Evolving concept of bipolar bone loss and the hill-sachs lesion: From "engaging/non-engaging" lesion to "on-track/off-track" lesion

Giovanni Di Giacomo, Eiji Itoi, Stephen S. Burkhart

Research output: Contribution to journalArticlepeer-review

378 Citations (Scopus)


For anterior instability with glenoid bone loss comprising 25% or more of the inferior glenoid diameter (inverted-pear glenoid), the consensus of recent authors is that glenoid bone grafting should be performed. Although the engaging Hill-Sachs lesion has been recognized as a risk factor for recurrent anterior instability, there has been no generally accepted method for quantifying the Hill-Sachs lesion and then integrating that quantification into treatment recommendations, taking into account the geometric interplay of various sizes and various orientations of bipolar (humeral-sided plus glenoid-sided) bone loss. We have developed a method (both radiographic and arthroscopic) that uses the concept of the glenoid track to determine whether a Hill-Sachs lesion will engage the anterior glenoid rim, whether or not there is concomitant anterior glenoid bone loss. If the Hill-Sachs lesion engages, it is called an "off-track" Hill-Sachs lesion; if it does not engage, it is an "on-track" lesion. On the basis of our quantitative method, we have developed a treatment paradigm with specific surgical criteria for all patients with anterior instability, both with and without bipolar bone loss.

Original languageEnglish
Pages (from-to)90-98
Number of pages9
JournalArthroscopy - Journal of Arthroscopic and Related Surgery
Issue number1
Publication statusPublished - 2014 Jan

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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