Engaging Hill-Sachs lesion: is there an association between this lesion and findings on MRI?

The objective of our study was to see whether there is an association between engagement on physical examination and the location or size of a Hill-Sachs lesion and the presence and degree of glenoid bone loss as assessed on MRI.

Thirty-three consecutive patients (32 males and one female) with a history of anterior shoulder dislocation who underwent preoperative MRI and arthroscopy at our institution and were tested for engagement on physical examination over a 9-month period were included in the study. Two blinded readers reviewed each study independently and documented the presence and size of the Hill-Sachs lesion, location of the Hill-Sachs lesion with a modified biceps angle, and presence and size of glenoid bone loss. Statistical analysis included the Mann-Whitney, logistic regression, Pearson correlation, and intraclass correlation tests.

Eleven patients had evidence of an engaging Hill-Sachs lesion on physical examination and 22 did not. There was no statistically significant difference between any of the dimensions or overall area of the Hill-Sachs lesion when comparing the group with an engaging Hill-Sachs lesion and the group with a nonengaging lesion (surface area, 3.60 vs 3.23 cm(3), respectively; p = 0.272). There was a trend for a larger biceps angle in the engaging group without a statistically significant difference (mean, 154.5° vs 143.9°; p = 0.069). There was a statistically significant difference in the amount of glenoid bone loss in the engaging group compared with the nonengaging group (mean, 20.2% vs 6.0%; p = 0.001).

There is a significant association between an engaging Hill-Sachs lesion on physical examination and the degree of glenoid bone loss as well as a trend toward increased engagement with more medially oriented Hill-Sachs lesions. These findings show the importance of considering both the Hill-Sachs lesion and glenoid bone loss when evaluating patients with engagement.