar Bone Loss Model. Arthroscopy 32:2466–2476
Hurley ET, Schwartz LB, Mojica ES, Campbell KA, Matache BA, Meislin RJ et al (2021) Short-term complications of the Latarjet procedure: a systematic review. J Shoulder Elbow Surg 30:1693–1699
Hybbinette SR (1932) De la transplation d’un fragment osseux pour remedier aux luxations recidivantes de l’épaule; constations et resultats operatoires. Acta Chir Scand 71:411–445
Katthagen JC, Anavian J, Tahal DS, Millett PJ (2016) Arthroscopic Remplissage and Open Latarjet Procedure for the Treatment of Anterior Glenohumeral Instability With Severe Bipolar Bone Loss. Arthrosc Tech 5:e1135–e1141
Kawakami J, Yamamoto N, Etoh T, Hatta T, Mineta M, Itoi E et al (2019) In Vivo Glenoid Track Width Can Be Better Predicted With the Use of Shoulder Horizontal Extension Angle. Am J Sports Med 47:922–927
Kordasiewicz B, Kicinski M, Malachowski K, Wieczorek J, Chaberek S, Pomianowski S (2018) Comparative study of open and arthroscopic coracoid transfer for shoulder anterior instability (Latarjet)-computed tomography evaluation at a short term follow-up. Part II Int Orthop 42:1119–1128
Kraus N, Amphansap T, Gerhardt C, Scheibel M (2014) Arthroscopic anatomic glenoid reconstruction using an autologous iliac crest bone grafting technique. J Shoulder Elbow Surg 23:1700–1708
Kurokawa D, Yamamoto N, Nagamoto H, Omori Y, Tanaka M, Sano H et al (2013) The prevalence of a large Hill-Sachs lesion that needs to be treated. J Shoulder Elbow Surg 22:1285–1289
Lafosse L, Lejeune E, Bouchard A, Kakuda C, Gobezie R, Kochhar T (2007) The arthroscopic Latarjet procedure for the treatment of anterior shoulder instability. Arthroscopy 23:1242.e1241-1245
Lazarides AL, Duchman KR, Ledbetter L, Riboh JC, Garrigues GE (2019) Arthroscopic Remplissage for Anterior Shoulder Instability: A Systematic Review of Clinical and Biomechanical Studies. Arthroscopy 35:617–628
Leuzinger J, Brzoska R, Métais P, Clavert P, Nourissat G, Walch G et al (2019) Learning Curves in the Arthroscopic Latarjet Procedure: A Multicenter Analysis of the First 25 Cases of 5 International Surgeons. Arthroscopy 35:2304–2311
Locher J, Wilken F, Beitzel K, Buchmann S, Longo UG, Denaro V et al (2016) Hill-Sachs Off-track Lesions as Risk Factor for Recurrence of Instability After Arthroscopic Bankart Repair. Arthroscopy 32:1993–1999
MacDonald P, McRae S, Old J, Marsh J, Dubberley J, Stranges G et al (2021) Arthroscopic Bankart repair with and without arthroscopic infraspinatus remplissage in anterior shoulder instability with a Hill-Sachs defect: a randomized controlled trial. J Shoulder Elbow Surg 30:1288–1298
Malahias MA, Chytas D, Raoulis V, Chronopoulos E, Brilakis E, Antonogiannakis E (2020) Iliac Crest Bone Grafting for the Management of Anterior Shoulder Instability in Patients with Glenoid Bone Loss: a Systematic Review of Contemporary Literature. Sports Med Open 6:12
Martinez-Catalan N, Werthel JD, Kazum E, Valenti P (2022) Failed Latarjet Treated With Full Arthroscopic Eden-Hybinette Procedure Using Two Cortical Suture Buttons Leads to Satisfactory Clinical Outcomes and Low Recurrence Rate. Arthroscopy 38:1126–1133
Metais P, Clavert P, Barth J, Boileau P, Brzoska R, Nourissat G et al (2016) Preliminary clinical outcomes of Latarjet-Patte coracoid transfer by arthroscopy vs. open surgery: Prospective multicentre study of 390 cases. Orthop Traumatol Surg Res 102:S271-s276
Mizuno N, Denard PJ, Raiss P, Melis B, Walch G (2014) Long-term results of the Latarjet procedure for anterior instability of the shoulder. J Shoulder Elbow Surg 23:1691–1699
Moon SC, Cho NS, Rhee YG (2015) Quantitative assessment of the latarjet procedure for large glenoid defects by computed tomography: a coracoid graft can sufficiently restore the glenoid arc. Am J Sports Med 43:1099–1107
Moroder P, Schulz E, Wierer G, Auffarth A, Habermeyer P, Resch H et al (2019) Neer Award 2019: Latarjet procedure vs. iliac crest bone graft transfer for treatment of anterior shoulder instability with glenoid bone loss: a prospective randomized trial. J Shoulder Elbow Surg 28:1298–1307
Olds M, Ellis R, Donaldson K, Parmar P, Kersten P (2015) Risk factors which predispose first-time traumatic anterior shoulder dislocations to recurrent instability in adults: a systematic review and meta-analysis. Br J Sports Med 49:913–922
Paladini P, Singla R, Merolla G, Porcellini G (2016) Latarjet procedure: is the coracoid enough to restore the glenoid surface? Int Orthop 40:1675–1681
Patel RM, Walia P, Gottschalk L, Kuklis M, Jones MH, Fening SD et al (2016) The Effects of Latarjet Reconstruction on Glenohumeral Kinematics in the Presence of Combined Bony Defects: A Cadaveric Model. Am J Sports Med 44:1818–1824
Patte D, Bernageau J, Rodineau J, Gardes JC (1980) Epaules douloureuses et inestables. Rev Chir Orthop Reparatrice Appar Mot 66(3):157–165
Provencher MT, Frank RM, Golijanin P, Gross D, Cole BJ, Verma NN et al (2017) Distal Tibia Allograft Glenoid Reconstruction in Recurrent Anterior Shoulder Instability: Clinical and Radiographic Outcomes. Arthroscopy 33:891–897
Provencher MT, Frank RM, Leclere LE, Metzger PD, Ryu JJ, Bernhardson A et al (2012) The Hill-Sachs lesion: diagnosis, classification, and management. J Am Acad Orthop Surg 20:242–252
Saliken D, Lavoué V, Trojani C, Gonzalez JF, Boileau P (2017) Combined All-arthroscopic Hill-Sachs Remplissage, Latarjet, and Bankart Repair in Patients With Bipolar Glenohumeral Bone Loss. Arthrosc Tech 6:e2031–e2037
Samim M, Small KM, Higgins LD (2018) Coracoid graft union: a quantitative assessment by computed tomography in primary and revision Latarjet procedure. J Shoulder Elbow Surg 27:1475–1482
Scheibel M, Kraus N, Diederichs G, Haas NP (2008) Arthroscopic reconstruction of chronic anteroinferior glenoid defect using an autologous tricortical iliac crest bone grafting technique. Arch Orthop Trauma Surg 128:1295–1300
Shaha JS, Cook JB, Rowles DJ, Bottoni CR, Shaha SH, Tokish JM (2016) Clinical Validation of the Glenoid Track Concept in Anterior Glenohumeral Instability. J Bone Joint Surg Am 98:1918–1923
Shaha JS, Cook JB, Song DJ, Rowles DJ, Bottoni CR, Shaha SH et al (2015) Redefining “Critical” Bone Loss in Shoulder Instability: Functional Outcomes Worsen With “Subcritical” Bone Loss. Am J Sports Med 43:1719–1725
Shields DW, Jefferies JG, Brooksbank AJ, Millar N, Jenkins PJ (2018) Epidemiology of glenohumeral dislocation and subsequent instability in an urban population. J Shoulder Elbow Surg 27:189–195
Taverna E, Garavaglia G, Perfetti C, Ufenast H, Sconfienza LM, Guarrella V (2018) An arthroscopic bone block procedure is effective in restoring stability, allowing return to sports in cases of glenohumeral instability with glenoid bone deficiency. Knee Surg Sports Traumatol Arthrosc 26:3780–3787
Tokish JM, Fitzpatrick K, Cook JB, Mallon WJ (2014) Arthroscopic distal clavicular autograft for treating shoulder instability with glenoid bone loss. Arthrosc Tech 3:e475-481
Ueda Y, Sugaya H, Takahashi N, Matsuki K, Tokai M, Morioka T et al (2021) Arthroscopic Iliac Bone Grafting for Traumatic Anterior Shoulder Instability With Significant Glenoid Bone Loss Yields Low Recurrence and Good Outcome at a Minimum of Five-Year Follow-Up. Arthroscopy 37(8):2399–2408
Valencia M, Fernández-Bermejo G, Martín-Ríos MD, Fernández-Jara J, Morcillo-Barrenechea D, Coifman-Lucena I et al (2020) Subscapularis structural integrity and function after arthroscopic Latarjet procedure at a minimum 2-year follow-up. J Shoulder Elbow Surg 29:104–112
Valencia Mora M, Ruiz-Iban MA, Heredia JD, Ruiz Diaz R, Cuellar R (2017) Management of Humeral Defects in Anterior Shoulder Instability. Open Orthop J 11:1011–1022
Xiang M, Yang J, Chen H, Hu X, Zhang Q, Li Y et al (2021) Arthroscopic Autologous Scapular Spine Bone Graft Combined With Bankart Repair for Anterior Shoulder Instability With Subcritical (10%-15%) Glenoid Bone Loss. Arthroscopy 37:2065–2074
Yamamoto N, Itoi E, Abe H, Minagawa H, Seki N, Shimada Y et al (2007) Contact between the glenoid and the humeral head in abduction, external rotation, and horizontal extension: a new concept of glenoid track. J Shoulder Elbow Surg 16:649–656
Yamamoto N, Muraki T, An K-N, Sperling J, Cofield R, Itoi E et al (2013) The Stabilizing Mechanism of the Latarjet Procedure A Cadaveric Study. The Journal of bone and joint surgery. American 95:1390–1397
Yazdi AA, Dib AG, Elphingstone JW, Schick S, Ponce BA, Momaya AM et al (2022) Allograft reconstruction for humeral head defects in the setting of shoulder instability: a systematic review. JSES Reviews, Reports, and Techniques 2:489–496
Zhao J, Huangfu X, Yang X, Xie G, Xu C (2014) Arthroscopic glenoid bone grafting with nonrigid fixation for anterior shoulder instability: 52 patients with 2- to 5-year follow-up. Am J Sports Med 42:831–839
The Authors would like to acknowledge Dr Miguel Garcia Navlet, from Hospital Coslada ASEPEYO, Madrid, Spain, for his contribution to the illustrations of this manuscript.
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Calvo, E., Delgado, C. Management of off-track Hill-Sachs lesions in anterior glenohumeral instability. J EXP ORTOP 10, 30 (2023). https://doi.org/10.1186/s40634-023-00588-x
- Iliac crest bone graft